GIT, Oral Cavity and Esophagus Path 3 Flashcards
↑ anti-endomysium is indicative of ______
celiac sprue
what are some causes of luminal intestinal obstruction
- swallowed foreign bodies
- food bolus
- therapeutic agnets (barium sulphate and antacids)
- ingested hair
- round worms
- tumors
what are some risk factors for someone getting a giardia infection? what would you see on histology to confirm
- drinking contaminated water with cysts and immunosuppression
- disk shaped organisms in the lumen
pain that starts initially at the periumbilical area that radiates to the RLQ is indicative of _______
appendicitis
intestinal obstruction is more common in the small/large intestine
small intestine
tTG ________’s gliadin
deaminates
dilation and hypertrophy is seen _____ to the aganglionic segment in Hirschsprung disease
proximal
describe the presentation of diverticular disease
flask like mucosal pouches that extend from the lumen through the colonic wall
NOT A TRUE DIVERTICULA LIKE MECKEL’S because this does not involve the muscular propria layer
describe the progression of mucinous lesions in the appendix:
mucocele → adenoma (confined to lumen) → low grade appendices mucinous neoplasm (LAMN; mucin eptihlum seen on the wall and can spread to peritoneum and ovary) → mucinous adenocarcinoma (destructive invasion that perforates through the wall
diverticular disease is most common seen in the ______
sigmoid colon
celiac sprue has a long term risk of _______ lymphoma
T- Cell
Meckel’s diverticulum is a pseudo/true diverticulum
true; involves all layers of the GIT
Meckel’s diverticulitis can be found on the ______ border
ANTI-mesenteric border
a patient with AIDS has chronic diarrhea. this is a common symptom of infection by _______
cryptosporidium;
self limiting in normal host
how does acute ischemia of the bowel present on histology?
attenuated villous epithelium with loss of goblet cells with DARK appearing entocytes
what are some endogenous causes of luminal obstruction in the intestines
- meconium ileus in infants with CF (thick mucus at mid-terminal ileum)
- gallstone ileus (usually through a cholecystoduodenal fistula)
list the complications of appendicitis (5)
- perforation
- peritonitis
- periappendiceal abscess
- liver abscess
- bacteremia
what type is the most common cause of intestinal obstruction and give examples of this type
extramural: herniation, adhesions, inussusception, and volvulus
histiocytes in the lamina propria in the intestines and be due to infection by ______ and ______; what would tests would you do?
tropheryma whippeli and mycobacterium tuberculosis
do a PAS stain (whippeli) and Ziel Neilen (myobacterium acid fast bacilli)
what is intussception?
telescoping of proximal bowel segment into distal (often due to tumors in adults)
part of the intestine folds into the structure next to it and usually occurs where the small and large intestine meet
what is psueodmyxoma peritonea and where does it occur the most?
- it is intraperitoneal accumulation of mucinous material from appendiceal tumor or ovarian tumor
- appendix; others: ovary, pancreas and colon
______ and _____ are shed in the gut when infected by giardiasis
trophozoites and cysts
the most common cause of acute appendicitis is due to _____
underlying obstruction of the lumen → inflammation of appendix
Hirschsprung most commonly occurs in the _____ and thus ______ is most often dilated
rectum;
sigmoid will be dilated (proximal to rectum)
what the are antibodies that are measured in diagnosing celiac sprue
- anti gliadin
- anti endomysium
- anti tTG
what it is the most common cause of diverticular disease?
lack of fiber in diet → sustained bowel contraction and ↑ intraluminal pressure
what HLA genotypes are associated with celiac sprue
HLA DQ2 (majority) and DQ8
what are some differences between non tropical (celiac sprue) and tropical sprue?
- in tropical sprue all parts of the small intestine is equally involved
- tropical sprue responds to antibiotics
- tropical sprue is endemic in Puerto Rico and Caribbean
- tropical sprue/whipple’s is a systemic disease so can also involve joints and CNS
what is the most common atypical presentation in propel with celiac sprue
- iron deficiency anemia
what congenital condition is associated with Hirschsprung disease?
What is the pathogenesis
down syndrome
due to the absence of ganglion cells in the Meissner (submucosal) and Auerbach (myenteric) plexus
rectum is almost always involved
how does infection by cyrptosporidium present on histology?
- intracellular but appears at the top of the cell
self limiting in normal host
chronic diarrhea in AIDS patients
what is the cause of tropical sprue/ Whipple disease
trophyerma whippeli (gram positive sickle shaped bacteria)
mucosa laden with distended macrophages (histiocytes) in lamina propria with PAS positive granules is indicative of _______
Whipple Disease caused by Tropheryma whippelii
defection in the migration of ______ cells is the cause of Hirschsprung
neural crest cells; this causes the congenital absence of ganglion cells → functional obstruction
inflammatory conditions are associated with what type of cause of intestinal obstruction
intramural;
Crohn, tb, drug induced stenosis, ischemic structures, radiation and infiltrative neoplasms
what are some complications of Hirschsprung Disease
- enterocolitis
- perforation and peritonitis
describe that pathogenesis of Celiac sprue
- gliadin (gluten derived peptide) passes through into the enterocyte where tTG (tissue transglutaminase) DEAMINATES gliadin
- deaminated gliadin is then presented to T cells via APC’s that have HLA DQ2 or HLA DQ8
- T cells then secrete IFN gamma and induce B cells to produce anti gliadin, anti endomysium and anti tTG
involves BOTH innate (CD8) and adaptive (CD4) and B cells
what is the choriastoma seen in Meckel’s diverticulum?
gastric mucosa or pancreatic tissue
what is the cause of meckel’s diverticulum?
incomplete involution of the vitelline duct
how does chronic ischemia of the bowel present?
- crypt atrophy with hyalinization and fibrosis
- PINK in color
diverticular disease is not a true diverticulum because it does not involve _______ layer
muscularis propria layer
celiac sprue causes changes most commonly in what part of the GIT?
what are some of these changes?
proximal intestine;
- villous atrophy (↓ area for absorption)
- ↑ intraepithelial lymphocytes ( > 30 / 100 enterocytes)
- elongated hyperplastic crypts
- ↑ lymphocytes, macrophages and plasma cells in lamina propria
disk shaped organism / pear shape in the lumina of enterocytes can be indicative of infection by what pathogen?
giardia a protozoa with flagella
