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Gastrointestinal - From Oral to Anal! > Pathology of Bowels > Flashcards

Pathology of Bowels Flashcards

1
Q

Peptic Ulcer Disease presents in which two regions? What is the MCC?

A

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).

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2
Q

Ulcer with irregularly raised margins in the stomach must have what done?

A

Biopsy. Duodenal ulcers do not require biopsy.

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3
Q

3 Serious Complications of an Ulcer.

A

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.

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4
Q

PPIs were invented in the 80’s and have lead to a significant decrease in what?

A

Decreased ulcer complications and decreased need for gastrectomy.

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5
Q

What is the most common malabsorption syndrome?

A

Celiac disease from an autoimmune rxn to gliadin found in wheat gluten.

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6
Q

IgA and anti-endomysial antibodies are associated with which inflammatory autoimmune disease

A

Celiac disease with destruction of villi leading to malabsorption.

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7
Q

How does a Celiac pt present?

A

Fatigue, wt loss, abdominal pain, steatorrhea. Can lead to anemia and loss of calcium can lead to osteopenia.

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8
Q

What is used to detect fat malabsorption and what is used to detect carb malabsorption?

A

Stool Sudan Test. D-xylose test for carb malabsorption.

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9
Q

How is Celiac aka Sprue officially diagnosed?

A

Biopsy will show blunting of villi and deepening of crypts. Serology can also be used to detect IgA tissue transglutaminase antibodies.

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10
Q

What are the HLA types more often found in Celiac pts

A

HLA-DQ2 and HLA-DQ8.

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11
Q

What is the treatment for Celiac and how long does it take?

A

Stop eating gluten. Should be fine in weeks.

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12
Q

What is Dermatitis Herpetiformis?

A

Itchy vesicular red rash which occurs in Celiac disease.

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13
Q

Celiac pts are more likely to develop which type of cancer?

A

T cell lymphomas.

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14
Q

Tropical Sprue and its treatment.

A

Occurs in tropical countries with megaloblastic anemia. Treatment is ABX.

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15
Q

Whipple Disease

A

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.

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16
Q

Lactose intolerance presents with…

A

Crampy abdominal pain and bloating and osmotic diarrhea.

Lactase breath test from the hydrogen created by bacteria fermenting lactose.

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17
Q

Pancreatic deficiency. What disease is it most commonly associated with?

A

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.

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18
Q

Despite Cystic Fibrosis being a pulmonary disease, what organ is the next most importantly involved?

A

Pancreatic insufficiency from the thick gunky mucus clogging up the ducts.

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19
Q

Vitamin A, Vitamin D, Vitamin E, Vitamin K deficiencies

A

Night vision. Osteopenia, Rickets. Anemia and Neuropathy from Vitamin E. Coagulopathy.

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20
Q

What are the 2 Inflammatory Bowel Diseases? Which part of the bowel is always involved in each?

A

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.

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21
Q

What type of lesions are seen in Crohn?

A

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.

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22
Q

Which IBD has frankly bloody diarrhea almost always? Which one has occasional bloody diarrhea?

A

Ulcerative Colitis has frankly bloody diarrhea.

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23
Q

Crohn is more associated with malabsorption…of what?

A

B12 is most common (terminal ileum) along with fat vitamins A, D, E, K.

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24
Q

Why do Crohn disease pts develop kidney stones?

A

The poor absorption of Vitamin D disrupts the Calcium metabolism leading to kidney stones.

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25
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).
26
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.
27
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.
28
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.
29
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.
30
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.
31
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.
32
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.
33
What is the treatment for IBD? What is the second line for Crohn disease? If nothing else works, what do we resort to?
5-ASA drugs (Aspirin like drugs involved in COX inhibition). Sulfasalazine, Mesalamine. 2nd line is ABX of Ciprofloxacin/Metronidazole. Steroids are also used as enemas to reduce systemic involvement. Final resort is Immunosuppressants like Azathioprine or 6-MP, Infliximab. Before surgery is considered.
34
Vitamin B12 deficiency has what associations?
Megaloblastic anemia with hypersegmented neutrophils. Neuropathy. Elevated methylmalonic acid and elevated homocysteine.
35
B12 is a coenzyme for what and does what in this process?
Formation of methionine from homocysteine as a coenzyme for methyltransferase and for methylmalonic CoA mutase.
36
Mild elevation of CRP (which normally should be below 10) indicates what?
Mild to moderate inflammatory disease processes.
37
First line for IBD are which 5-amino salicylates?
Mesalamine or Sulfasalazine. Steroids used for more severe cases.
38
Irritable Bowel Syndrome is characterized by what traits?
Alternating diarrhea and constipation. Worsened by stress. Abdominal pain somewhat relieved by defecation. Normal histology upon Bx. cholestasis, such as fatigue, pruritus, and right upper quadrant discomfort, with an elevated alkaline phosphatase level and positive antimitochondrial antibodies. 3 days of recurrent pain/discomfort over a period of 3 months for official diagnosis.
39
Pseudomembranous Colitis has what associations?
Leukocytosis.
40
Primary biliary cholangitis is more common in middle-aged women in their 40's and presents with features of...
Cholestasis, such as fatigue, pruritus, and right upper quadrant discomfort, with an elevated alkaline phosphatase level and positive antimitochondrial antibodies.
41
Primary Sclerosing Cholangitis shows jaundice and increased what? Which antibodies is it associated with?
Alkaline Phosphatase. Inflammation and progressive obliterative fibrosis of intra- and extrahepatic bile ducts. This extraintestinal manifestation in turn carries an increased risk of cholangiocarcinoma. PSC in the context of UC is associated with positive perinuclear antineutrophil cytoplasmic (p-ANCA) autoantibodies.
42
Decreased ceruloplasmin is associated with which disease?
Copper deficiency of Wilson disease.
43
Elevated Carbohydrate Antigen 19-9 is associated with which cancers?
Elevated carbohydrate antigen 19–9 would be found in gastrointestinal cancers, including cholangiocarcinoma, pancreatic cancer, and colon cancer.
44
Histologic finding of cells with loss of mucin and hyperchromatic nuclei suggests what diagnosis?
Colorectal cancer.
45
70% of pts with PSC also have Ulcerative Colitis. What percent of UC pts will develop PSC though?
Only 4%. PSC increases risk for cholangiocarcinoma. Onion skin periportal fibrosis and eventual stenosis and eventual liver failure.
46
HLA-B27 acronym is PAIR - standing for which diseases?
Psoriasis, Ankylosing Spondylitis, IBD, Reactive Arthritis.
47
DM type 1 is associated with which HLA types? What about SLE and Rheumatoid Arthritis?
HLA-DR3 and HLA-DR4 for DM1. Lupus is associated with HLA-DR3. RA is HLA-DR4.
48
HLA-DR2 is associated with which diseases?
Multiple Sclerosis, Hay Fever, Goodpasture Syndrome,, SLE.
49
SLE and DM type one are associated with which HLA subtypes?
SLE is HLA-DR2 and HLA-DR3. DM1 is HLA-DR3 and HLA-DR4.
50
Unpasteurized milk, consumption of poultry and MCC of bloody diarrhea in the US.
Campylobacter jejuni causes bloody enterocolitis with fever and abdominal pain.
51
Dysentery (bloody mucus filled stools) causing enterocolitis is normally from what source? How is it detected?
Amebic Enterocolitis from Entamoeba Histolytica. Stool antigen or liver abscess aspirate.
52
Infection with helminths causes what type of cell to increase?
Eosinophilia.
53
Shigellosis. What is a strangely prominent feature?
Rapid onset with bloody diarrhea (within 48 hours of meeting with pathogen) and course is normally 5 days - whereas E. histolytica takes days to onset and lasts for ages. Tenesmus is a prominent feature.
54
Envelope shaped crystals in the kidney of Crohn pts are what type of stone?
Calcium oxalate stones.
55
What type of cancer are Crohn pts at risk for? Which people are more prone to this?
Colon adenocarcinoma. Jews.
56
Acute diverticulitis presents... What is the treatment?
Constipation, Lower left quadrant pain indicative of the sigmoid colon, abdominal tenderness with lump, involuntary guarding, painless rectal bleeding. Increased luminal pressure can lead to microperforation. Ciprofloxacin and MTZ. Colonoscopy required to rule out malignancy. Xray can be used to rule out perforation.
57
Azathioprine, an antimetabolite prodrug, which is converted to 6-mercaptopurine.
Inhibits purine synthesis and decreases proliferation of WBCs, leading to increased susceptibility to infection.
58
Orange discoloration of body fluids can be caused by which drug used to treat IBD?
Sulfasalazine.
59
Pneumonitis is a rare adverse effect of which drug used to treat IBD?
Methotrexate.
60
Vincristine is used for which cancers and what is an adverse effect?
Nausea, vomiting, weight loss, peripheral neuropathy such as numbness or tingling. Vincristine is used in the treatment of acute leukemia, rhabdomyosarcoma, neuroblastoma, Wilms tumor, Hodgkin disease, and other lymphomas.
61
Calcineurin inhibitors, such as tacrolimus and cyclosporin used for IBD have what infamous adverse effect?
Nephrotoxicity.
62
Necrosis of the femoral head leading to hip joint pain or a limp is caused by which drug class? What other things does this drug class cause?
Other long-term adverse effects of steroid use include abdominal striae and increased girth, suppression of the hypothalamic-pituitary-adrenal axis, hyperglycemia, osteoporosis, moon facies, buffalo hump, immunosuppression, and impaired wound healing. Important to note that only systemic corticosteroids have these significant side effects. They are not normally associated with inhaled corticosteroids.
63
For refractory Crohn disease, which drugs might we use targeting TNF-a.
anti-TNF-α monoclonal antibody, such as infliximab or adalimumab.
64
Flank pain radiating to the groin with hematuria is suggestive of what - esp in a Crohn pt?
Kidney stones - envelope shaped calcium oxalate.
65
RUQ pain with nausea and vomiting in a pt with Crohn disease and gall bladder thickening would suggest what condition?
Acute cholecystitis.
66
Appendicitis and Emergent surgery!
In adults, caused by fecolith. In children, usually a mass of lymphoid tissue. Pressure and infarction --> perforation and sepsis. Crampy colicky pain at first and then very well localized RLQ pain.
67
Pt with RLQ pain could have which problems besides appendicitis?
Ovarian torsion, ectopic pregnancy, diverticulitis (though this is more commonly in sigmoid region), terminal ileitis. Yersinia enterolytica infection (mimics pain of appendicitis so much that it is called pseudoappendicitis).
68
McBurney's Point is where...
One third of the way from ASIS to Umbilicus in RLQ. Migration of pain from epigastric to McBurney Point.
69
Psoas sign and Obdurator sign do what. Rovsing sign detects what?
Diagnose appendicitis. Psoas involves extending the hip to stretch Psoas muscle. Obdurator involves flexing of the right leg and rotate inward to elicit abdominal pain. Rovsing sign detects irritation of peritoneum. Call it the Wrong Side Sign (press to stretch lower left quadrant).
70
Appendicitis workup and treatment
CT of abdomen and pelvis. Give ABX. Get them to the OR stat. Leukocytosis.
71
T10 dermatome covers umbilicus. Which dermatome covers the anus? What does L1 cover?
inguinal and genital areas. S5, S4 are anus. S3 is the fat part of the butt. :)
72
Severe acute pain and hip flexion suggest peritoneal inflammation from what?
Appendicitis irritating the peritoneum or possible rupture. Also look for leukocytosis.
73
Redundant loops of the sigmoid colon around the mesentery is called what?
Volvulus.
74
Vomiting, bloody diarrhea, hyperactive bowel sounds, and a palpable mass around the ileocecal junction should make you suspect what?
Intussception (telescoping of the intestine)
75
What would make you suspect a Psoas abscess? What is the MC pathogen?
Pt feels better when flexing knee in supine position. Staph aureus.
76
Focal weakness leading to outpouching is known as...
Diverticulum. True Diverticulum involves all 4 layers of mucosa, submucosa, muscularis, serosa. Most are pseduodiverticulums in the body - esp those in the colon. Pseudodiverticulosis is merely focal weakening of muscularis propria (mucosa, submucosa).
77
Diverticulosis is associated with what RFs?
Old age (50% of people over 60 have one), and low fiber diet. MCC of lower GI bleed - bright red in stool - diverticula compress Mesenteric arteries.
78
Differentiate between Diverticulosis and Diverticulitis. Most common presentation?
Diverticulitis means inflammation has ensued. No longer will the bleeding be painless as in Diverticulosis. Usually Rectosigmoid hence LLQ pain.
79
Most common complications of Diverticulitis.
Fistulas, esp colovesicular fistulas between colon and bladder. Leads to both tons of UTIs and Pneumoturia (fart where you pee). Other two: Obstruction, Perforation.
80
Management of Diverticulitis?
Uncomplicated is managed with ABX like Ciprofloxacin. Complicated requires surgery. Next step is colonoscopy to rule out malignancy.
81
Meckel diverticulum is the result of a persistent omphalomesenteric (vitelline) duct. How does it present and what is the rule of twos?
2 inches long and is 2 feet from the ileocecal valve. It contains two types of tissue (most common gastric, also pancreatic). It often presents before 2 years of age, it is two times more likely in males, and it occurs in 2% of the population. Presents with bloody stools but otherwise healthy pt. This is one of the rare true diverticula.
82
Angiodysplasia is dilation of blood vessels where?
Usually right side of colon with hematochezia. Opposite diverticulosis. Weirdly associated with Aortic stenosis and valve replacement helps fix problem somehow.

Gastrointestinal - From Oral to Anal! (9 decks)

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