Intestines 2 Flashcards
What general condition is a major global health problem killing 12,000 children each day due to an acquired infection leading to abdominal pain, urgency/incontinence, perianal discomfort, diarrhea, and hemorrhage?
Infectious enterocolitis
What causes infectious enterocolitis?
Viral, bacterial, and protozoal agents
What condition is caused by Virbrio cholerae?
Cholera
How is cholera transmitted?
Fecal-oral route (H2O)
Where is cholera seen the most?
India/Africa
How is cholera able to affect chloride ion secretion?
Secretes cholera toxin and opens CFTR channel releasing massive amounts of chloride ions
What unique stool appearance is associated with cholera?
“Rice water” stool
Does cholera affect tissues?
Minimal tissue damage (noninvasive)
What are the symptoms of cholera?
Cramping, hypotension, shock, dehydration, electrolyte imbalances
What is the mortality rate for cholera?
50-70% lethal without treatment most commonly in 24 hours
What is the appearance of Vibrio cholerae and is it a gram negative or gram positive bacteria?
Comma-shaped, gram-negative
What is the treatment for cholera?
Fluids, electrolytes, antibiotics, zinc
What is the pathogen responsible for campylobacter enterocolitis?
Campylobacter jejuni
What is the most common bacterial enteric pathogen in the U.S.?
Campylobacter jejuni
What is the most common pathogen that causes traveler’s diarrhea?
E. coli
Traveler’s diarrhea is acquired from what kinds of contaminated food?
Chicken, water, milk
Which is more common: non-invasive or invasive campylobacter enterocolitis?
Non-invasive
What are the results of invasive campylobacter enterocolitis?
Enterotoxins lead to dysentery and pyrexia
What other conditions may be initiated by campylobacter enterocolitis?
Reactive arthritis (+HLA-B27) or GBS
What kinds of pathogens can be responsible for acute self-limited colitis that lasts for less than month without treatment?
Campylobacter, Shigella, E. coli, Salmonella
What is another name for antibiotic-associated colitis?
Pseudomembranous colitis
What causes pseudomembranous colitis?
Antibiotics disrupts microbiota
Due to extreme inflammation, which leukocyte is largely present in pseudomembranous colitis?
Neutrophils
What pathogen is responsible for pseudomembranous colitis?
Clostridium difficile (overgrowth in the colon from natural microbiota)
What are the risk factors for pseudomembranous colitis?
Hospitalization, older age, decreased immunity
What kind of diarrhea is associated with antibiotic-associated colitis?
Watery and bloody (rare) diarrhea
What is the treatment for pseudomembranous colitis?
Vancomycin or metronidazole (resistant strains present)
What forms the pseudomembranes seen in antibiotic-associated colitis?
Cellular debris and leukocytes
What KIND of pathogen causes half of all gastroenteritis cases?
Viral pathogens
How is viral gastroenteritis acquired?
Direct contact of contaminated food or water
How does viral gastroenteritis lead to malabsorption?
Injury to superficial epithelia
What virus most commonly causes gastroenteritis in children (6 months to 2 years of age)? In adults?
Children - Rotavirus
Adults - Norovirus
What is the treatment for viral gastroenteritis?
Palliative care, fluid replacement
How many people worldwide are affected by a parasitic disease?
Over 1/2
What is the most common parasitic infection of the U.S.?
Giardiasis “Beaver Fever” (aka duodenalis, intestinalis)
What things can be resisted by Giardia lamblia?
Cold and chlorine
What is the non-invasive way in which Giardia lamblia affects the GI tract?
Alters SI enzymes
What is another name for sigmoid diverticulitis?
Colonic diverticulosis
What are the complications associated with sigmoid diverticulitis?
Infection, abscess, possible perforation/hemorrhage
What are the risk factors for sigmoid diverticulitis?
Age, refined foods, constipation
Eating what kind of foods can reduce straining and pressure that could lead to sigmoid diverticulitis?
Food high in fiber
What is the age bias associated with sigmoid diverticulitis?
50% of those over age 60
What are symptoms of sigmoid diverticulitis?
Cramping, left lower abdominal pain, tenesmus, diarrhea
What is the treatment for sigmoid diverticulitis?
Reduce intraluminal pressure
Increase fiber intake
Irritable bowel syndrome most commonly develops at what age?
Between 20-40 years
What is the gender bias associated with irritable bowel syndrome?
Females
What intestinal condition is unique because it is not associated with any cellular abnormalities?
IBS
What is the treatment for IBS?
Fiber, decrease in carbs, stress management
IBS affects what percent of the U.S.?
5-10%
What is the gender, age, and ethnic bias associated with inflammatory bowel disease?
Females, adolescence, Caucasians
What are the two forms of IBD?
Crohn’s disease
Ulcerative colitis
What is the most common location for Crohn’s disease?
Terminal ileum, ileocecal valve, or cecum (but found in the entire GI tract)
Which form of IBD is associated with transmural inflammation?
Crohn’s disease
What are the most common locations for ulcerative colitis?
1 Rectum (where it ALWAYS starts) 2 Distal colon
Which form of IBD affects both the mucosa and submucosa?
Ulcerative colitis
What is the hypothesis for the cause of Crohn’s disease?
T cell autoimmune reaction
Which form of IBD involves skip lesions, granulomas, ulcerations, and strictures?
Crohn’s disease
What kind of feces are associated with Crohn’s disease?
Melana (with mild diarrhea)
What other symptoms/conditions can arise from Crohn’s disease?
Skin reaction, arthritis, AS, eye irritation, fatigue
What is the treatment for Crohn’s disease?
No cure but treatment includes probiotics and immunosuppressive meds
Crohn’s disease presents a risk for what kind of cancer?
G.I. adenocarcinoma
When does a GI adenocarcinoma tend to develop in a patient with Crohn’s disease?
8-10 years after diagnosis
Creeping mesenteric fat can be seen accumulating in individuals with what condition?
Crohn’s disease
Pain is felt in which quadrant with Crohn’s disease?
Right lower quadrant
What condition presents as superficial mucosal ulcerations of the intestines?
Ulcerative colitis
What is the age bias for U.C.?
20-25 years old
What drug has been shown to be inhibitory toward ulcerative colitis?
Nicotine (smoking)
Which form of IBD does not have granulomas or skip lesions?
Ulcerative colitis
What is the appearance of the stool with ulcerative colitis?
Grossly bloody and mucoid (stringy)
What type of cancer is seen to develop in patients with ulcerative colitis abut 8-10 years after diagnosis?
Adenocarcinoma
What preventative treatment can be done in patients with ulcerative colitis who are at a high risk for developing cancer?
Prophylactic colectomy
Pseudopolyps are associated with which inflammatory intestinal condition?
Ulcerative colitis
Which IBD is not malabsorptive?
Ulcerative colitis
Which IBD presents with fibrosis?
Crohn’s disease
What types of colon polyps present with minimal risk?
Inflammatory
Harmatomas
What type of colon polyp resemble dysplasia but is actually well-differentiated?
Hyperplastic
What type of colon polyp is a neoplastic mass that is considered “pre-malignant”?
Adenomatous
What is the most common age group to develop hyper plastic colon polyps?
Elderly (50-60 years)
How common are intestinal adenomas in the U.S.?
50% of all adults over 50
What is the age of onset for intestinal adenomas?
Over 40 years old
What presents as a great risk for developing intestinal adenomas?
Familial history (4X)
What are some signs of intestinal adenomas?
Occult bleeding, anemia
What is the relationship between size of an adenoma and malignancy?
Larger adenoma = greater cancer risk
What is the age of onset for familial adenomatous polyposis?
Teenage years
What gene in mutated in familial adenomatous polyposis?
APC gene, chromosome 5
What is the likelihood that someone with familial adenomatous polyposis will develop cancer?
100%
Most patients with familial adenomatous polyposis will develop cancer by what age?
30
What is the treatment for familial adenomatous polyposis?
Prophylactic colectomy
How many polyps must be present for a diagnosis of familial adenomatous polyposis?
100 or more
What is the most common amount of polyps present in an individual with familial adenomatous polyposis?
500-2,500
What is the most common type of colon tumor that arises from epithelial tissue?
Carcinoma
What percent of the country develops colorectal cancer?
5%
What is the mortality rate for colorectal cancer?
40%
What are the types of colon tumors?
Adenocarcinomas
Carcinoid tumors
What is the most common malignancy of the GI tract?
Colorectal adenocarcinoma
Colorectal adenocarcinomas are most commonly diagnosed in what age range?
50-70
What are the risk factors for colorectal adenocarcinoma?
Male, IBD, developed nations (due to diet)
What type of diet is directly associated with a 30X increased risk of colorectal adenocarcinoma development?
Highly processed diet
What country has the highest rates of colorectal adenocarcinomas?
USA
What drug has been shown to be somewhat protective against colorectal adenocarcinoma?
Aspirin
What is the most common location for colorectal adenocarcinoma?
Ascending colon (30%) Sigmoid colon (25%)
What types of foods present a higher risk for colorectal adenocarcinomas?
1 low vegetable fiber
2 high refined carbs
3 high fat
4 decreased antioxidants
When an elderly patient presents with anemia, what overlying condition must be rule out first?
Colorectal cancer
What is the most common location of colorectal adenocarcinoma metastasis?
Liver (but can also go to lymph nodes, lungs, and bone marrow)
Which are more common: neoplasms of the small or large intestine?
Large
