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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
Q

what are the 4 infectious causes of colitis

A

 Bacterial enterocolitis
 Pseudomembranous colitis
 Viral gastroenteritis
 Parasitic enterocolitis

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26
Q

what are 2 Non-infectious causes of colitis

A

 Ischemic colitis

 Microscopic colitis

27
Q

PSEUDOMEMBRANOUS COLITIS is Most often caused by _________ and is common in ____ patients (up to 30%).

A

Clostridium difficile,

hospitalized

28
Q

Colitis often occurs after course of antibiotic therapy (“antibiotic-associated colitis”). Most frequently implicated antibiotics are ________

A

third-generation cephalosporins

29
Q

patients with PSEUDOMEMBRANOUS COLITIS present with

A

fever, leukocytosis, abdominal pain, cramps, watery diarrhea

30
Q

IN PSEUDOMEMBRANOUS COLITIS

WHAT IS A “PSEUDOMEMBRANE”?

A

A “volcano-like” eruption of neutrophils and mucinous debris attached to the surface epithelium

31
Q

what is the Most common cause of severe childhood diarrhea and diarrheal mortality worldwide

A

Rotavirus

32
Q

how does rotavirus cause diarrhea?

A

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
Q

what are the clinical features of ISCHEMIC COLITIS

A

Older individuals with co-existing cardiac or vascular disease
Young patients: long-distance runners, women on oral contraceptives
Mechanical Obstruction: hernias, volvulus

34
Q

what is the Pathogenesis of ischemic colitis

A

Lack of blood flow due to:
 Low cardiac output
 Occlusive disease of vascular supply to bowel

35
Q

what are the clinical features of MICROSCOPIC COLITIS

A

Chronic watery diarrhea
Presents primarily in middle-aged and older women
NSAIDs implicated

36
Q

diagnosis of MICROSCOPIC COLITIS

A

 Endoscopy: Normal

 Tissue biopsy shows characteristic lymphocytic inflammation +/- a thickened subepithelial collagen layer

37
Q

what is irratable bowel syndome (IBS)

A

Chronic functional bowel disorder

with Abdominal pain, and altered bowel habits

38
Q

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:

A
  1. Related to defecation
  2. Associated with a change in frequency of stool
  3. Associated with a change in form (appearance) of
    stool
39
Q

describe IBS MACROSCOPIC & HISTOLOGIC

APPEARANCE

A

Normal

40
Q

Inflammatory bowel disease (IBD) is a chronic condition resulting from __________

A

inappropriate mucosal immune activation

41
Q

IBD encompasses 2 distinct disorders

A 
Crohn(‘s) disease (CD)
Ulcerative colitis (UC)
42
Q

what Epithelial defects are seen in Crohn’s disease

A

Defects in intestinal epithelial tight junction barrier function, NOD2 polymorphisms (intracellular receptor for microbes)

43
Q

what epithelium defects are seen in Ulcerative colitis:

A

Defects in intestinal epithelial tight junction barrier function, ECM2 polymorphisms (extracellular matrix protein)

44
Q

what Epithelial defects are seen in Crohn’s disease

A

Defects in intestinal epithelial tight junction barrier function, NOD2 polymorphisms (intracellular receptor for microbes)

45
Q

what epithelium defects are seen in Ulcerative colitis:

A

Defects in intestinal epithelial tight junction barrier function, ECM2 polymorphisms (extracellular matrix protein)

46
Q

what are the Clinical Features of Crohn’s disease

A

Relapsing and remitting disease

Intermittent attacks of relatively mild non-bloody diarrhea, fever, abdominal pain

47
Q

what are the Extraintestinal manifestations of Crohn’s disease

A

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
Q

what are disease characteristics of Crohns disease

A

 Skip lesions
 Ileal involvement (“regional enteritis”)
 Transmural chronic inflammation
 Inflammatory strictures
 Fissuring ulcers, sinus tracts, fistulae

49
Q

Risk of adenocarcinoma is similar in CD (colonic disease) and UC (25-year cumulative risk approx 10%) and is related to:

A

Duration of disease
Extent of disease (pancolitis vs localized involvement)
Family history
Extra-intestinal manifestations (i.e. primary sclerosing cholangitis)

50
Q

what are the clinical features of ulcerative colitis

A

Bloody diarrhea or loose stools with lower abdominal pain,
cramps,
Symptoms relieved by defecation

51
Q

what is the Extraintestinal manifestations of ulcerative colitis

A

Primary sclerosing cholangitis

52
Q

Pseudopolyps are more common and numerous in which IBD

A

Ulcerative Colitis

53
Q

describe the microscopic appearance of Ulcers in crohns

A

Deep, knife-like

54
Q

describe the appearance of Ulcers in crohns

A

Deep, knife-like

55
Q

describe the Wall appearance in ulcerative collitis

A

Thinned

56
Q

DISTINGUISHING MICROSCOPIC FEATURES of CROHN’S DISEASE are:

A

Granulomas and Fissuring ulcers

57
Q

DISTINGUISHING MICROSCOPIC FEATURES of CROHN’S DISEASE

A

Granulomas and Fissuring ulcers

58
Q

A diverticulum is an _______

A

outpouching/herniation of the mucosa and submucosa

59
Q

Diverticular disease is most common in the ______ colon. Prevalence approaches 60% in Western adult populations over age ________. Asymptomatic or intermittent cramping, lower abdominal discomfort

A

sigmoid,

60

60
Q

Diverticulosis =

A

presence of diverticula

61
Q

Diverticulitis =

A

inflammation of the diverticula, usually secondary to obstruction

62
Q

what complications can arise from DIVERTICULITIS

A

 Obstruction
 Perforation
 Abscess Formation
 Bleeding

63
Q

classic finding in appendicitis?

A

McBurney’s sign

64
Q

what is the pathogenesis of appendicitis

A

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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