Path: Intestines

Question 1

What is the mechanism of Hirschsprung Disease?

Answer 1

Lack of neural crest cell migration to form the enteric ganglia in the descending colon to the rectum. Leads to a chronic tonic colon because no VIP or NO to relax the colon.

Question 2

Condition highly associated with Hirschsprung Disease.

Answer 2

Down Syndrome

Question 3

What condition can lead to an acquired Hirschsprung Disease?

Answer 3

Chagas disease

Question 4

What is the difference in diarrhea and dysentery?

Answer 4

Diarrhea: larger volume, usually watery
Dysentery: small volume, very painful, bloody

Question 5

Which population presents with Necrotizing Enterocolitis (NEC)

Answer 5

Premature infants

Question 6

How does NEC present?

Answer 6

Dilated abdomen, air seen on radiology outside the intestinal walls

Question 7

Skin condition associated with Celiac Sprue

Answer 7

Dermatitis Herpetiformis

Question 8

Neurologic Condition associated with Celiac Sprue

Answer 8

Tetany

Question 9

3 cancers associated with Celiac Sprue

Answer 9

1. Non-hodkins lymphoma
2. Adenocarcinoma
3. Esophageal Carcinoma

Question 10

Symptoms presented in patients with Whipple disease.

Answer 10

Arthritis (brings them into the office)
GI symptoms
Vision problems

Question 11

What can be seen on biopsy that indicates Whipple Disease?

Answer 11

Macrophages stained with PAS on intestinal mucosa biopsy

Question 12

Four characteristics that differentiate Crohn Disease (CD) from ulcerative colitis (UC).

Answer 12

CD: granulomas, skip lesions, deeper lesions into the colonic mucosa, can extend from the rectum all the way up to the mouth

Question 13

Major causes of Ischemic bowel disease

Answer 13

1. arterial thrombosis
2. arterial embolus
3. heart failure or shock

Question 14

Major cause of acquired diverticulosis in the U.S.

Answer 14

Lack of fiber in diet

Question 15

Two biggest risks leading to GI adenocarcinomas.

Answer 15

1. IBD (CD and UC)

2. Celiac Sprue

Question 16

Type of polyp that doesn’t have a risk of turning into malignant cancer.

Answer 16

Hyperplastic Polyp

Question 17

What is Peutz-Jeghers Syndrome?

Answer 17

Hamartomatous (benign) polyps throughout the GI tract with hyperpigmentation freckled on lips, oral mucosa, and genital skin.

Indicates increased risk for colorectal, breast, and gynecological cancers

Question 18

What is Familial Adenomatous Polyposis (FAP)?

Answer 18

Genetic mutation resulting in a “carpet” of polyps covering the lining of the colon

Question 19

What is Gardner Syndrome?

Answer 19

Polyps in the colon accompanied by extra-colic tumors:
Osteomas in skull
Thryoid tumors
sebaceous cysts

Question 20

What is Turcot Syndrome?

Answer 20

Genetic mutation resulting in colonic polyps along with CNS tumors:
medulloblastomas

Question 21

What are the differences between colonic adenocarcinoma in the proximal colon vs. distal colon.

Answer 21

Proximal: no obstruction, bleeding
Distal: “napkin ring” constriction w/ constipation, no bleeding

Question 22

What is iron deficiency anemia in men > 50 and post-menopausal women until proven otherwise?

Answer 22

GI cancer (usually indicates very slow and almost unnoticeable GI bleed)

Question 23

How is cancer staging based?

Answer 23

On the depth of the tumor

Question 24

What is carcinoid syndrome?

Answer 24

Tumor that produces serotonin (5-HT) and its metabolite (5-HIAA) hydroxyindoleacetic acid. Patients present with flushed skin, diarrhea, and it can lead to heart failure and bronchoconstriction

Question 25

What is dangerous about peritoneal tumors?

Answer 25

All are malignant