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GI II > Pathology of the GI Tract- SI and Colon (6) > Flashcards

Pathology of the GI Tract- SI and Colon (6) Flashcards

1
Q

infectious enterocolitis presents with a broad range of symptoms including what?

A

diarrhea, abdominal pain, urgency, perianal discomfort, incontinence, and hemorrhage

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2
Q

what should the diagnostic tests for infectious enterocolitis be driven by?

A

clinical history

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3
Q

few or no leukocytes and many erythrocytes in fecal test suggests what?

A

amebiasis

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4
Q

what are the characteristics of vibrio cholerae?

A

they are comma-shaped, gram negative bacteria

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5
Q

what is cholera?

A

a disease that has been endemic in the Ganges Valley of India and Bangladesh throughout history

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6
Q

how are the stools described in cases of cholera?

A

rice water stools with a fishy odor

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7
Q

what is the most common bacterial enteric pathogen in developed countries and is an important cause of traveler’s diarrhea?

A

C. jejuni

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8
Q

what causes campylobacter enterocolitis?

A

c. jejuni

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9
Q

how does one typically get c. jejuni?

A

improperly cooked chicken, unpasteurized milk, or contaminated water

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10
Q

how does campylobacter enterocolitis present?

A

watery or bloody diarrhea; enteric fever; reactive arthritis , guillain-barre, and erythema nodosum

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11
Q

what is bloody diarrhea generally associated with?

A

bacterial invasion and is caused by only a minority of campylobacter strains

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12
Q

what is enteric fever?

A

systemic infection that is associated with abdominal pain and fever- non-specific

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13
Q

when does enteric fever occur?

A

when bacteria proliferate within the lamina propria and mesenteric lymph nodes

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14
Q

what patients are at more of a risk of getting reactive arthritis when infected with campylobacter infection?

A

patients with HLA-B27 genotype

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15
Q

what is guillain-barre syndrome?

A

acute inflammatory demyelinating polyneuropathy; an ascending process

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16
Q

what is erythema nodosum?

A

a type of skin inflammation that is located in a part of the fatty layer of the skin

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17
Q

how does erythema nodosum typically present?

A

reddish, painful, tender lumps most commonly located in the front of the legs below the knees

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18
Q

what are the characteristics of shigella?

A

they are gram-negative unencapsulated, nonmotile, facultative anaerobes that belong to the Enterobacteriaceae family and are closely related to enteroinvasive E. coli

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19
Q

what is the most common causes of bloody diarrhea worldwide?

A

shigella

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20
Q

who is at risk for getting infected with shigella?

A

in the US and europe- children in daycare centers, migrant workers, travelers to low resource countries, and individuals in nursing homes

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21
Q

who is at risk of death associated with shigella?

A

deaths are generally limited to children younger than 5 years of age

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22
Q

where is shigella endemic?

A

in countries with poor sanitation

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23
Q

in what part of the GI tract does shigella most commonly infect?

A

shigella infections are most prominent in the left colon, but the ileum may also be involved, perhaps reflecting the abundance of M cells in the dome epithelium overlying Peyer patches

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24
Q

what is the histology like in cases of shigella?

A

because of the tropism for M cells, aphthous ulcers similar to those seen in Crohn disease may occur

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25
Q

what does the mucosa look like in cases of shigella?

A

it is hemorrhagic and ulcerated, and pseudomembranes may be present

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26
Q

after an incubation period of up to 1 week, what does shigella cause?

A

self-limited disease characterized by 7-10 days of diarrhea, fever, and abdominal pain (enteric fever)

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27
Q

how does shigella infection present in children?

A

duration of symptoms is usually shorter in children, but severity is often much greater

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28
Q

in adults, what is an uncommon subacute presentation of shigella?

A

weeks of waxing and waning diarrhea that can mimic new-onset ulcerative colitis

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29
Q

what does confirmation of shigella require?

A

stool culture

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30
Q

how should you treat shigella infections?

A

antibiotics but NOT antidiarrheal medications

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31
Q

what are the complications associated with shigellosis?

A

extra-intestinal manifestations (reactive arthropathy); shiga toxin can cause hemolytic-uremic syndrome; toxic megacolon

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32
Q

discuss the likelihood of becoming infected with salmonella?

A

very few viable salmonella are necessary to cause infection; the absence of gastric acid, in individuals with atrophic gastritis or those on acid-suppressive therapy, further reduces the required inoculum

33
Q

what population of people is salmonella most common?

A

young children or older adults, with peak incidence in the summer and fall

34
Q

what is essential for the diagnosis of salmonella?

A

stool cultures

35
Q

what are the two types of salmonella infection?

A

typhoidal and non-typhoidal

36
Q

what does typhoidal salmonella infection cause?

A

typhoid fever and paratyphoid fever

37
Q

what does non-typhoidal salmonella cause?

A

gastroenteritis and food poisoning

38
Q

infection by salmonella paratyphi is more common among what group of people?

A

travelers

39
Q

what areas are strongly associated with salmonella typhoidal?

A

travel to india, mexico, philippines, pakistan, el salvador, and haiti

40
Q

who is the reservoir for salmonella typhi and paratyphi?

A

humans

41
Q

gallbladder colonization with S. typhi or S. paratyphi may be associated with what?

A

gallstones and a chronic carrier state

42
Q

how does acute infection with salmonella typhi present?

A

anorexia, abdominal pain, bloating, nausea, vomiting, and bloody diarrhea; followed by a short asymptomatic phase that gives way to bacteremia and fever with flu-like symptoms; abdominal tenderness may mimic appendicitis

43
Q

what does systemic dissemination of salmonella typhi cause?

A

extraintestinal complications including encephalopathy, meningitis, seizures, endocarditis, myocarditis, PNA, and cholecystitis

44
Q

who are the at risk groups for salmonella typhi?

A

cancer, immunosuppression, EtOH, cardiovascular, sickle cell, hemolytic anemia patients

45
Q

what skin manifestation is associated with salmonella typhi infection?

A

erythematous maculopapular rash (rose spots)

46
Q

what are 3 species of yersinia?

A

enterocolitica, pseudotuberculosis, pestis

47
Q

how is iron associated with yersinia?

A

iron enhances virulence and stimulates systemic dissemination- this explains why individuals with increased non-heme iron, such as those with certain chronic forms of anemia or hemochromatosis, are at greater risk for sepsis and death

48
Q

What part of the GI tract does yersinia typically involve?

A

right side: ileum, appendix, and right colon

49
Q

where do the yersinia organisms proliferate?

A

extracellularly in lymphoid tissue, resulting in regional lymph node and peyer patch hyperplasia as well as bowel wall thickening

50
Q

what happens to the mucosa in yersenia infections?

A

the mucosa overlying lymphoid tissue may become hemorrhagic and aphthous erosions and ulcers may appear along with neutrophil infiltrates and granulomas

51
Q

what is yersinia sometimes confused with?

A

crohn disease

52
Q

what are the post yersinia infection complications?

A

reactive arthritis with urethritis and conjunctivitis, myocarditis, erythema nodosum, and kidney disease

53
Q

what are the characteristics of escherichia coli?

A

they are gram-negative bacilli that colonize the healthy GI tract; most are nonpathogenic, but a subset cause human disease

54
Q

what is ETEC?

A

enterotoxigenic- principal cause of traveler’s diarrhea

55
Q

what is EHEC?

A

enterohemorrhagic- E. coli O157:H7 and nonOH157:H7

56
Q

what is pseudomembranous colitis?

A

disruption of the normal colonic microbiota by antibiotics allows overgrowth of Clostridioides difficile

57
Q

who is at risk for pseudomembranous colitis?

A

in addition to antibiotic treatment, risk factors include advanced age, hospitalization, and immunosuppression

58
Q

what are pseudomembranes made up of?

A

an adherent layer of inflammatory cells and debris

59
Q

what is specifically characteristic or indicative of pseudomembranous colitis?

A

pathognomonic histopathology

60
Q

what is the presentation of pseudomembranous colitis?

A

fever, leukocytosis, abdominal pain, cramps, watery diarrhea, and dehydration

61
Q

what is a potentially fatal complication associated with pseudomembranous colitis?

A

toxic megacolon

62
Q

how is the diagnosis of pseudomembranous colitis typically made?

A

by detection of C. difficile toxin, rather than by culture, and supported by the characteristic histopathology

63
Q

what are generally effective therapies for pseudomembranous colitis?

A

metronidazole and vancomycin

64
Q

what is whipple disease?

A

a rare, multivisceral chronic disease, first described as intestinal lipodystrophy

65
Q

what population of people is whipple disease most common?

A

in caucasian men, particularly farmers and others with occupational exposure to soil or animals

66
Q

what is the clinical presentation of whipple disease?

A

triad of diarrhea, weight loss, and arthralgia

67
Q

what are the extraintestinal symptoms associated with whipple disease that typically precede malabsorption?

A

arthritis, arthralgia, fever, lymphadenopathy, and neurologic, cardiac, or pulmonary disease

68
Q

what is the morphologic hallmark of whipple disease?

A

a dense accumulation of distended, foamy, macrophages in the small intestinal lamina propria

69
Q

what do the macrophages seen in whipple disease contain?

A

periodic acid-Schiff (PAS)- positive, diastase-resistant granules that represent partially digested bacteria within lysosomes

70
Q

a similar infiltrate of foamy macrophages is present in intestinal mycobacterial infections, and the organisms are PAS-positive in both whipple disease and mycobacterial infections. How can you tell them apart?

A

the acid-fast stain can be helpful, since mycobacteria stain positively, while T. whippelii does not

71
Q

approximately half of all gastroenteritis outbreaks worldwide are thought to be due to what?

A

norovirus

72
Q

what is responsible for most sporadic cases of norovirus?

A

fecal-oral transmission

73
Q

where do norovirus infections spread easily?

A

within schools, hospitals, nursing homes, and other large groups in close quarters, such as on cruise ships

74
Q

who is especially at risk for significant infections of norovirus?

A

immunocompromised patients

75
Q

what is rotavirus?

A

an encapsulated virus with a segmented, double-stranded RNA genome

76
Q

who is the most vulnerable for rotavirus?

A

children between 6 and 24 months

77
Q

where are rotavirus outbreaks common?

A

in hospitals and daycare centers

78
Q

what is the effect of rotavirus?

A

the loss of absorptive function and net secretion of water and electrolytes is compounded by an osmotic diarrhea cause by the incomplete absorption of nutrients

GI II (20 decks)

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