Path- SI/Colon

Question 1

This condition is when the peritoneum protrudes through an opening, causing an obstruction.

Answer 1

Hernia

Question 2

This is the condition 2 segments of the intestine fuse as a result of peritoneal inflammation

Answer 2

Adhesions

Question 3

This is the condition where a portion of the bowel twists around itself and can cause an obstruction.

Answer 3

Volvulus

Question 4

This is the condition where 1 bowel segment telescopes on itself.

Answer 4

Intussception

Question 5

What can happen to the bowels of there is an infarct in the celiac, SMA, or IMA?

Answer 5

Ischemia

Question 6

This injury occurs at the onset of vascular compromise.

Answer 6

Initial hypoxic injury

Question 7

This injury in IBD occurs when there is a restoration of blood supply.

Answer 7

Reperfusion injury.

Question 8

What substances cause the reperfusion injury in IBD

Answer 8

free radicals

Question 9

The splenic flexure, sigmoid colon, and surface epithelium are at risk for ischemic injury because of what feature of the arterial supply?

Answer 9

they’re in watershed zones.

Question 10

What are the morphological features of the wall of the bowel in IBD?

Answer 10

it becomes edematous, thick, and rubbery with coagulative necrosis of the muscularis propria

Question 11

Patients with what pre-existing constions are susceptible for IBD?

Answer 11

cardiac or vascular disease

Question 12

This is the condition when tortuous dilation of submucosal vessels leads to hematochezia.

Answer 12

Angiodysplasia

Question 13

Where is angiodysplasia present in the bowels?

Answer 13

Lower stuff (cecum, terminal ileum, ascending colon)

Question 14

This is the condtion hallmarked by steatorrhea, and symptoms include weight loss, anorexia, abdominal distention, borborygmi, and muscle wasting.

Answer 14

Malabsorption

Question 15

This condition is a result of Ab development against gliadin, leading to immune destruction of mucosal cells.

Answer 15

Celiac disease

Question 16

Along with atropy of the villi, which WBC do you see in the lamina propria in celiac disease?

Answer 16

Plasma cells.

Question 17

Pt’s with celiac disease have an increased risk of what type of lymphoma?

Answer 17

small bowel T-cell lymphoma

Question 18

Case: a patient comes into the office complaining of malabsorption. You do an endoscopic exam and realize the entire small bowel has sprue, instead of just in the distal ileum and jejunum. Labs show abnormal d-xylose and antiglidin Ab’s. What is the probable cause of this disease?

Answer 18

Bacterial inflammation (tropical sprue)

Question 19

This condition is an X-linked disorder characterized by severe persistent diarrhea, especially in young children.

Answer 19

Autoimmune enteropathy

Question 20

What is a severe form of autoimmune enteropathy?

Answer 20

IPEX syndrome

Question 21

What gene is at fault to cause the IPEX syndrome?

Answer 21

FOXP3

Question 22

This type of lactase insufficiency produces explosive diarrhea with watery and frothy stools due to an ER mutation in the lactase gene.

Answer 22

Congenital lactase deficiency

Question 23

This type of lactase deficiency is from down-regulation of the lactase gene, present after childhood, and presents as abdominal fullness, diarrhea, and farting.

Answer 23

Acquired lactase deficiency

Question 24

What happens if you cannot synthesize apolipoprotein B? What happens to fat absorption?

Answer 24

You can absorb fat into your intestinal epithelia but cannot get it out cuz u cant make chylomicrons

Question 25

What are the Sx of abetalipoproteinemia?

Answer 25

early childhood malabsorption, failure to thrive, diarrhea/steatorrhea, and neuro manifestations

Question 26

This organisms enterotoxin causes severe ricewater stools.

Answer 26

Vibrio cholera

Question 27

What does cholera stimulate excessively in the cells to cause the severe watery diarrhea?

Answer 27

Adenylate Cyclase

Question 28

This organism produces crypt abscesses after it invades the SI and colonic mucosa.

Answer 28

Campylobacter jejuni | jejuni b/c jejunum!

Question 29

This genre of bacteria target the ileum and left colon and produce mucosal ulceration and pseudomembranous inflammation.

Answer 29

Shigella | Shigellosis

Question 30

What is the main salmonella species to cause acute limited colitis, kinda like Campy and Shigella?

Answer 30

S. enteriditis (non-typhoidal)

Question 31

What happens during the first week of S. typhi infections (typhoid fever)? (think pathogenesis)

Answer 31

it attaches and invades the terminal ileum over Peyers patches, get ulcers, and produces septicemia.

Question 32

What happens during the 2nd week of S. typhi infections (typhoid fever)? (think Sx)

Answer 32

diarrhea, bradycardia, neutropenia and hepatosplenomegaly with typhoid nodules.

Question 33

This genre of bacteria invade M cells and use adhesion proteins to cause regional lymph node and Peyes patch hyperplasia and bowel wall thickening.

Answer 33

Yersinia

Question 34

What is the role of the heat-labile toxin (LT) for Enterotoxigenic E. Coli?

Answer 34

stimualtes cAMP --> secretory diarrhea, normal mucosa

Question 35

What is the role of the heat-stable toxin (ST) for Enterotoxigenic E. Coli?

Answer 35

stimulates guanylate cyclase --> increase cGMP --> secretory diarrhea

Question 36

What is the serotype of EHEC?

Answer 36

O157:H7

Question 37

What are the Sx to EHEC infections?

Answer 37

uremic syndrome, bloody diarrhea, hemorrhagic or pseudomembranous colitis

Question 38

What are the Sx to EIEC infections?

Answer 38

bloody diarreha, mucosal necrosis and inflammation. invasion of the lower intestine

Question 39

What is the pathogenesis for EAEC?

Answer 39

attach to enterocytes using fimbrae and dispersin --> produce enterotoxin --> non-bloody diarrhea

Question 40

This bacteria produces a toxin in the colon and causes watery smelly diarrhea, fever, and pain.

Answer 40

C. diff

Question 41

This disease is characterized by fever, diarrhea, joint pain, emaciation, skin pigmentation, lymphadenopathy, and neurological abnormalitis.

Answer 41

Whipple disease | T. whippeli

Question 42

What is the characteristic finding in the lamina propria in whipple disease?

Answer 42

PAS-positive foamy macrophages

Question 43

What virus causes watery, nonbloody diarrhea in kids by infecting and damaging bursh border enzymes?

Answer 43

Rotavirus

Question 44

What virus causes gastroenteritis in adults?

Answer 44

Norwalk virus

Question 45

Which virus causes epithelial degeneration but often non-villous atrophy and crypt hyperplasia, tpyically in kids and the military?

Answer 45

Adenovirus

Question 46

This nematode causes hepatic abscesses and induces a eosinophil-rich inflammatory rxn?

Answer 46

Ascaris lumbricoides

Question 47

Where does strongyloides infect?

Answer 47

it causes peripheral eosinophilia and induces inflammatory infiltrates in the lungs and residues in the intestine

Question 48

What are the 2 hookworms?

Answer 48

Necator duodenale and ancylostoma duadenale

Question 49

What is the pathogenesis to hookworms?

Answer 49

They "hook" onto duodenal mucosa and such blood --> superficial erosions focal hemorrhage + inflammatory infiltrates

Question 50

What is the genre fro pinworms?

Answer 50

Enterobius vermicularis

Question 51

True or False: pinworms rarely cause disease cuz they live their entire life in the intestinal lumen

Answer 51

True

Question 52

How do you Dx pinworms?

Answer 52

put tape on your b-hole and look for huevos

Question 53

What is the genre fro whipworm?

Answer 53

Trichuris trichiura (tricky tricky)

Question 54

This parasite resides in mesenteric veins and their eggs get reapped in the mucosa and submucosa --> immune rxns --> granulomas, bleeding and obstruction.

Answer 54

Schistosomiasis

Question 55

Diphyllobothrium, taenia solium, and hymenolepsis are all types of what parasitic infection?

Answer 55

Tape worm

Question 56

What are the Sx of tapeworm infeciton?

Answer 56

abdominal pain, diarrhea, and nausea

Question 57

What is the parasite that causes dysentary/amebiasis?

Answer 57

Entamoeba histolytica

Question 58

How does entamoeba cause ulcerations of the colon?

Answer 58

cyts colonize --> apoptosis in lamina propria --> neurotphils recruit --> tissue dmg --> flask shaped ulcer

Question 59

What is the pathogenesis of giardia lamblia to cause acute or chronic diarrhea?

Answer 59

it decreases production of brush0border enzymes --> microvillous dmg --> apoptosis of SI epithelial cells

Question 60

How does cryptosporidium cause watery diarrhea?

Answer 60

induces actin polymerization on enterocytes --> engulfment of parasite --> Na malabsorption + Cl secretion --> watery diarrhea weirdo.

Question 61

This condition is when there is an abnormality in colonic motility that is commonly precipitated by stress or consumption of high fat meals.

Answer 61

Irritable Bowel Syndrome (IBS)

Question 62

What are the Sx to IBS?

Answer 62

alternating bouts of diarrhea and constipation, cramping, abd pain, tenesmus, mucous in the stool, and pain relieved by bowel mvmt. my ex-gf had IBS and it was super annoying. she'd blow up my toilet on the reg. that's why we're no longer together.

Question 63

You think I'm joking.

Answer 63

I'm not.

Question 64

This is the condition resulting from inappropriate mucosal immune activation.

Answer 64

Inflammatory Bowel Disease (IBD)

Question 65

What are the 2 classical IBD's?

Answer 65

Crohn's disease and Ulcerative Colitis

Question 66

This IBD is when there is severe ulcerating inflammatory disease that is limited to the colon and rectum and extends only from the mucosa to the submucosa.

Answer 66

Ulcerative Colitis | literally meaning, "ulcers in the inflamed colon"

Question 67

This IBD is regional in the GI tract and is transmural.

Answer 67

Crohns disease

Question 68

What types of people are susceptible to IBD?

Answer 68

young white females. esp Ashkenazi jews.

Question 69

Case: you do a colonoscopy and find a patch in the colon with far creeping around the serosa, thick bowel wall and narrow lumen, ulcers, and strictures. Which disease are u thinking could be the cause?

Answer 69

Crohns disease

Question 70

Case: on a different colonoscopy, in the rectum you find inflammatory polyps friable mucosa, uceration and hemorrhage. What is the etiology?

Answer 70

Ulcerative colitis.

Question 71

So which one is caused by a disordered response to bacteria, Crohns or Ulcerative colitis?

Answer 71

Crohns

Question 72

So which one is caused by an immune response, Crohns or Ulcerative colitis?

Answer 72

Ulcerative colitis

Question 73

So you finally treat the ulcerative colitis surgically, but now the patient is at risk for what other type of colitis where an ostomy forms?

Answer 73

Diversion colitis

Question 74

This is the colitis when there is a presence of a dense subepithelial collagen layer, increased # of intraepithelial lymphocytes, and inflammatory infiltrate in the lamina propria.

Answer 74

Collagenous colitis

Question 75

What is the condiiton when the collagen layer is of normal thickness and there is an increase in lymphocytes?

Answer 75

Lymphocytic colitis

Question 76

What type of colitis formed after bone marrow transplant, and there is epithelial apoptosis of crypt cells over the SI and colon?

Answer 76

Graft-vs-host disease

Question 77

This is an outpouching of the lower colonic mucosa and submucosa.

Answer 77

Sigmoid diverticulitis

Question 78

What is the main cause of sigmoid diverticulitis?

Answer 78

icnreased intraluminal pressure

Question 79

Which quadrant in the abdomen will a patient present with pain from sigmoid diverticulitis?

Answer 79

LLQ

Question 80

What are sessile polyps?

Answer 80

Those that have a broad base that's firmly attached ot the mucosa

Question 81

What are pedunculated polyps?

Answer 81

Those that have a stalk

Question 82

What type of polyps form with soltary rectal ulcer syndrome?

Answer 82

inflammatory polyps | think ulcers = inflammation

Question 83

The impaired relaxation of what sphincter causes recurrent abrasions and thus inflammatory polyps and the solitary rectal ulcer syndrome?

Answer 83

rectoanal sphincter

Question 84

Which polypsoccur sporadiccally and in the context of various genetic or acquired syndromes?

Answer 84

Hamartomatous polyps

Question 85

These are polyps that form reddish-brown, round, smooth polyps on the rectum of kids.

Answer 85

Juvenile polyps

Question 86

If there is only 1 juvenile polyp, is there an increased risk for adenocarcinoma?

Answer 86

no

Question 87

This AD disease is assocated with multiple non-malignant hamartomatous polyps in the SI, colon and stomach.

Answer 87

Peutz-Jeghers syndrome

Question 88

IN PJS, there is pigementation of what epithelial tissues?

Answer 88

Lips, mouth, hands, and genetalia

Question 89

This Ad syndrome is characterized by macrocephaly, intestinal hamartomatous polyps, and benign skin tumors.

Answer 89

Cowden syndrome.

Question 90

Which 3 carcinomas does Cowden syndrome predispose you for?

Answer 90

breast, thyroid, and endometrial carcinoma.

Question 91

Which syndrome has mental deficiencies, developmental delays, and lower instances of neoplasia as compared to Cowden syndrome?

Answer 91

Bannayan-Ruvalcaba-Riley Syndrome YEAH LETS PUT ALL OUR LONG NAMES TOGETHER FOR 1 THING

Question 92

True or False: Cronkhite-canada syndrome has no hereditary disposition and is assocaited with juvenile type polyps throughout the intestines.

Answer 92

True

Question 93

What is the most common polyp in the colon?

Answer 93

Hyperplastic polyp

Question 94

What causes hyperplastic polyps to form?

Answer 94

A defect in maturation of the epithelial cells

Question 95

What do hyperplastic polyps look like histologically?

Answer 95

hyperplastic epithelium with a sawtooth appearance

Question 96

True or False: any neoplastic mass lesion in the GI may produce a polyp.

Answer 96

True

Question 97

Colonic adenomas cause benign polyps that are precursors to what type of cancer?

Answer 97

colorectal adenocarcinomas

Question 98

Colorectal adenomas are characterized by the presence of what abnormal epithelial growth?

Answer 98

epithelial dysplasia

Question 99

What is the most common polyposis syndrome?

Answer 99

Familial adenomatous polyposis (FAP)

Question 100

What # of polyps must u have to be diagnosed as having FAP?

Answer 100

>100

Question 101

Is FAP autosomal dominant or recessive?

Answer 101

AD

Question 102

What gene is suppressed in FAP?

Answer 102

APC supressor gene

Question 103

By 40 years old, what % of FAP patients will have cancer?

Answer 103

100%

Question 104

This condition is when there is familial clustering of cancers at several sites in the body, from mutations in DNA repair mechanisms.

Answer 104

Hereditary non-polyposis colorectal cancer | Lynch syndrome

Question 105

What is the genetic defect to cause colonic adenocarcinoma development via the WNT pathway?

Answer 105

APC/B-catenin pathway

Question 106

What is the genetic factor to cause defects in DNA mismatch repair, leading to colonic adenocarcinomas?

Answer 106

Microsatellite instability pathway

Question 107

What are the clinical features of right-sided colonic adenocarcinomas?

Answer 107

polypoid appearance, usually bleed

Question 108

What are the clinical features of left-sided colonic adenocarcinomas?

Answer 108

napkin ring/apple-core lesion due to smaller diameter, constipation (obvi)

Question 109

These are tumors of the anal canal which are populated by immature cells derived from the basal layer of transitional epithelium.

Answer 109

basaloid tumors

Question 110

Pure squamous cell carcinomas of the anus are associated with what infection?

Answer 110

HPV

Question 111

The classification of hemorrhoids (internal/external) are based off which line?

Answer 111

Pectinate line

Question 112

True or false: all hemorroids present with pain or itching.

Answer 112

False. internal do not.

Question 113

60% of acute appendicitis is caused by fecalith blockage of what part of the intestine?

Answer 113

Lumen to the appendix

Question 114

What WBC invades the appendix in acute appendicits?

Answer 114

Neutrophils

Question 115

What forms in the walls in acute supporative appendicitis?

Answer 115

focal abscesses

Question 116

What happens to the appendix in acute gangenous appendicits?

Answer 116

there are large areas of ulceration and gangenous necrosis that extends to the serosa.

Question 117

Which sign can u use for acute appendicits in clinical exam?

Answer 117

McBurneys sign

Question 118

What is the most common tumor of the appendix?

Answer 118

Carcinoid tumor