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Hannah MS2 GI > large intestina > Flashcards

large intestina Flashcards

1
Q

what is the tumor marker to measure response to treatment of colonic adenocarcinoma

A

CEA

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2
Q

acquired malformation of mucosal/submucosal capillary beds leading to increase risk of rupture and hematochezia.

A

angiodysplasia (most common at cecum and right colon due to high wall tension/stress)

(morphological: tortuous blood vessels)

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3
Q

what population is ischemic bowel disease common

A

women > 70 with heart/ vascular disease

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4
Q

what is necrotizing enterocolitis

A

acute disorder leading to transmural necrosis

  • most common acquired GI emergency in neonates
  • at risk if premature
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5
Q

characteristic inflammation and gross appearance of UC vs Crohns

A

UC: pseudopolyps, and loss of hausfrau = “lead pip sign”
-crypt abscesses with neutrophils

Crohns: cobblestone mucosa, creeping fat, strictures (“string sign”)
-noncaseasting granulomas *TH1

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6
Q

most common neoplastic polyps

A

colonic adenomas

adenomatous polyps

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7
Q

genes associated with Crohns

A

NOD2 (increased NFKB)
ATG16L1
IRGM

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8
Q

details of juvenile polyps

A
  • age: <5 yo
  • location: rectum
  • sporadic= solitary; no dysplasia
  • congenital = multiple; dysplastic; risk of GI adenocarcinoma
  • characteriscically CYSTIC
  • gene: SMAD4 (TGFb signaling)
  • polyps can bleed
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9
Q

chronic colitis associated with dense collagenous layer, increased intraepithelial lymphocytes (assoc with celiac and AI dz) , and mixed inflammatory infiltrate seen in older women and sx of chronic watery diarrhea

A 
micropscopic colitis 
(NL on radiograph and endoscopy)
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10
Q

non classic AR FAP (adenomatous polyp)

A

not APC mutation, it is MYH mutation and the onset is 30-50 yo not 10-15

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11
Q

details of Gardner syndrome (adenomatous polyp)

A

***classic FAP, osteomas, and fibromatosis
(OFF)
(osteomas, thyroid/desmoid tumors, skin cysts)

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12
Q

two types of hamartomous polyps (occur spontaneously via genetics or acquired)

A

juvenile and Peutz Jehgers syndrome

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13
Q

most common cause of ischemic colitis and other causes. include sx

A

MCC: SMA atherosclerosis leading to infarct at watershed areas (splenic flexure)
other: AAA, OC, heart emboli, decreases BP, hypercoagability, CMV, radiation

ischemia sx: post prandial pain, weight loss,
infarction sx: ab pain, blood diarrhea

2 phases: hypo injury and repurfusion injury (RI = most damage)

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14
Q

chronic colitis from surgical treatment and current stony use and associated hallmark NUMEROUS MUCOSAL LYMPH FOLLICLES

A

diversion colitis

-colitis forms in diverted segment; common in UC

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15
Q

outpouching of mucosa/submucosa though muscularis propria layer due to increased intraluminal pressure usually at weak points where vasa recta transverse the MP layer (Sigmoid colon)

A

diverticulosis

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16
Q

sx of UC vs Crohns

A

UC: LLQ pain, bloody diarrhea, *no malabsorption , and associated with p ANCA and primary sclerosing cholangitis and TOXIC MEGACOLON

crohns: RLQ pain, non bloody diarrhea, fat malabsorption and steatorheea, calcium oxalate kidney stones, and fistulas
associated with erythema nodosum, uveitis, sacroilitis, migratory polyarthitis,

17
Q

dx of IBS

A

dx: ab pain 3day /mo for 3 months with improvement of pain on defection

18
Q

colonic adenocarcinoma pts have increased risk of ____

A

strep bovis endocardiits

19
Q

sx of diverticulosis

A

usually asx
sx: hematochezia, cramping, digestion, feel like can’t empty rectum completely, can lead to diverticulitis (which is LLQ appendicitis like pain)

20
Q

does UC or crohns have high reoccurrence after surgery

A

Crohns

21
Q

IBD + ____ = increased risk of cancer

A

IBD + primary sclerosing cholangitis

22
Q

wall involvement of UC vs Crohns

A

UC: mucosal and submucosal inflammation only in a continuous pattern of the colon only

crohns: transmural inflammation with knife like fissures in a skip lesion pattern anywhere on GI but most common in terminal ileum

23
Q

unqiue traits of sporadic type of colon adenocarcinoma

A

APC mutation related, adenoma carcinoma sequence, villious type

  • left side: annular “napkin lesion”
  • left side sx: LLQ pain, occult bleeding, changed bowel habits
24
Q

details of “classic” FAP (adenomatous polyp)

A
  • AD DO, age 10-15
  • colorectal adenomas as a teen and high likely hood of malignant progression
  • APC mutation
  • extra GI sx: congenital hypertrophy of retinal pigment epithelium
25
Q

what is the malignant potential of crohns vs UC

A

UC: always risk of malignancy (based on extent of colonic involved)
Crohns: only if colonic

26
Q

what are the two pathway associated with development of colonic adenocarcinoma

A
  1. adenoma-carcinoma sequence (APC/ B catenin pathway)
    * sporadic type
  2. MSI pathway (defect DNA mismatch repair system)
    * HNPCC type serrated sessile adenoma
27
Q

Turcot syndrome (adenomatous polyp)

A

classic FAP and CNS tumors ( medulloblastoma and glioblastoma)

28
Q

chronic relapsing ab pain, gas, bloating, bowel habit changes (diarrhea/constipation) most common in middle aged females (20-40)
*NO CHRONIC INFLAMMATION

A

IBS (irritable bowel syndrome)

dx: pain 3day /mo for 3 months with improvement of pain on defection

29
Q

unqiue traits of HNPCC type of colon adenocarcinoma

A 
MSH2/MLH1 gene 
AD DO 
MSI pathway 
serrated type
right side: polyploid exophytic mass 
right side sx: iron def anemia, fatigue
30
Q

details of Peutz Jeghers syndrome

A
  • age: 5-10 yo
  • AD DO
  • gene: STK 11
  • multiple polyps all over GI with hyperpigmentation on lips, oral mucosa, genitals (freckle like)
  • *INCREASED RISK OF COLORECTAL, BREAST, and GYNECOLOGIC cancer
31
Q

diagnostic staging factors of colonic adenocarcinoma

A

T: invasion depth
N: LN metastasis (liver is common site)
M: distant spread

32
Q

describe the adenocarcinoma pathway

A
  1. APC mutation - polyp risk
  2. KRAS mutation - adenomatous poly form
  3. p53 mutation/increased COX2 - carcinoma on left side
    * *ASPRIN CAN STOP THIS PATHWAY
33
Q

details of GVHD colitis

A
  • follows stem cell transplant
  • histoL epithelial cell apoptosis (esp crypt cells)
  • sx: watery diarrhea (maybe bloody sometimes)

Hannah MS2 GI (10 decks)

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