GIT, Oral Cavity and Esophagus Path 3

Question 1

↑ anti-endomysium is indicative of ______

Answer 1

celiac sprue

Question 2

what are some causes of luminal intestinal obstruction

Answer 2

• swallowed foreign bodies
• food bolus
• therapeutic agnets (barium sulphate and antacids)
• ingested hair
• round worms
• tumors

Question 3

what are some risk factors for someone getting a giardia infection? what would you see on histology to confirm

Answer 3

• drinking contaminated water with cysts and immunosuppression
• disk shaped organisms in the lumen

Question 4

pain that starts initially at the periumbilical area that radiates to the RLQ is indicative of _______

Answer 4

appendicitis

Question 5

intestinal obstruction is more common in the small/large intestine

Answer 5

small intestine

Question 6

tTG ________’s gliadin

Answer 6

deaminates

Question 7

dilation and hypertrophy is seen _____ to the aganglionic segment in Hirschsprung disease

Answer 7

proximal

Question 8

describe the presentation of diverticular disease

Answer 8

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

Question 9

describe the progression of mucinous lesions in the appendix:

Answer 9

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

Question 10

diverticular disease is most common seen in the ______

Answer 10

sigmoid colon

Question 11

celiac sprue has a long term risk of _______ lymphoma

Answer 11

T- Cell

Question 12

Meckel’s diverticulum is a pseudo/true diverticulum

Answer 12

true; involves all layers of the GIT

Question 13

Meckel’s diverticulitis can be found on the ______ border

Answer 13

ANTI-mesenteric border

Question 14

a patient with AIDS has chronic diarrhea. this is a common symptom of infection by _______

Answer 14

cryptosporidium;

self limiting in normal host

Question 15

how does acute ischemia of the bowel present on histology?

Answer 15

attenuated villous epithelium with loss of goblet cells with DARK appearing entocytes

Question 16

what are some endogenous causes of luminal obstruction in the intestines

Answer 16

• meconium ileus in infants with CF (thick mucus at mid-terminal ileum)
• gallstone ileus (usually through a cholecystoduodenal fistula)

Question 17

list the complications of appendicitis (5)

Answer 17

• perforation
• peritonitis
• periappendiceal abscess
• liver abscess
• bacteremia

Question 18

what type is the most common cause of intestinal obstruction and give examples of this type

Answer 18

extramural: herniation, adhesions, inussusception, and volvulus

Question 19

histiocytes in the lamina propria in the intestines and be due to infection by ______ and ______; what would tests would you do?

Answer 19

tropheryma whippeli and mycobacterium tuberculosis

do a PAS stain (whippeli) and Ziel Neilen (myobacterium acid fast bacilli)

Question 20

what is intussception?

Answer 20

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

Question 21

what is psueodmyxoma peritonea and where does it occur the most?

Answer 21

• it is intraperitoneal accumulation of mucinous material from appendiceal tumor or ovarian tumor
• appendix; others: ovary, pancreas and colon

Question 22

______ and _____ are shed in the gut when infected by giardiasis

Answer 22

trophozoites and cysts

Question 23

the most common cause of acute appendicitis is due to _____

Answer 23

underlying obstruction of the lumen → inflammation of appendix

Question 24

Hirschsprung most commonly occurs in the _____ and thus ______ is most often dilated

Answer 24

rectum;

sigmoid will be dilated (proximal to rectum)

Question 25

what the are antibodies that are measured in diagnosing celiac sprue

Answer 25

• anti gliadin
• anti endomysium
• anti tTG

Question 26

what it is the most common cause of diverticular disease?

Answer 26

lack of fiber in diet → sustained bowel contraction and ↑ intraluminal pressure

Question 27

what HLA genotypes are associated with celiac sprue

Answer 27

HLA DQ2 (majority) and DQ8

Question 28

what are some differences between non tropical (celiac sprue) and tropical sprue?

Answer 28

• 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

Question 29

what is the most common atypical presentation in propel with celiac sprue

Answer 29

• iron deficiency anemia

Question 30

what congenital condition is associated with Hirschsprung disease?
What is the pathogenesis

Answer 30

down syndrome
due to the absence of ganglion cells in the Meissner (submucosal) and Auerbach (myenteric) plexus
rectum is almost always involved

Question 31

how does infection by cyrptosporidium present on histology?

Answer 31

• intracellular but appears at the top of the cell

self limiting in normal host
chronic diarrhea in AIDS patients

Question 32

what is the cause of tropical sprue/ Whipple disease

Answer 32

trophyerma whippeli (gram positive sickle shaped bacteria)

Question 33

mucosa laden with distended macrophages (histiocytes) in lamina propria with PAS positive granules is indicative of _______

Answer 33

Whipple Disease caused by Tropheryma whippelii

Question 34

defection in the migration of ______ cells is the cause of Hirschsprung

Answer 34

neural crest cells; this causes the congenital absence of ganglion cells → functional obstruction

Question 35

inflammatory conditions are associated with what type of cause of intestinal obstruction

Answer 35

intramural;

Crohn, tb, drug induced stenosis, ischemic structures, radiation and infiltrative neoplasms

Question 36

what are some complications of Hirschsprung Disease

Answer 36

• enterocolitis

- perforation and peritonitis

Question 37

describe that pathogenesis of Celiac sprue

Answer 37

• 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

Question 38

what is the choriastoma seen in Meckel’s diverticulum?

Answer 38

gastric mucosa or pancreatic tissue

Question 39

what is the cause of meckel’s diverticulum?

Answer 39

incomplete involution of the vitelline duct

Question 40

how does chronic ischemia of the bowel present?

Answer 40

• crypt atrophy with hyalinization and fibrosis

- PINK in color

Question 41

diverticular disease is not a true diverticulum because it does not involve _______ layer

Answer 41

muscularis propria layer

Question 42

celiac sprue causes changes most commonly in what part of the GIT?
what are some of these changes?

Answer 42

proximal intestine;

• villous atrophy (↓ area for absorption)
• ↑ intraepithelial lymphocytes ( > 30 / 100 enterocytes)
• elongated hyperplastic crypts
• ↑ lymphocytes, macrophages and plasma cells in lamina propria

Question 43

disk shaped organism / pear shape in the lumina of enterocytes can be indicative of infection by what pathogen?

Answer 43

giardia a protozoa with flagella