path slide set 3 Flashcards
What adenocarcinoma produces occult bleeding, changes in bowel habits, or cramping and left lower quadrant discomfort
Left sided colorectal adenocarcinoma
Defects in intestinal epithelial tight junction barrier function are present in what IBD
Crohn and a subset of their healthy 1st degree relatives
Th17 cells likely contribute to disease pathogenesis in IBD. consistent with this, polymorphisms in what confer REDUCTIONS in the risk of both Crohn and UC
IL-23 receptor
Most common cause of intestinal obstruction in the U.S.
adhesions
Polyp: thought to result from decreased epithelial cell turnover and delayed shedding of surface epithelial cells, leading to a “piling up” of goblet cells and absorptive cells
hyperplastic polyp
MTP mutations
Abetalipoproteinemia
3 classifications of adenomas
- tubular
- tubulovillous
- villous
IBD: mural thickening is NOT present. serosal surface is normal. strictures do NOT occur
UC
where is highest incidence of adenocarcinoma
North America
histology of lymphocytic colitis
similar to collagenous colitis but the subepithelial collagen layer is of normal thickness and the increase in intraepithelial lymphocytes is greater
Ectatic nests, tortuous veins, venules, and capillaries
-limited injury may result in significant bleeding
Angiodysplasia
These result from the unique structure of the colonic muscularis propria and elevated intraluminal pressure in sigmoid colon
Colonic diverticula
What is the most frequent cause of intestinal obstruction WORLDWIDE
hernias
what can be used both diagnostically and therapeutically for idiopathic intussusception in infants and young children
contrast enemas
intestinal hypoperfusion can be associated with what?
- cardiac failure
- shock
- dehydration
- vasoconstrictive drugs
Most common site of metastasis for colonic adenocarcinoma
liver
small, flask-like outpouchings in regular distribution alongside the taeniae coli
Colonic diverticula
IBD: fistulae
Crohn
explosive diarrhea with watery, frothy stools and abdominal distention upon milk ingestion
congenital lactase deficiency
What may develop in extensive small bowel Crohn
- serum protein loss
- hypoalbuminemia
- generalized nutrient malabsorption
- malabsorption of B12 and bile salts
after how many years does the risk of colitis associated neoplasia sharply increase?
8-10 years
depth of transmural infarction
all three wall layers
Polyps are most common where
colo-rectal regions
which IBD: repeated cycles of crypt destruction and regeneration lead to DISTORTION OF MUCOSAL ARCHITECTURE
Crohn
important causes of acute arterial obstruction
- severe atherosclerosis (prominent at origin of mesenteric vessels)
- AA
- hypercoaguable states
- oral contraceptive use
- embolization of cardiac vegetations or aortic atheromas (happens alot with malignancy)
risk factors for C. diff associated colitis
- advanced age
- hospitalization
- antibiotic treatment
upper anal canal epithelium
columnar rectal
What is an extraintestinal manifestation of FAP that can be detected at birth and therefore may be an adjunct to early screening
congenital hypertrophy of the retinal pigment epithelium
Waxing and Waning diarrhea that can mimic new-onset ulcerative colitis
shigella
histology of collagenous colitis
dense subepiethelial collagen layer, increased numbers of intraepithelial lymphocytes, and a mixed inflammatory infiltrate within lamina propria
bright red seen on toilet tissue
hemorrhoids
What effectively cures intestinal disease of UC but extraintestinal manifestations may persist
colectomy
4 major categories of diarrhea
- Secretory
- Osmotic
- Malabsorptive
- exudative
Diarrhea is defined as an increase in stool mass, frequency, or fluidity, greater than what amount
200 grams per day
IBD: toxic megacolon
UC
Polyp that occur sporadically or as components of various genetically determined or acquired syndromes
Hamartomatous polyps
at least 100 polyps
FAP
Describe the cysts of Giardia and what this causes
- resistant to chlorine
- endemic in unfiltered public water supplies
a patient with celiac disease starts on gluten free diet. How long before restoration of normal mucosa
6 to 24 months
The failure of intraluminal digestion that occurs in cystic fibrosis can be effectively treated with what?
oral enzyme supplementation
Giardia trophozoites can be identified where
duodenal biopsies
inferior hemorrhoid plexus below anorectal line
external hemorrhoids
from 3 to 100 hamartomatous polyps and may require colectomy
autosomal dominant syndrome of jevenile polyposis
What is an additional mutation in the pathogenesis of colon adenocarcinoma that is a late event and promotes growth and prevents apoptosis?
KRAS
Distribution of adenocarcinomas
approximately equally over entire colon
in both acute and chronic ischemia, bacterial superinfection and enterotoxin release by induce what?
pseudomembrane formation that resembles clostridium difficile
Gluten-free diet in patients with celiac will reduce risk for what
- anemia
- female infertility
- osteoporosis
- cancer
itchy, blistering skin lesion called dermatitis herpetiformis
celiac disease
When does Abetalipoproteinemia present?
What symptoms
at infancy
-failure to thrive, diarrhea, steatorrhea
when definite diagnosis between UC and Crohn is not possible due to so much overlap
Indeterminate Colitis
Cancer and Crohn
increased risk of colonic adenocarcinoma
NOD2 leads to what pathway
NF-kB
Abrupt onset of watery diarrhea and vomiting following an incubation period of 1 to 5 days
- voluminous RICE WATER stools
- FISHY odor
Cholera
Polyp: distinctive histologic features include mixed inflammatory infiltrates, erosion, and epithelial hyperplasia together with lamina propria fibromuscular hyperplasia
inflammatory polyp
most juvenile polyps are located where?
present with what?
rectum
rectal bleeding
What develops in 100% of untreated FAP patients often before age 30 and nearly always by age 50
colorectal adenocarcinoma
HLAs and celiac disease
DQ2 and DQ8
antibodies against the bacterial protein flagellin are most common in which IBD
Crohn patients who have NOD2 variants
mucosal and mural infarctions cann follow what
acute or chronic hypoperfusion
most common approach for surveillance of adenomas
colonoscopy
Colonic diverticula prevalence is about 50% at what age in Western populations
older than 60
underlying cause of solitary rectal ulcer syndrome which then leads to inflammatory polyps
impaired relaxaton of the anorectal sphincter that creates a sharp angle at the anterior rectal shelf and leads to recurrent agrasion and ulceration of the overlying rectal mucosa
association of celiac disease and what other immune diseases
- type 1 diabetes
- thyroiditis
- Sjogren
- IGA nephropathy
most frequent predisposing influences for hemorrhoids?
- straining at defacation because of constipation
- venous stasis of pregnancy
- portal HTN
What are the most common chronic malabsorptive disorders in the U.S.
- pancreatic insufficiency
- celiac disease
- Crohn Disease
in Whipple disease, where can bacteria laden macrophages accumulate
- mesenteric lymph nodes
- synovial membranes of affected joints
- cardiac valves
- brain
Courvoisier’s sign
Jaundice and a palpable gallbladder . . pancreatic cancer
morphological signature of ischemic intestinal disease
surface epithelial atrophy, or even necrosis and sloughing, with normal or hyperproliferative crypts
eruption reminiscent of a volcano eruption from the crypt
C. diff
Most sensitive noninvasive serologic test for celiac, prior to biopsy
measure for IgA antibodies against tissue transglutaminase
IgA anti-endomysial antibodies also present
what type of diarrhea in shigella
Bloody
what is the most common cause of intestinal obstruction in children younger than 2 years of age
intussusception
Most striking feature of diversion colitis, besides mucosal erythema and friability
development of numerous lymphoid follicles
IBD; polyps fuse to form mucosal bridges
UC
transmural infarction is typically caused by what
acute vascular obstruction
What is a hallmark of the APC/B-catenin pathway
chromosome instability
treatment of hemorrhoidal bleeding
- sclerotherapy
- rubber band ligation
- infrared coagulation
2 types of lactase deficiency
congenital and acquired
what kind of herniation does an adhesion cause
internal
what is the only disease that has defect in Lymphatic transport
Whipple disease
Abetalipoproteinema leads to deficiencies in what?
fat soluble vitamins as well as lipid membrane defects
When colitis develops within diverted segment from surgical treatment of UC, Hirschprung disease, and other intestinal disorders
Diversion Colitis
cases of intussusception have been associated with viral infections and what vaccine
rotavirus vaccines, perhaps due to reactive hyperplasia of Peyer patches
Adenocarcinomas of distal colon
- annular lesion
- napkin ring constriction
- sometimes obstruction
What therapy is necessary when intussusception is due to a mass, which is generally the case in older children and adults
surgical intervention
clinical diagnosis of IBS requires what?
occurrence of abdominal pain or discomfort at least 3 days per month over 3 months with improvement following defecations and a changein stool frequency or form
most common locations for sessile serrated adenoma
right colon
NO PATHOLOGIC ABNORMALITY
IBS
pathogenesis of angiodysplasia
normal distention and contraction of bowel intermittently occlude submucosal veins and leads to focal dilation and tortuosity
what is an important cause of malabsorption and diarrhea after allogeneic hemotopoietic stem cell transplantation
intestinal graft-versus-host disease
Re-activation of Crohn can be associated with what external triggers
- physical or emotional stress
- specific dietary items
- CIGARETTE SMOKING
acute appendicitis most common in what age
adolescents and young adults
IPEX and FOXP3 mutations have defective functions of what cells
CD4+
which IBD: noncaseating Granulomas
Crohn
celiac disease in older children with nonclassical symptoms
Extraintestinal manifestations
- constipation instead of diarrhea
- bloating
- vomiting
- abdominal pain
- arthritis/joint pain
- apthous ulcers
- stomatitis
- iron deficiency anemia
- delayed puberty
- short stature
earliest lesion in Crohn
Aphthous ulcer
IBD with psuedopolyps and ulcers
UC
Classifications of NONneoplastic polyps
- inflammatory
- hamartomatous
- hyperplastic
This differentiation pattern is present in tumors populated by immature cells derived from the basal layer of transitional epithelium (anal canal)
Basaloid
diarrhea characterized by isotonic stool and PERSISTS during fasting
Secretory
SMAD4 and BMPR1A
Juvenile polyposis
complete absence of all plasma lipoproteins containing apoliprotein B
Abetalipoproteinema
most shigells infections and deaths occur in who?
children younger than 5
Which phase of intesinal response to ischemia? . . initiated by restoration of blood. . greatest damage occurs. May trigger multiorgan failure in severe cases
reperfusion injury
What side of the colon gives a more severe disease course in ischemic bowel disease and double mortality rate
right side . . super mesenteric A. which also supplies small intestine
Match symptom with deficiency: anemia and mucositis
bleeding
ostepenia and tetany
peripheral neuopathy
- pyridoxine folate and vitamin B12
- vitamin K
- calcium, magnesium, or vitamin D
- vitamin A or B12
Inflammatory response and neoplasia in IBD
Neutrophils confers increased risk
Acute colonic ischemia typically presents with what
sudden onset of cramping, LEFT LOWER abdominal pain, a DESIRE to defacate, and passage of blood or bloody diarrhea
young person. Family history breast and pancreas cancer.
HNPCC
IBD: deep, knife like ulcer
Crohn
Autosomal dominant disorder in which patients develop numberous colorectal adenomas as teenagers
Familial adenomatous polyposis (FAP)
Campylobacter infection can result in reactive arthritis is patients with what?
HLA-B27
most common histological finding in Graft-versus-host disease
Epithelial apoptosis particularly of crypt cells
a weakness or defect in the agdominal wall which may permit protrusion of a serosa-lined pouch of peritoneum
hernia
IBD limited to colon and rectum and extends only into the mucosa and submucosa
UC
results of a volvulus
luminal and vascular compromise as it acts like both obstruction and infarction
Percussion in bowel obstruction
tympanic
when does surveillance for neoplasia usually start in a patient with IBD and primary sclerosing cholangitis
at the time of diagnosis
caused by inherited mutations in genes that encode proteins responsible for the detection, excision, and repair of errors that occur during DNA replication
HNPCC
most common sites for Crohn’s at presentation
- terminal Ileum
- Ileocecal valve
- Cecum
metastasis of carcinomas of anal region
they skip liver
IBD: higher risk for primary sclerosing cholangitis
UC
What can provide symptomatic improvement in diverticular disease
diets supplemented with fiber
Pediatric infectious diarrhea which may result in severe dehydration and metabolic acidosis is commonly caused by what
enteric viruses
What is the standard therapy for individuals carrying APC mutations
prophylactic colectomy
most frequent hernia in U.S.
inguinal
What must be considered in a patient with abdominal pain, diarrhea, and weight loss, despite having a strict gluten-free diet
cancer or refractory sprue
reciprocal translocation, t(11,22)
EWS and WT1 fusion gene
desmoplastic small round cell tumor
describe the surveillance for cancer of those with Peutz-Jeghers Syndrome
- beginning at birth for sex cord tumors of testes
- late childhood for gastric and small intestinal cancers
- 2nd and 3rd decades for colon, pancreatic, breast, lung, ovarian, and uterine
Shigella infections most prominent in what location of the body
left colon
Twisting of a loop of bowel about its mesenteric point of attachment
volvulus
Which IBD: PANETH CELL METAPLASIA in Left colon where paneth cells are normally absent
Crohn
What is one of the most feared long term complication of UC and Crohn
development of neoplasia
most common pattern of ischemic bowel disease
segmental or patchy but can be continuous
- PAS-positive
- Rod-shaped bacilli
Whipple disease
What are the 4 phases of nutrient absorption
- intraluminal digestion
- Terminal digestion
- transepithelial transport
- lymphatic transport of absorbed lipids
age for celiac disease
gender
30 to 60
in adults, twice as frequent in women
poor prognostic factors for ischemic bowel disease
- right side
- COPD
- persistence of symptoms for more than 2 weeks
most common neoplastic polyp
adenoma . . which has potential to progress to cancer
What are the two most important prognostic factors in colonic adenocarcinoma
- depth of invasion
- presence of lymph node metastases
Intussusception is rare in older children and adults and is generally caused by what?
intraluminal mass or tumor that serves as the leading edge
semi distinguishing symptoms of those with diverticular disease
- sensation of never being able to completely empty the rectum
- alternating constipation and diarrhea
periumbilical pain that ultimately localizes to right lower quadrant
appendicitis
Rare autosomal dominant syndrome presents with multiple GI hamartomatous polyps and mucocutaneous hyperpigmentation
Peutz-Jeghers syndrome
This occurs when dysplastic epithelial cells breach the basement membrane to invade the lamina propria or muscularis mucosa
intramucosal carcinoma
Biopsy of what segments is generally diagnostic of celiac disease
second portion of duodenum and proximal jejunum