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DEMS Exam 1 > pathology of small bowel and colon > Flashcards

pathology of small bowel and colon Flashcards

1
Q

what is the Pathogenesis of celiacs disease

A

Cytotoxic and autoantibody formation → inflammation ( ↑ T-lymphocytes) → villous atrophy → tissue damage → loss of mucosal and brush-border surface area → malabsorption, diarrhea

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2
Q

Celiac’s is Association with other autoimmune diseases:

A

Type 1 DM, thyroiditis, Sjögren syndrome

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3
Q

what is the CLASSICAL presentation of celiacs disease:

A 
Bulky fatty diarrhea, 
flatulence, 
weight loss, 
anemia,
nutritional deficiencies, 
growth failure in children
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4
Q

what is the Serological diagnosis of celiacs disease

A

IgA antibodies to tissue transglutaminase

Anti-endomysial antibodies

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5
Q

NORMAL SMALL INTESTINAL MUCOSA should have a Villi to crypt length ratio of ____

A

~4:1 ratio

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6
Q

Celiac disease often presents with what 4 extra-intestinal complaints:

A
  • Fatigue
  • Iron deficiency anemia
  • Pubertal delay, short stature
  • Aphthous stomatitis (canker sores)
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7
Q

celiacs is Associated with ______, a blistering skin disease

A

dermatitis herpetiformis

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8
Q

Describe tropical sprue and its prevalence

A

Post-infectious Tropical Malabsorbtion with No single causative infectious agent.
Prevalent in Haiti, the Dominican Republic,
Puerto Rico, and Cuba and Ind

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9
Q

tropical sprue presents with

A

Chronic diarrhea
malabsorption (B12,folate, D,E,K,A)
Bacterial overgrowth

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10
Q

epidemiology of peptic disease

A

Highest incidence in Western countries
Patients >40
Males > Females

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11
Q

PEPTIC DISEASE is Caused by toxic effects on the duodenal mucosa
by _____

A

excess gastric acid

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12
Q

_________ infection found in majority of patients with peptic ulcer disease

A

Helicobacter pylori

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13
Q

peptic disease is Most commonly found

in the ________

A

duodenal bulb

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14
Q

peptic disease Appears nodular or polypoid on endoscopy due to _______ hyperplasia

A

Brunner gland

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15
Q

microscopic changes seen in PEPTIC DUODENITIS

A

Villous blunting,

gastric mucin cell metaplasia

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16
Q

Bleeding ulcers cause up to _____ of upper GI bleeding

A

50%

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17
Q

GROSS FINDINGS-PEPTIC ULCER

DISEASE

A

Most ulcers found in the duodenal bulb
Ulcers tend to be circular, rarely >3 cm in diameter
Surrounding mucosa appears nodular on endoscopy
due to Brunner gland hyperplasia

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18
Q

a patient has Multiple duodenal ulcers in
association with gastrin hypersecretion by neuroendocrine tumor of pancreas or duodenum, this patient most likely has _________

A

ZOLLINGER-ELLISON SYNDROME

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19
Q

what is the pathogensesis of WHIPPLE DISEASE

A

Pathogenesis
Caused by gram-positive bacilli Tropheryma whippelii
Bacilli absorbed by lamina propria macrophages ->
macrophage accumulation within the small intestinal lamina propria and mesenteric lymph nodes → lymphatic obstruction -> Impaired lymphatic transport causes malabsorptive diarrhea

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20
Q

what are the clinical features of WHIPPLE DISEASE

A

Clinical Features
 Triad of diarrhea, weight loss, malabsorption
 Other common symptoms: arthritis, lymphadenopathy, neurologic disease
 Typically presents in middle-aged or elderly white males

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21
Q

how to diagnose whipple disease

A

Diagnosis

 Tissue biopsy demonstrates the presence of the organisms

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22
Q

what is the incubation period for Giardia lamblia

A

7-14 days

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23
Q

what is a key microscopic finding in giardiasis

A

pear-shaped organisms with paired nuclei,

located in lumen

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24
Q

In the US, ______ is a major source of transmission of giardiasis

A

water

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25
what are the 4 infectious causes of colitis
 Bacterial enterocolitis  Pseudomembranous colitis  Viral gastroenteritis  Parasitic enterocolitis
26
what are 2 Non-infectious causes of colitis
 Ischemic colitis |  Microscopic colitis
27
PSEUDOMEMBRANOUS COLITIS is Most often caused by _________ and is common in ____ patients (up to 30%).
Clostridium difficile, | hospitalized
28
Colitis often occurs after course of antibiotic therapy (“antibiotic-associated colitis”). Most frequently implicated antibiotics are ________
third-generation cephalosporins
29
patients with PSEUDOMEMBRANOUS COLITIS present with
fever, leukocytosis, abdominal pain, cramps, watery diarrhea
30
IN PSEUDOMEMBRANOUS COLITIS | WHAT IS A “PSEUDOMEMBRANE”?
A “volcano-like” eruption of neutrophils and mucinous debris attached to the surface epithelium
31
what is the Most common cause of severe childhood diarrhea and diarrheal mortality worldwide
Rotavirus
32
how does rotavirus cause diarrhea?
Selectively infects and destroys mature enterocytes → villus surface repopulated by immature secretory cells → loss of absorptive function → net secretion of water and electrolytes →osmotic diarrhea DEHYDRATION = DEATH
33
what are the clinical features of ISCHEMIC COLITIS
Older individuals with co-existing cardiac or vascular disease Young patients: long-distance runners, women on oral contraceptives Mechanical Obstruction: hernias, volvulus
34
what is the Pathogenesis of ischemic colitis
Lack of blood flow due to:  Low cardiac output  Occlusive disease of vascular supply to bowel
35
what are the clinical features of MICROSCOPIC COLITIS
Chronic watery diarrhea Presents primarily in middle-aged and older women NSAIDs implicated
36
diagnosis of MICROSCOPIC COLITIS
 Endoscopy: Normal |  Tissue biopsy shows characteristic lymphocytic inflammation +/- a thickened subepithelial collagen layer
37
what is irratable bowel syndome (IBS)
Chronic functional bowel disorder | with Abdominal pain, and altered bowel habits
38
DIAGNOSTIC CRITERIA FOR IRRITABLE BOWEL SYNDROME = Recurrent abdominal pain, on average, at least 1 day per week in the last 3 months, associated with 2 or more of the following criteria:
1. Related to defecation 2. Associated with a change in frequency of stool 3. Associated with a change in form (appearance) of stool
39
describe IBS MACROSCOPIC & HISTOLOGIC | APPEARANCE
Normal
40
Inflammatory bowel disease (IBD) is a chronic condition resulting from __________
inappropriate mucosal immune activation
41
IBD encompasses 2 distinct disorders
``` Crohn(‘s) disease (CD) Ulcerative colitis (UC) ```
42
what Epithelial defects are seen in Crohn's disease  
Defects in intestinal epithelial tight junction barrier function, NOD2 polymorphisms (intracellular receptor for microbes)
43
what epithelium defects are seen in Ulcerative colitis:
Defects in intestinal epithelial tight junction barrier function, ECM2 polymorphisms (extracellular matrix protein)
44
what Epithelial defects are seen in Crohn's disease  
Defects in intestinal epithelial tight junction barrier function, NOD2 polymorphisms (intracellular receptor for microbes)
45
what epithelium defects are seen in Ulcerative colitis:
Defects in intestinal epithelial tight junction barrier function, ECM2 polymorphisms (extracellular matrix protein)
46
what are the Clinical Features of Crohn's disease
Relapsing and remitting disease Intermittent attacks of relatively mild non-bloody diarrhea, fever, abdominal pain
47
what are the Extraintestinal manifestations of Crohn's disease
Uveitis (inflammation of the middle layer of the eye), migratory polyarthritis, sacroiliitis, ankylosing spondylitis, erythema nodosum (flat, firm, hot, red, and painful lumps that usually appear on the shins)
48
what are disease characteristics of Crohns disease
 Skip lesions  Ileal involvement (“regional enteritis”)  Transmural chronic inflammation  Inflammatory strictures  Fissuring ulcers, sinus tracts, fistulae
49
Risk of adenocarcinoma is similar in CD (colonic disease) and UC (25-year cumulative risk approx 10%) and is related to:
Duration of disease Extent of disease (pancolitis vs localized involvement) Family history Extra-intestinal manifestations (i.e. primary sclerosing cholangitis)
50
what are the clinical features of ulcerative colitis
Bloody diarrhea or loose stools with lower abdominal pain, cramps, Symptoms relieved by defecation
51
what is the Extraintestinal manifestations of ulcerative colitis
Primary sclerosing cholangitis
52
Pseudopolyps are more common and numerous in which IBD
Ulcerative Colitis
53
describe the microscopic appearance of Ulcers in crohns
Deep, knife-like
54
describe the appearance of Ulcers in crohns
Deep, knife-like
55
describe the Wall appearance in ulcerative collitis
Thinned
56
DISTINGUISHING MICROSCOPIC FEATURES of CROHN’S DISEASE are:
Granulomas and Fissuring ulcers
57
DISTINGUISHING MICROSCOPIC FEATURES of CROHN’S DISEASE
Granulomas and Fissuring ulcers
58
A diverticulum is an _______
outpouching/herniation of the mucosa and submucosa
59
Diverticular disease is most common in the ______ colon. Prevalence approaches 60% in Western adult populations over age ________. Asymptomatic or intermittent cramping, lower abdominal discomfort
sigmoid, | 60
60
Diverticulosis =
presence of diverticula
61
Diverticulitis =
inflammation of the diverticula, usually secondary to obstruction
62
what complications can arise from DIVERTICULITIS
 Obstruction  Perforation  Abscess Formation  Bleeding
63
classic finding in appendicitis?
McBurney’s sign
64
what is the pathogenesis of appendicitis
Luminal obstruction by stone-like mass of stool (“fecalith”)→ ischemic injury and stasis of luminal contents → inflammatory response

DEMS Exam 1 (28 decks)

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