Pathology of Bowels Flashcards
Peptic Ulcer Disease presents in which two regions? What is the MCC?
Early duodenum or gastric antrum. H. Pylori is MCC. Gastric can also be due to NSAIDs. Duodenal can be due to Zollinger-Ellison Gastrinoma (esp if jejunal ulcers exist).
Ulcer with irregularly raised margins in the stomach must have what done?
Biopsy. Duodenal ulcers do not require biopsy.
3 Serious Complications of an Ulcer.
Hemorrhage of Left Gastric artery at Lesser Curvature of Stomach. Or Gastroduodenal artery posterior duodenum.
Obstruction on the duodenal side of the pyloric sphincter from edema.
Perforation, with acid leaking into the peritoneum and causing Peritonitis - requires immediate surgery. Pt have early satiety, nausea, vomiting. Pt will have involuntary guarding and rebound tenderness. Leads to ileus.
PPIs were invented in the 80’s and have lead to a significant decrease in what?
Decreased ulcer complications and decreased need for gastrectomy.
What is the most common malabsorption syndrome?
Celiac disease from an autoimmune rxn to gliadin found in wheat gluten.
IgA and anti-endomysial antibodies are associated with which inflammatory autoimmune disease
Celiac disease with destruction of villi leading to malabsorption.
How does a Celiac pt present?
Fatigue, wt loss, abdominal pain, steatorrhea. Can lead to anemia and loss of calcium can lead to osteopenia.
What is used to detect fat malabsorption and what is used to detect carb malabsorption?
Stool Sudan Test. D-xylose test for carb malabsorption.
How is Celiac aka Sprue officially diagnosed?
Biopsy will show blunting of villi and deepening of crypts. Serology can also be used to detect IgA tissue transglutaminase antibodies.
What are the HLA types more often found in Celiac pts
HLA-DQ2 and HLA-DQ8.
What is the treatment for Celiac and how long does it take?
Stop eating gluten. Should be fine in weeks.
What is Dermatitis Herpetiformis?
Itchy vesicular red rash which occurs in Celiac disease.
Celiac pts are more likely to develop which type of cancer?
T cell lymphomas.
Tropical Sprue and its treatment.
Occurs in tropical countries with megaloblastic anemia. Treatment is ABX.
Whipple Disease
Foamy macrophages with Tropheryma whippleii. Cutest name ever?
Malabsorption actually presents late in Whipple. First they get arthralgias and possible endocarditis. Late stage neurological dementia.
Lactose intolerance presents with…
Crampy abdominal pain and bloating and osmotic diarrhea.
Lactase breath test from the hydrogen created by bacteria fermenting lactose.
Pancreatic deficiency. What disease is it most commonly associated with?
Lack of proteases, amylases, etc leads to malabsorption and weight loss - diarrhea and steatorrhea. Same as in Celiac.
Decreased bicarb from pancreas causes B12 deficiency.
Insulin-dependent Diabetes.
Despite Cystic Fibrosis being a pulmonary disease, what organ is the next most importantly involved?
Pancreatic insufficiency from the thick gunky mucus clogging up the ducts.
Vitamin A, Vitamin D, Vitamin E, Vitamin K deficiencies
Night vision. Osteopenia, Rickets. Anemia and Neuropathy from Vitamin E. Coagulopathy.
What are the 2 Inflammatory Bowel Diseases? Which part of the bowel is always involved in each?
Crohn always begins its inflammation and attack at the terminal ileum and can run the whole way through. UC almost always involves rectum and is principally in the colon.
What type of lesions are seen in Crohn?
Crohn has discontinuous patchy skip lesions of bumpy cobblestone mucosa but transmural - through all 4 layers of the wall (lumen, mucosa, submucosa, muscularis, serosa aka adventitia). Also has linear ulcers and fissures. It also has creeping fat that starts taking over the intestine.
Which IBD has frankly bloody diarrhea almost always? Which one has occasional bloody diarrhea?
Ulcerative Colitis has frankly bloody diarrhea.
Crohn is more associated with malabsorption…of what?
B12 is most common (terminal ileum) along with fat vitamins A, D, E, K.
Why do Crohn disease pts develop kidney stones?
The poor absorption of Vitamin D disrupts the Calcium metabolism leading to kidney stones.
What do the lesions in Ulcerative Colitis look like?
UC only affects mucosa and submucosa - so why is it the one that’s so bloody? Weird. Diffuse ulcers with friable tissue (easily tears and sloughs off). UC also has muck of crypt abscesses (WBCs).
What a huge distinction between Crohn and UC immunlogically?
Crohn has a granulomatous response and associated with a Th1 response. UC has no granulomas and is mediated by Th2 cells.
2 late stage complications of UC.
Toxic Megacolon is a huge dilation of the bowel with loss of haustra. End stage is called Fulminant Ulcerative Colitis in which pt is having over 10 bowel movements a day and is at serious risk of perforation –> sepsis.
What is the String sign?
Both Crohn and UC have areas of wall thickening but Crohn narrows far more leading to the String Sign when bowel is seen on contrast.
Even though Crohn is transmural, it doesn’t lead very often to perforations and traumatic events but instead infamously forms what?
Fistulas or communicating tracts to skin, vagina, other bowel. Never fun to have feces leaking from your vagina but the most serious one is Enterovesicular fistulas of the bladder leading to recurrent polymicrobial UTIs. Crohn forms abscesses and noncaseating granulomas.
Despite UC involving rectum, Crohn disease has perianal disease of skin tags or chronic itching or even severe perianal abscesses in the case of 1/3rd of pts.
Both UC and Crohn disease present with abdominal pain and diarrhea and tenesmus. What two serious complications do they share?
Bowel obstruction (Crohn can do SBO and LBO whereas UC only obstructs in the colon).
Both have increased risk of Colorectal cancer from high turnover from inflammation.
What are important Cxs often found in IBD?
Inflammatory polyarthritis (esp shoulder, elbow, knees). Ankylosing spondylitis (Vertebral immobility with eventual kyphosis). Uveitis with red eyes around the iris - pt has photophobia and vision loss. Erythema nodosum are painful nodules on the shins. Pyoderma gangrenosum is hideous pustule on legs and back that turns into an ulcer but isn’t life threatening.
Crohn pts are more likely to have bowel obstruction while UC pts are more likely to have Primary Sclerosing Cholangitis (poor little gall bladder).
DVT and Thromboembolisms are more common in IBD pts. Ugh, what don’t these people have to deal with?!
Kidney stones are specific to Crohn because calcium disruption at terminal ileum.
Describe Primary Sclerosing Cholangitits.
Most often found in UC, it is an inflammatory biliary obstruction which eventually results in shutdown of the liver if left untreated.
Biliary tree extends throughout the liver.
