path slide set 3 Flashcards
1
Q
What adenocarcinoma produces occult bleeding, changes in bowel habits, or cramping and left lower quadrant discomfort
A
Left sided colorectal adenocarcinoma
2
Q
Defects in intestinal epithelial tight junction barrier function are present in what IBD
A
Crohn and a subset of their healthy 1st degree relatives
3
Q
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
A
IL-23 receptor
4
Q
Most common cause of intestinal obstruction in the U.S.
A
adhesions
5
Q
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
A
hyperplastic polyp
6
Q
MTP mutations
A
Abetalipoproteinemia
7
Q
3 classifications of adenomas
A
- tubular
- tubulovillous
- villous
8
Q
IBD: mural thickening is NOT present. serosal surface is normal. strictures do NOT occur
A
UC
9
Q
where is highest incidence of adenocarcinoma
A
North America
10
Q
histology of lymphocytic colitis
A
similar to collagenous colitis but the subepithelial collagen layer is of normal thickness and the increase in intraepithelial lymphocytes is greater
11
Q
Ectatic nests, tortuous veins, venules, and capillaries
-limited injury may result in significant bleeding
A
Angiodysplasia
12
Q
These result from the unique structure of the colonic muscularis propria and elevated intraluminal pressure in sigmoid colon
A
Colonic diverticula
13
Q
What is the most frequent cause of intestinal obstruction WORLDWIDE
A
hernias
14
Q
what can be used both diagnostically and therapeutically for idiopathic intussusception in infants and young children
A
contrast enemas
15
Q
intestinal hypoperfusion can be associated with what?
A
- cardiac failure
- shock
- dehydration
- vasoconstrictive drugs
16
Q
Most common site of metastasis for colonic adenocarcinoma
A
liver
17
Q
small, flask-like outpouchings in regular distribution alongside the taeniae coli
A
Colonic diverticula
18
Q
IBD: fistulae
A
Crohn
19
Q
explosive diarrhea with watery, frothy stools and abdominal distention upon milk ingestion
A
congenital lactase deficiency
20
Q
What may develop in extensive small bowel Crohn
A
- serum protein loss
- hypoalbuminemia
- generalized nutrient malabsorption
- malabsorption of B12 and bile salts
21
Q
after how many years does the risk of colitis associated neoplasia sharply increase?
A
8-10 years
22
Q
depth of transmural infarction
A
all three wall layers
23
Q
Polyps are most common where
A
colo-rectal regions
24
Q
which IBD: repeated cycles of crypt destruction and regeneration lead to DISTORTION OF MUCOSAL ARCHITECTURE
A
Crohn
25
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)
26
risk factors for C. diff associated colitis
- advanced age
- hospitalization
- antibiotic treatment
27
upper anal canal epithelium
columnar rectal
28
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
29
Waxing and Waning diarrhea that can mimic new-onset ulcerative colitis
shigella
30
histology of collagenous colitis
dense subepiethelial collagen layer, increased numbers of intraepithelial lymphocytes, and a mixed inflammatory infiltrate within lamina propria
31
bright red seen on toilet tissue
hemorrhoids
32
What effectively cures intestinal disease of UC but extraintestinal manifestations may persist
colectomy
33
4 major categories of diarrhea
- Secretory
- Osmotic
- Malabsorptive
- exudative
34
Diarrhea is defined as an increase in stool mass, frequency, or fluidity, greater than what amount
200 grams per day
35
IBD: toxic megacolon
UC
36
Polyp that occur sporadically or as components of various genetically determined or acquired syndromes
Hamartomatous polyps
37
at least 100 polyps
FAP
38
Describe the cysts of Giardia and what this causes
- resistant to chlorine
| - endemic in unfiltered public water supplies
39
a patient with celiac disease starts on gluten free diet. How long before restoration of normal mucosa
6 to 24 months
40
The failure of intraluminal digestion that occurs in cystic fibrosis can be effectively treated with what?
oral enzyme supplementation
41
Giardia trophozoites can be identified where
duodenal biopsies
42
inferior hemorrhoid plexus below anorectal line
external hemorrhoids
43
from 3 to 100 hamartomatous polyps and may require colectomy
autosomal dominant syndrome of jevenile polyposis
44
What is an additional mutation in the pathogenesis of colon adenocarcinoma that is a late event and promotes growth and prevents apoptosis?
KRAS
45
Distribution of adenocarcinomas
approximately equally over entire colon
46
in both acute and chronic ischemia, bacterial superinfection and enterotoxin release by induce what?
pseudomembrane formation that resembles clostridium difficile
47
Gluten-free diet in patients with celiac will reduce risk for what
- anemia
- female infertility
- osteoporosis
- cancer
48
itchy, blistering skin lesion called dermatitis herpetiformis
celiac disease
49
When does Abetalipoproteinemia present?
What symptoms
at infancy
-failure to thrive, diarrhea, steatorrhea
50
when definite diagnosis between UC and Crohn is not possible due to so much overlap
Indeterminate Colitis
51
Cancer and Crohn
increased risk of colonic adenocarcinoma
52
NOD2 leads to what pathway
NF-kB
53
Abrupt onset of watery diarrhea and vomiting following an incubation period of 1 to 5 days
- voluminous RICE WATER stools
- FISHY odor
Cholera
54
Polyp: distinctive histologic features include mixed inflammatory infiltrates, erosion, and epithelial hyperplasia together with lamina propria fibromuscular hyperplasia
inflammatory polyp
55
most juvenile polyps are located where?
present with what?
rectum
rectal bleeding
56
What develops in 100% of untreated FAP patients often before age 30 and nearly always by age 50
colorectal adenocarcinoma
57
HLAs and celiac disease
DQ2 and DQ8
58
antibodies against the bacterial protein flagellin are most common in which IBD
Crohn patients who have NOD2 variants
59
mucosal and mural infarctions cann follow what
acute or chronic hypoperfusion
60
most common approach for surveillance of adenomas
colonoscopy
61
Colonic diverticula prevalence is about 50% at what age in Western populations
older than 60
62
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
63
association of celiac disease and what other immune diseases
- type 1 diabetes
- thyroiditis
- Sjogren
- IGA nephropathy
64
most frequent predisposing influences for hemorrhoids?
- straining at defacation because of constipation
- venous stasis of pregnancy
- portal HTN
65
What are the most common chronic malabsorptive disorders in the U.S.
- pancreatic insufficiency
- celiac disease
- Crohn Disease
66
in Whipple disease, where can bacteria laden macrophages accumulate
- mesenteric lymph nodes
- synovial membranes of affected joints
- cardiac valves
- brain
67
Courvoisier's sign
Jaundice and a palpable gallbladder . . pancreatic cancer
68
morphological signature of ischemic intestinal disease
surface epithelial atrophy, or even necrosis and sloughing, with normal or hyperproliferative crypts
69
eruption reminiscent of a volcano eruption from the crypt
C. diff
70
Most sensitive noninvasive serologic test for celiac, prior to biopsy
measure for IgA antibodies against tissue transglutaminase
IgA anti-endomysial antibodies also present
71
what type of diarrhea in shigella
Bloody
72
what is the most common cause of intestinal obstruction in children younger than 2 years of age
intussusception
73
Most striking feature of diversion colitis, besides mucosal erythema and friability
development of numerous lymphoid follicles
74
IBD; polyps fuse to form mucosal bridges
UC
75
transmural infarction is typically caused by what
acute vascular obstruction
76
What is a hallmark of the APC/B-catenin pathway
chromosome instability
77
treatment of hemorrhoidal bleeding
- sclerotherapy
- rubber band ligation
- infrared coagulation
78
2 types of lactase deficiency
congenital and acquired
79
what kind of herniation does an adhesion cause
internal
80
what is the only disease that has defect in Lymphatic transport
Whipple disease
81
Abetalipoproteinema leads to deficiencies in what?
fat soluble vitamins as well as lipid membrane defects
82
When colitis develops within diverted segment from surgical treatment of UC, Hirschprung disease, and other intestinal disorders
Diversion Colitis
83
cases of intussusception have been associated with viral infections and what vaccine
rotavirus vaccines, perhaps due to reactive hyperplasia of Peyer patches
84
Adenocarcinomas of distal colon
- annular lesion
- napkin ring constriction
- sometimes obstruction
85
What therapy is necessary when intussusception is due to a mass, which is generally the case in older children and adults
surgical intervention
86
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
87
most common locations for sessile serrated adenoma
right colon
88
NO PATHOLOGIC ABNORMALITY
IBS
89
pathogenesis of angiodysplasia
normal distention and contraction of bowel intermittently occlude submucosal veins and leads to focal dilation and tortuosity
90
what is an important cause of malabsorption and diarrhea after allogeneic hemotopoietic stem cell transplantation
intestinal graft-versus-host disease
91
Re-activation of Crohn can be associated with what external triggers
- physical or emotional stress
- specific dietary items
- CIGARETTE SMOKING
92
acute appendicitis most common in what age
adolescents and young adults
93
IPEX and FOXP3 mutations have defective functions of what cells
CD4+
94
which IBD: noncaseating Granulomas
Crohn
95
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
96
earliest lesion in Crohn
Aphthous ulcer
97
IBD with psuedopolyps and ulcers
UC
98
Classifications of NONneoplastic polyps
- inflammatory
- hamartomatous
- hyperplastic
99
This differentiation pattern is present in tumors populated by immature cells derived from the basal layer of transitional epithelium (anal canal)
Basaloid
100
diarrhea characterized by isotonic stool and PERSISTS during fasting
Secretory
101
SMAD4 and BMPR1A
Juvenile polyposis
102
complete absence of all plasma lipoproteins containing apoliprotein B
Abetalipoproteinema
103
most shigells infections and deaths occur in who?
children younger than 5
104
Which phase of intesinal response to ischemia? . . initiated by restoration of blood. . greatest damage occurs. May trigger multiorgan failure in severe cases
reperfusion injury
105
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
106
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
107
Inflammatory response and neoplasia in IBD
Neutrophils confers increased risk
108
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
109
young person. Family history breast and pancreas cancer.
HNPCC
110
IBD: deep, knife like ulcer
Crohn
111
Autosomal dominant disorder in which patients develop numberous colorectal adenomas as teenagers
Familial adenomatous polyposis (FAP)
112
Campylobacter infection can result in reactive arthritis is patients with what?
HLA-B27
113
most common histological finding in Graft-versus-host disease
Epithelial apoptosis particularly of crypt cells
114
a weakness or defect in the agdominal wall which may permit protrusion of a serosa-lined pouch of peritoneum
hernia
115
IBD limited to colon and rectum and extends only into the mucosa and submucosa
UC
116
results of a volvulus
luminal and vascular compromise as it acts like both obstruction and infarction
117
Percussion in bowel obstruction
tympanic
118
when does surveillance for neoplasia usually start in a patient with IBD and primary sclerosing cholangitis
at the time of diagnosis
119
caused by inherited mutations in genes that encode proteins responsible for the detection, excision, and repair of errors that occur during DNA replication
HNPCC
120
most common sites for Crohn's at presentation
- terminal Ileum
- Ileocecal valve
- Cecum
121
metastasis of carcinomas of anal region
they skip liver
122
IBD: higher risk for primary sclerosing cholangitis
UC
123
What can provide symptomatic improvement in diverticular disease
diets supplemented with fiber
124
Pediatric infectious diarrhea which may result in severe dehydration and metabolic acidosis is commonly caused by what
enteric viruses
125
What is the standard therapy for individuals carrying APC mutations
prophylactic colectomy
126
most frequent hernia in U.S.
inguinal
127
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
128
reciprocal translocation, t(11,22)
| EWS and WT1 fusion gene
desmoplastic small round cell tumor
129
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
130
Shigella infections most prominent in what location of the body
left colon
131
Twisting of a loop of bowel about its mesenteric point of attachment
volvulus
132
Which IBD: PANETH CELL METAPLASIA in Left colon where paneth cells are normally absent
Crohn
133
What is one of the most feared long term complication of UC and Crohn
development of neoplasia
134
most common pattern of ischemic bowel disease
segmental or patchy but can be continuous
135
- PAS-positive
| - Rod-shaped bacilli
Whipple disease
136
What are the 4 phases of nutrient absorption
- intraluminal digestion
- Terminal digestion
- transepithelial transport
- lymphatic transport of absorbed lipids
137
age for celiac disease
gender
30 to 60
in adults, twice as frequent in women
138
poor prognostic factors for ischemic bowel disease
- right side
- COPD
- persistence of symptoms for more than 2 weeks
139
most common neoplastic polyp
adenoma . . which has potential to progress to cancer
140
What are the two most important prognostic factors in colonic adenocarcinoma
- depth of invasion
| - presence of lymph node metastases
141
Intussusception is rare in older children and adults and is generally caused by what?
intraluminal mass or tumor that serves as the leading edge
142
semi distinguishing symptoms of those with diverticular disease
- sensation of never being able to completely empty the rectum
- alternating constipation and diarrhea
143
periumbilical pain that ultimately localizes to right lower quadrant
appendicitis
144
Rare autosomal dominant syndrome presents with multiple GI hamartomatous polyps and mucocutaneous hyperpigmentation
Peutz-Jeghers syndrome
145
This occurs when dysplastic epithelial cells breach the basement membrane to invade the lamina propria or muscularis mucosa
intramucosal carcinoma
146
Biopsy of what segments is generally diagnostic of celiac disease
second portion of duodenum and proximal jejunum
147
multiple, separate, sharply delineated areas of disease, resulting in SKIP LESIONS
Crohn
148
surveilance of adenomas in the US
all adults by age 50
149
therapy for autoimmune enteropathy
- cyclosporine
| - in rare cases, hematopoietic stem cell transplantation
150
Despite the severe diarrhea, Vibrio (cholera) organismas are what?
noninvasive and remain within the intestinal lumen
151
Where are the fibrosing strictures of Crohn found
terminal ileum
152
MYH-associated polyposis compared to FAP
- polyp development at later ages
- fewer than 100 adenomas
- delayed appearance of colon cancer, often at 50 or older
153
extraintestinal complications of campylobacter
- erythema nodosum
| - GUILLAIN-BARRE syndrome, a flaccid paralysis caused by immunologically mediated inflammation of peripheral nerves
154
Colorectal adenoma are characterized by the presence of what
epithelial dysplasia
155
biggest complication of shigella
Hemolytic uremic syndrome (HUS)
156
characterized by chronic, relapsing abdominal pain, bloating, and changes in bowel habits
Irritable bowel syndrome (IBS)
157
which type of juvenile polyps are usually solitary and may also be referred to as retention polyps
sporadic
158
Diverticula location in Western populations
sigmoid
159
what polyp: intussusception, intestinal obstruction, or polyp prolapse through the anal sphincter may occur
juvenile polyps
160
many colon cancers withough APC mutations harbor what?
B-catenin mutations
161
most pancreatic cancers are what
adenocarcinomas
162
most common age for ischemic disease of the colon
gender
older than 70
slightly more in women
163
what type of people are often severely affected by Giardia
- immunosuppressed
- agammaglobulinemic
- malnourished
164
What pharmocologic agents have protective effects against colorectal cancer
aspirin or other NSAIDs
165
pediatric celiac disease age and gender
6-24 months
males=females
166
- intraepithelial CD8+ lymphocytes
- crypt hyperplasia
- Villous atrophy
Celiac disease
167
After an incubation period of up to 1 week, Shigella causes self-limited disease characterized by what?
1 week of diarrhea, fever, and abdominal pain
168
Rare autosomal recessive disease characterized by an inability to secrete triglyceride-rich lipoproteins
Abetalipoproteinemia
169
IBD: Marker Lymphoid reaction, fibrosis, and serositis
Crohn
170
age and gender of collagenous colitis
middle aged and older women
171
Pure squamous cell carcinoma of the anal canal is frequently associated with what infection?
This can also cause what precursor lesion?
HPV
Condyloma acuminatum
172
peritonitis caused by leakage of bile or pancreatic enzymes
sterile peritonitis
173
ethnicity for IBD
- most common in caucasians in US
| - 3-5 times more in Ashkenazi Jews in Europe
174
Psuedomembranous colitis
C. diff
175
What part of GI tract is most often involved in obstruction
small intestine
176
Painful, bloody, small-volume diarrhea
dysentery
177
What patients are particularly susceptible to Salmonella osteomyelitis
Sickle cell patients
178
- common shaped- flagellated gram-negative
- incubation period of up to 8 days
- watery-diarrhea, either acute or following an influenza-like prodrome
campylobacter
179
progression of colonic diverticular disease
will resolve spontaneously
180
in transmural infarction, what does the infarcted bowel look like initially?
Later?
intensely congested and dusky to purple-red
blood tinged mucus or frank blood accumulated in lumen and wall becomes edematous, thickened, and rubbery
181
Initial attack of UC
may be severe enough to constitute a medical or surgical emergency
182
- APC mutation
- medulloblastoma
- glioblastoma
Turcot syndrome
183
IBD: recurrence after surgery common
Crohn
184
When does surveillance for neoplasia usually start with IBD
8 years after diagnosis
185
two phases of intestinal response to ischemia
- hypoxic injury (initial)
| - reperfusion injury (second)
186
Polyp: ARBORIZATION and presence of SMOOTH muscle intermixed with lamina propria
Peutz-Jeghers
187
What may develop in colonic Crohn
iron deficiency anemia
188
What are the principal cause of traveler's diarrhea and spread via contaminated food and water
ETEC
189
another name for Hereditary non-polyposis colorectal cancer (HNPCC)
Lynch syndrome
190
Creeping fat
Crohn
191
Tell me about the risk of neoplasia after a colectomy in a FAP patient
- risk at other sites
| - Adenomas may develop in GI tract, particularly adjacent to the ampulla of Vater and in the stomach
192
prognosis for tumors of peritoneal cavity
Grave
193
Location of Indeterminate colitis
NO small bowel
- continuous colonic disease
- patchy histology and Crohn features
194
normal true diverticulum of cecum prone to acute and chronic inflammation
appendix
195
2 Hamartomatous polyp syndromes
- juvenile polyps
| - Peutz-Jeghers syndrome
196
in Graft-versus-Host disease, what part of GI is usually involved
small bowel and colon
197
individuals with celiac have higher than normal rate of what?
malignancy
198
what IBD; strictures
Crohn
199
what is the goal of surveillance biopsies
to identify dysplastic epithelium which is a precursor to colitis associated carcinoma
200
age for Peutz-Jeghers syndrome
10-15 (median of 11)
201
hallmark of malabsorption
Steatorrhea
202
IBD: NO GRANULOMAS
UC
203
Acanthocytic red cell (burr cell)
Abetalipoproteinemia
204
What is the most common epigenetic event that may enhance progression along either pathway in the pathogeneis of colorectal adenocarcinoma
methylation induced gene silencing
205
arthritis, urethritis, and conjunctivitis in HLA-B27-positive men between 20 and 40
Shigella
206
archaic term given to an anal canal tumor that the entirety displays basaloid pattern
cloacogenic carcinoma
207
APC and Wnt pathway
FAP
208
diarrhea in salmonella
- clinically indistinguishable from other enteric pathogens
| - range from loose stools to cholera-like profuse diarrhea to dysentery
209
intraepithelial neoplasms that range from small, often pedunculated polyps to large sessile lesions
adenomas
210
ECM1, which inhibits matrix metalloproteinase 9
UC, but NOT Crohn
211
Clinical manifestations of intestinal obstruction
- abdominal pain and distention
- vomiting
- constipation
212
chronic bowel ischemia is accompanied by what
fibrous scarring of the lamina propria
213
alcohol-soluble fraction of gluten that contains most of the disease producing components
Gliadin
214
region most often affected by volvulus
- large redundant loops of sigmoid colon
| - then cecum, small bowel, stomach or rarely transverse colon
215
Spontaneous bacterial peritonitis is seen most often in what patients
- cirrhosis
| - less frequent in children with nephrotic syndrome
216
What are things that may lead to development of adhesion between bowel segmens
- surgical procedures
- infection
- peritoneal inflammation such as endometriosis
217
surveilance for adenomas in those with family history of colorectal adenocarcinoma
at least 10 years before the youngest age at which a relative was diagnosed
218
superior hemorrhoidal plexus within distal rectum
internal hemorrhoids
219
FOX3P mutation
IPEX . . severe familial form of autoimmune enteropathy
| -immune dysregulation, polyendocrinopathy, enteropathy, and X-linkage
220
IBD with fissures and ulcers
Crohn
221
this microscopic colitis shows strong association with celiac disease and autoimmune diseases including Graves, RA, and gastritis
lymphocytic colitis
222
Geography for IBD
most common in North America, northern Europe, and Australia
223
chronic condition resulting from inappropriate mucosal immune activation
Inflammatory Bowel Disease (IBD)
224
Serrated surface architecture is the morphologic hallmark of these . . serration restricted to upper third or less of the crypt
hyperplastic polyp
225
describe the KRAS mutation and its relationship to size of adenocarcinoma
- mutation in less than 10% of adenomas less than 1 cm
| - but in 50% of adenomas greater than 1 cm
226
what ethnic groups get the acquired form of lactase deficiency which is due to down-regulation of lactase gene expression
- Native Americans
- African Americans
- Chinese
227
histologic criteria for sessile serrated adenoma
serrated architecture throughout the full length of the glands
228
What IBD: microscopically, clusters of neutrophils within a crypt referred to as CRYPT ABSCESSES
Crohn
-similar to UC actually but with this it will be diffuse and will only involve mucosa and submucosa
229
Adonocarcinomas of proximal colon grow how?
Obstruction?
polypoid, exophytic masses
No
230
This disease can lead to intestinal obstruction but commonly results in formation of pancreatic intraductal concretions . . .leads to exocrine pancreatic insufficiency in 80%
Cystic fibrosis
231
watershed areas most vulnerable to ischemia by generalized hypoperfusion
- splenic flexure (inferior and superior mesenteric)
| - less commonly sigmoid colon and rectum (inferior mesenteric, pudendal, and iliac arteries)
232
Polyp: forms as part of the solitary rectal ulcer syndrome (SRUS): triad of rectal bleeding, mucus discharge, and an inflammatory lesion of the anterior rectal wall
Inflammatory polyp
233
Hypermethylation and pancreatic cancer
-CDKN2A leads to silencing and loss of function
234
in HNPCC where do majority of mutations due to impaired DNA repair occur
microsatellites
235
- APC mutation
- Osteomas
- thyroid and desmoid tumors
- skin cysts
Gardner syndrome
236
Linear mucosal ulcer which impart a cobbliestone appearance
Crohn
237
most common parasitic pathogen in humans
Giardia lamblia
238
describe the classic adenoma-carcinoma sequence . . . mutation of APC
- no degredation of B-catenin so it accumulates and goes into nucleus
- activates MYC and cyclin D1
- these promote proliferation
239
Hyperplastic polyps are significant because they need to be differentiated from what, which are histologically similar and DO have malignant potential
sessile serrated adenoma
240
Microscopic colitis encompasses what two entities
- collagenous colitis
| - lymphocytic colitis
241
age of colon cancer in HNPCC compared to sporadic colon cancers
-younger ages
242
IBD: 20% with right lower quadrant pain, fever, and bloody diarrhea that may mimic acute appendicitis
Crohn
243
risk of dysplasia in IBD is related to what factors
- duration of disease
- extend of disease
- Nature of the inflammatory response
244
Describe the steps of how gliadin causes celiac disease
- induce epithelial cells to express IL-15
- this activates CD8+ cells which express NKG2D
- NKG2D is a receptor for MIC-A
- Enterocytes that have been induced to express MIC-A, in response to stress, are attacked by the NKG2D CD8+ cells
- this enhances passage of gliadin into lamina propria where is can get deaminated by tissue transglutaminase
245
most common malignancy of the GI tract and major cause of morbidity and mortality
adenocarcinoma
246
Vast majority of juvenile polyps occur in what age
children younger than 5
247
what responses are important for clearance of Giardia
secretory IgA and mucosal IL-6
248
ischemic disease and highly atypical "radiation fibroblasts" within the stroma
radiation enterocolitis
249
disorder prevalent in areas and populations with poor sanitation and hygiene (sub-saharan Africa, Gambia, Northern Australia, South american and Asia, Brazil, Guatemala, India, Pakistan)
Environmental enteropathy
250
those with environmental enteropathy often suffer from what/
- malabsorption and malnutrition
- stunted growth
- defective intestinal mucosal immune functions
251
time frame for death in cholera infection
within first 24 hours
252
2 main compenents of pathogenesis of IBD
- mucosal immune responses
| - Epithelial defects
253
IBD: broad based ulcers
UC
254
The underlying cause of iron deficiency anemia in an older man or postmenopausal woman is what until proven otherwise
GI cancer
255
under 50, right sided colon cancer
- MLH1 and MSH2
| - sessile serrated adenoma
256
Colonic diverticula are rare younger than what age
30
257
lower third anal canal epithelium
stratified squamous epithelium
258
acquired lactase deficiency can develop following what
enteric viral or bacterial infections
259
Do a majority of adenomas progress to become adenocarcinomas
No
260
Smoking and UC
- initial onset has occurred shortly after cessation
| - smoking can partially RELIEVE symptoms
261
Rose spots: erythematous maculopapular lesions on chest and abdomen
Salmonella typhi (typhoid fever)
262
Association of celiac disease and neurologic disorders
- Ataxia
- Autism
- depression
- epilepsy
- Down syndrome
- Turner syndrome
263
What is positive in more than 90% of affected individuals during the febrile phase of Typhoid fever?
What can prevent further disease progression?
Blood cultures
Antibiotic treatment
264
Epidemiology for Whipple
caucasian men, particularly farmers
265
What has revolutionized treatment of Crohn disease
Anti-TNF antibodies
266
hyperplastic polyp and malignancy
WITHOUT malignant potential
267
X-linked disorder characterized by severe persistent diarrhea . . often in young children
Autoimmune enteropathy
268
what type of places is Cholera common
- poor sanitation
- inadequate public health measures
- natural disasters
269
30-50% of patients with juvenile polyposis develop what?
colonic adenocarcinoma by age 45
270
Most common bacterial enteric pathogen in developed countries and an important cause of traveler's diarrhea
Campylobacter Jejuni
271
segment of intestine, constricted by a wave of peristalsis, telescopes into immediately distal segement
intussusception
272
location of HNPCC cancers
right colon
273
What is the most common acquired GI emergency in neonates, particularly those who are premature or of low birth weight
when does it present
Necrotizing enterocolitis (NEC)
when oral feeding is initialed
274
what are the two genetic pathways in the pathogenesis of colorectal adenocarcinoma
- APC/B-catenin pathway
| - microsatellite instability pathway
275
diarrhea and defects in physical and cognitive development . . . childhood deaths worldwide
environmental enteropathy
276
age for colorectal cancer
Peaks at 60 to 70
277
Autoantibodies to what are common in autoimmune enteropathy
enterocytes and goblet cells
278
underlying mechanism of reperfusion injury include what
- leakage of gut lumen bacterial products (lipopolysaccharide) into systemic circulation
- free radical production
- neutrophil infiltration
- release of inflammatory mediators
279
The link of angiodysplasia and what, suggests possibility of a developmental component
Meckel diverticulum
280
HNFA
UC, but NOT Crohn
-strongly associted with maturity onset diabetes of the young (MODY)
281
What is the most important characteristic of an adenoma that correlates to risk of malignancy?
give specifics
Size
cancer extremely rare in adenomas less than 1 cm
40% of lesions larger than 4 cm contain foci of cancer
282
Cholera primarily transmitted how
contaminated drinking water
283
likely to cause large outbreaks of bloody diarrhea, Hemolytic uremic syndrome (HUS), and ischemic colitis
0157:H7 EHEC
284
What are the major variables in ischemic bowel disease
- severity of vascular compromise
- time frame which it develops
- vessels affects
285
excessive fecal fat and bulky, frothy, greasy, yellow or clay colored stools
steatorrhea
286
gender for acute appendicitis
males slightly more than females
287
most common soft tissue tumor of peritoneum
describe it
desmoplastic small round cell tumor
aggressive
occurs in children and young adults
resembles Ewing sarcoma
288
most infections of Campylobacter are from what?
ingestion of improperly cooked chicken. outbreaks also caused by unpasteurized mild or contaminated water
289
gram-negative UNencapsulated, nonmotile, facultative anaerobe
Shigella
290
treatment needed for cholera
fluid replacement
291
Giardia infection is usually documented by what
immunofluorescent detection of cysts in stool samples
292
ATG16L1 and IRGM;
what type of pathways
Crohn
autophagy
293
most common agents that infect the peritoneum following perforation
- E. coli
- Strep
- Staph
- enterococci
- C. perfringens
294
These adenocarcinomas are most often called to clinical attention by appearance of fatique and weakness due to iron deficiency anemia
cecal and right sided colon cancers
295
IBD that may involve any area of GI tract and is transmural
Crohn
296
underlying causes of environmental enteropathy
unknown
297
Diverticula in Asia and Africa affect what part of colon
right
298
transmission of Giardia
fecally contaminated water or food
299
Variants of FAP from other APC mutations
- Gardner syndrome
| - Turcot syndrome
300
serrated polyps with KRAS mutations are frequently present in what
MUTYH-associated polyposis
301
Extent of disease and Neoplasia in IBD
pancolitis has greater risk than those with only left-sided disease
302
Acquired pseudodiverticular outpouchings of the colonic mucosa and submucosa
Diverticular disease
303
depth of mural infarction
mucosa and submucosa
304
Most common affected of Shigella
- children in daycare
- migrant workers
- travelers to developing countries
- those in nursing homes
305
describe shape and gram of Salmonella
gram-negative bacillia
306
what two aspects of intestinal vascular anatomy contribute to the distribution of ischemic damage
- watershed zones
| - intestinal capillaries
307
characterized by malformed submucosal and mucosal blood vessels
Angiodysplasia
308
age and gender for adenomas
small male predominance
| -30% of adults by age 60
309
asbestos
mesotheliomas
310
malabsorptive diarrhea due to impaired lymphatic transport
Whipple disease
311
UC of entire colon
Pancolitis
312
Except for pregnant women, hemorrhoids are rarely encounter in persons younger than what age?
30
313
extraintestinal complications include encephalopathy, meningitis, seizures, endocarditis, myocarditis, pneumonia, and cholecytisis
Typhoid fever
314
Extraintestinal manifestations of Crohn
similar to UC
- Uveitis
- Migratory polyarthritis
- sacroilitis
- ankylosing spondylitis
- erythema nodosum
- clubbing of fingertips
315
mutations of base-excision repair gene MYH (or MUTYH)?
referred to as what
polyposis patients without APC loss
MYH-associated polyposis
316
Pathogenesis of IBS is poorly defined but there in clear interplay between what?
psychologic stressors and diet
317
most common celiac associated cancer
enteropathy-associated T-cell lymphoma
also small intestinal adenocarcinoma
318
If a celiac patient has IgA deficiency, what serological evidence will help diagnose
IgG against anti-tissue transglutaminase
319
depth of mucosal infarction
no deeper than muscularis mucosa
320
Location and age for angiodysplasia
- most often cecum or right colon
| - after the sixth decade of life
321
What is a key negative regulator of B-catenin, a component of the Wnt signaling pathway
APC
322
polyps of peutz-Jeghers most common where
small intestine
323
When should surgical intervention be considered in ischemic bowel disease
if peristaltic sounds diminish or disappear . . paralytic ileus
-guarding or rebound tenderness
324
-dense accumulation of distended, foamy macrophages in the small intestinal lamina propria
Whipple disease
325
2 forms of IBD
ulcerative colitis (UC) and Crohn disease
326
Serology found Crohn but not UC
antibodies to Saccharomyces cerevisiae
327
Acquired hernias typically occur anteriorly via what?
- inguinal and femoral canals
- umbilicus
- sites of surgical scars
328
- occurs with lactase deficiency
- due to excessive osmotic forces exerted by unabsorbed luminal solutes
- diarrhea fluid is more than 50 mOsm more concentrated than plasma and ABATES (gets better) during fasting
Osmotic
329
which type of lactase deficiency: Abdominal fullnes, diarrhea, and flatulence
acquired
330
follows generalized failure of nutrient absorption and is associated with steatorrhea and is RELIEVED by fasting
malabsorptive diarrhea
331
Hemorrhoids develop secondary to what?
persistantly elevated venous pressure within the hemorrhoidal plexus
332
ischemic bowel disease may occur from endothelial damage and small vessel occlusion after what infections
- CMV
| - E. coli 0157:H7
333
serology found in 75% of UC but only 11% of Crohn
peri-nuclear anti-neutrophil cytoplasm antibodies
334
hamartomatous polyps that can cause intussusception and is occasionally fatal. . . Also has MARKEDLY increased risk of several malignancies
Peutz-Jeghers syndrome
335
Most common tumor of appendix
well differentiated neuroendocrine tumor (carcinoid)
336
age for IBD
present in teens and early 20s
337
Chronic malabsorption can be accompanied by what?
- weight loss
- anorexia
- abdominal distention
- borborygmi
- muscle wasting
338
What is the most common syndromic form of colon cancer
Lynch syndrome/HNPCC
339
Hypertrophy of the circular layer of muscularis propria in affected bowel is common
colonic diverticula
340
symptoms of cholera infectious enterocholitis
- dehydration
- hypotension
- muscular cramping
- anuria
- shock
- loss of consciousness
- DEATH
341
middle third anal canal epithelium
transitional
342
inheritance for congenital lactase deficiency
autosomal recessive
343
location and size for hyperplastic polyp
Left colon and less than 5 mm
344
- pear shape
| - 2 equally sized nuclei
Giardia
345
transmission of salmonella
ingestion of contaminated food, particularly raw or undercook meat, poultry, eggs, and milk
346
time frame for coagulative necrosis to occur in muscularis propria in transmural infarction
1 to 4 days
347
also referred to as antibiotic-associated colitis or antibiotic associated diarrhea
Psuedomembranous colitis
348
Which type of juvenile polyp is dysplasia extremely rare?
Common?
sporadic
juvenile polyposis syndrome
349
NOD2
Crohn
350
Which phase of intesinal response to ischemia? . . some damage but epithelial cells lining intestine are relatively resistant to transient hypoxia
hypoxic injury
351
These polyps are associated with syndromes that often have increased cancer risk and are thus considered to be pre-malignant neoplastic lesions, much like adenoma
hamartomatous polyps
352
Dark blue to brown macules on the lips, nostrils, BUCCAL MUCOSA, palmar surfaces of hands, genitalia, and perianal region
Peutz-Jeghers syndrome
353
cutaneous granulomas that form nodules in Crohn disease are called what
metastatic Crohn disease
| -misnomer because it is NOT cancer
354
comma-shaped gram-negative bacteria endemic in Ganges Valley of India and Bangladesh
Cholera
355
flagellated protozoans that cause decreased expression of brush border enzymes, including lactase
Giardia
356
Polyp: benign epithelial proliferations that are typically discovered in the 6th and 7th decades of life
hyperplastic polyp
357
STK11
Peutz-Jeghers syndrome
358
3 disease that have defects in intraluminal digestion
- Chronic pancreatitis
| - Cystic fibrosis
359
Most, if not all, polyps begin as small elevations of the mucosa referred to as what?
sessile
360
age and gender for IBS
females 20-40
361
MSH2 or MLH1
HNPCC
362
due to inflammatory disease and is characterized by purulent, bloody stools that CONTINUE during fasting
exudative diarrhea
363
Relapsing disorder characterized by attacks of bloody diarrhea with stringy mucoid material, lower abdominal pain, and cramps that are temporarily relieved by defacation
UC
364
primary malignant tumors arising from peritoneal lining
mesotheliomas
365
Oil red-O stain . . especially after a meal
Abetalipoproteinemia
366
complications of a hernia
- obstruction
- incarceration
- strangulation
367
dietary factors most closely associated with increased rates of colorectal cancer
- low intake of unabsorbable vegetable fiber
| - high intake of refine carbohydrates
