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Gastrointestinal > Path of small intestines > Flashcards

Path of small intestines Flashcards

1
Q

What is the clinical course of gastric carcinoma?

A

Asymptomatic until late

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2
Q

What is the prognosis of gastric carcinoma? Why?

A

Depends on depth, and mets, but usually found late d/t lack of symptoms until late

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3
Q

What are the three nodes that usually have mets from gastric carcinomas?

A

Virchow nodes
Sister Mary Joseph nodule
Krukenbery tumors

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4
Q

What a the sister mary joseph nodule?

A

mets around the umbilicus (reddening

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5
Q

What are Krukenberg tumors?

A

Mets to the ovaries from gastric carcinomas

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6
Q

What are the usually histologically characteristics of Krukenburg tumors?

A

Signet rings that are PAS positive (from diffuse type)

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7
Q

What lymphomas are associated with gastric tumors? Why?

A

B cell lymphoma (MALTomas) d/t B cell proliferation in response to H.Pylori infection

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8
Q

What are the B cell markers?

A

CD19 CD20, CD21

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9
Q

What are carcinoid tumors?

A

Neuroendocrine tumors from gastric cells that can secrete 5HT and bradykinin

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10
Q

What are the histological characteristics of gastric lymphomas?

A

Lymphoid cells infiltrate through glands and walls (uniform B cell)

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11
Q

What is the cause of GIST? (genetic, cell type)

A

Cells of Cajal get a c-KIT oncogene

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12
Q

What is the treatment for GIST?

A

Imatinib

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13
Q

What is the major prognostic factor for GIST?

A

Size

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14
Q

What cells are constantly proliferating in the GI Tract?

A

Basal cells

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15
Q

What is idiopathic IBD?

A

Chronic, relapsing inflammatory disorders of the intestinal tract of obscure origin

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16
Q

What are the two types of IBD?

A

Crohn’s disease

Ulcerative colitis

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17
Q

What is the supposed cause of IBD?

A

Unregulated and exaggerated immune response to normal gut flora

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18
Q

Which has extraintestinal inflammatory manifestations: Crohn’s or Ulcerative colitis?

A

Both

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19
Q

Which has epithelial changes that can lead to carcinoma: crohn’s disease or Ulcerative colitis

A

Both

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20
Q

How do you diagnose IBD?

A

H&P
x-ray
histology

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21
Q

What is the antibody that is associated with Crohn’s? UC?

A 
UC = ANCA
Crohn's = anti-saccharomyces
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22
Q

What cell has an abnormal response in IBD?

A

T cells

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23
Q

What do Th2 cells drive?

A

Humoral response

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24
Q

What type of hypersensitivity reaction is suspected in IBD?

A

delayed type hypersensitivity

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25
Q

What is Crohn’s disease? Where in the GI tract can this occur?

A

Trans-mural chronic ulceration IBD characterized by bowel inflammation, non-caseous granulomas,

Can occur anywhere in the GI tract

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26
Q

What is the most affected region in Crohn’s disease?

A

terminal ileum

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27
Q

Who usually gets Crohn’s disease?

A

Female Jews who smoke

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28
Q

What are the ssx of Crohn’s disease?

A

Diarrhea, fever, pain.

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29
Q

What is the major complication of Crohn’s disease?

A

Transmural fistula development

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30
Q

What are the malabsorption problems that can occur with Crohn’s disease?

A

Steatorrhea

Pernicious anemia

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31
Q

Which has a stronger predisposition to develop into cancer: UC or Crohn’s disease?

A

UC

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32
Q

What are skip lesions? What disease is it seen in?

A

a wound or inflammation that is clearly patchy, “skipping” areas that thereby are unharmed. It is a typical form of intestinal damage in Crohn’s disease

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33
Q

What disease has early aphthoid ulcers?

A

Crohn’s disease

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34
Q

Cobblestone mucosa is characteristic of what disease?

A

Crohn’s disease

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35
Q

What is the string sign of Crohn’s disease?

A

Thickened luminal narrowing of the intestines seen in Crohn’s disease when using radiolabeled dye

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36
Q

What is the “creeping fat” found in Crohn’s disease?

A

Dull gray granular serosa that surround that entire intestines

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37
Q

Linear ulcers in the intestines are characteristics of what disease? What are these called?

A

Crohn’s disease

Aphthous ulcers

38
Q

What causes of the rubber hose symptom of Crohn’s disease?

A

Thickening of the walls of the intestines

39
Q

What are the histological characteristics of Crohn’s disease?

A

Early PMN infiltration of epithelial layer, and crypt abscess formation

40
Q

What are the signs of chronic mucosal damage of Crohn’s disease?

A

Metaplasia
Mucosal atrophy
Architectural distortion

41
Q

Non-caseating granulomas occur in which IBD?

A

Crohn’s disease

42
Q

What are the extraintestinal manifestation of Crohn’s disease? (3)

A

Migratory polyarthritis
Sacroiliitis
ankylosing spondylitis

43
Q

Clubbing of the fingertips can be seen in what intestinal disease?

A

Crohn’s disease

44
Q

What is ulcerative colitis?

A

Ulceroinflammatory disease limited to colon and affecting only mucosa and submucosa

45
Q

Are the granulomas in Ulcerative colitis?

A

No

46
Q

Which IBD has granuloma formation?

A

Crohn’s disease

47
Q

How does ulcerative colitis spread through the intestines?

A

In a contiguous fashion, as opposed to the skip lesions seen in Crohn’s disease

48
Q

Thickening of the bowel is more common in what IB? Thinning?

A 
Thickening = Crohn's
Thinning = UC
49
Q

Who is usually affects with UC?

A

20-25 years olds

50
Q

What are the ssx of UC?

A

Bloody, mucoid diarrhea

51
Q

What is the morphology of Ulcerative colitis? What part(s) of the GI tract are involved?

A

Contiguous ulcer starting at the rectum and spreading upward to possibly involve the entire colon.

52
Q

What are the pseudopolyps of ulcerative colitis?

A

Coalescence of ulcers

53
Q

What are the common complications of ulcerative colitis?

A

Toxic megacolon

Perforation

54
Q

What is the “backwash” ileitis seen in UC?

A

Inflammatory soup of colon goes back into the ileum

55
Q

What are the gross characteristics of UC?

A

Edema, hyperemia, crypt abscesses, ulceration

56
Q

What are the histological characteristics of acute ulcerative colitis? (4)

A
  1. early PMN infiltration in the lamina propria
  2. Crypt abscesses
  3. Ulcerations
  4. Granulation tissue (NO granulomas)
57
Q

What are the histological characteristics of chronic ulcerative colitis? (4)

A

Ulcerations
Submucosal fibrosis
Gland disarray
Possibly carcinoma

58
Q

What are the inflammatory pseudopolyps seen in ulcerative colitis?

A

granulation tissue formation and regenerative hyperplasia as a result of previus ulceration

59
Q

What layers of the GI tract are unaffected by ulcerative colitis?

A

Muscularis propria and serosa

60
Q

What happens to the overall thickness of the intestines in UC?

A

Normal to decreased

61
Q

How do crypt abscesses appear histologically?

A

Circular glands filled with PMNs

62
Q

What are the mucosal changes seen with UC?

A

Crypt distortion with dysplasia

Mucosal simplification and dysplasia

63
Q

What are the histological characteristics of dysplasia?

A

Piling up of cells

hyperchromatic nuclei

64
Q

What are the ssx of ulcerative colitis?

A

Remitting, lower abdominal pain relieved by defecation

Bloody mucoid diarrhea

65
Q

What are the two characteristics of cells in UC?

A

DNA damage and microsatellite instability of mucosal cells

66
Q

What IBD can develop adhesions? Intestinal fistulas? Perianal abscesses? Ulceration of the GI tract outside the intestines?

A

All Crohn’s disease

67
Q

Which IBD has a predisposition to developing toxic megacolon? Stenosis?

A 
Megacolon = UC
Stenosis = Crohn's
68
Q

Transmural inflammation = ?

A

Crohn’s disease

69
Q

What is ischemic bowel disease?

A

Occlusion of the mesenteric vessels

70
Q

What are the two watershed areas of the bowel? What are these, and what is their significance?

A

Splenic flexure
Rectosigmoid

Areas of the bowel that receive blood via anastomoses of two blood vessel = susceptible to ischemia

71
Q

What arteries supply the splenic flexure?

A

SMA and IMA

72
Q

What arteries supply the rectosigmoid area?

A

IMA and hypogastric artery

73
Q

What are the causes of ischemic bowel disease?

A
  1. Emboli/thrombi
  2. Low flow states (CHF, a-fib)
  3. Volvulus, radiation
74
Q

What is the usual cause of mural or mucosal infarction of the intestines?

A

Acute or chronic hypoperfusion

75
Q

What does transmural infarction of the bowel lead to?

A

gangrenous necrosis

76
Q

What are mural infarcts?

A

Infarcts of the bowel down to the muscularis propria

77
Q

What is most often the cause of mural and mucosal infarction?

A

Non-occlusive hypoperfusion

78
Q

What happens when there is a mural or mucosal infarct? Is the serosa involved?

A

Luminal hemorrhage and mucosal necrosis

No serosal involvement

79
Q

True or false: mural and mucosal infarctions are reversible if caught early

A

True

80
Q

What are the ssx of mural/mucosal infarctions? (2)

A

Nonspecific abdominal complaints

Hematochezia

81
Q

What is the usual cause of transmural infarctions?

A

Compromise of major blood vessels supplying the intestines d/t thrombosis/embolism

82
Q

What are the signs of a transmural infarct?

A

Hemorrhagic

Fibrinopurulent exudate

83
Q

Who usually gets ischemic bowel disease?

A

Older adults

84
Q

What are the ssx of chronic ischemia of the bowel?

A

Mimic IBD ssx

85
Q

What happens grossly with chronic ischemia of the bowel?

A

Atrophic surface epithelium, fibrous scarring of the lamina propria

86
Q

Is chronic ischemic bowel usually continuous or patchy?

A

Patchy

87
Q

What is the common complication with chronic ischemia of the bowel?

A

Strictures

88
Q

What is angiodysplasia?

A

Non-neoplastic proliferation of blood vessels beneath the mucosa and submucosa

89
Q

What are the ssx of angiodysplasia?

A

BRBPR

90
Q

What are the complications of angiodysplasia?

A
  • Massive bleeding

- Intermittent occlusion

91
Q

What are ectatic nests?

A

Area of blood vessel proliferation in angiodysplasia

Gastrointestinal (42 decks)

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