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Gastrointestinal - step > Pathology - small tubes > Flashcards

Pathology - small tubes Flashcards

1
Q 
diarrhoea
steatorrhoea
weight loss
weakness
vitamin def
mineral def
A

malabsorption

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2
Q

causes of malabsorption

A 
celiac disease
disaccharide deficiency
pancreatic insufficiency
tropical sprue
whiple disease
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3
Q

northern European

malabsorption

A

celiac disease

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4
Q

population with highest incidence of celiac disease

A

infants when first fed grain

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5
Q

what is celiac disease

A

autoimmune-mediated intolerance of gliadin

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6
Q

where do you find gliadin

A

rye, wheat, barley

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7
Q

HLA associations with celiac disease please

A

HLA-DQ2

HLA-DQ8

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8
Q

I say dermatitis herptiformis you think

A

celiac disease

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9
Q

I say acanthosis nigricans you think

A

gastric cancer

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10
Q

autoabs of celiac disease pelase

A

Ig G and IgA anti-transtissue glutaminase
IgA anti endomysial
igA and IgG antigliadin

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11
Q

anti-endomysial
anti-gliadin
anti-trans tissue glutaminase

A

celiac disease

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12
Q

blunt villi

lymphocytes in lamina propria

A

celiac disease

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13
Q

consequnces of celiac

A

malabsorption

slight increased risk ofT cell lymphoma

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14
Q

what portion of the git does celiac hit?

A

mucosal absorption primarily in the distal duodenum and or proximal jejunum.

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15
Q 
anaemia
dermatitis herpetiforms
osteoporosis
seizures depression
infertility
A

consequences of celiac disease

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16
Q

describe what dermatiformis herptiformus looks like

A 
erythema on extensor surfaces of forearm
CELIAC DISEASE (version with low auto abs)
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17
Q

what is most common dissacharide deficiency

A

lactase deficiency

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18
Q

who is most likely to be lactase deficient?

A

native americans
Asians
blacks

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19
Q

describe the histopathos of lactase deficieinc

A

normal villi

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20
Q

what can cause acquired lactase deficiency

A

viral enteritis

lactase is located at the tip of intestinal villi resulting in self limited lactase deficiency after injury

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21
Q

what can casue self limited lactase deficiency

A

injury to tip of villi where lactase is located ie viral enteriitis

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22
Q

how to diagnose lactase deficiency

A

lactose tolerance test is positive if administration of lactose produces symptoms and serum glucose rises < 20 mg/dL

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23
Q

what can cause pancreatic insufficiency

A

cystic fibrosis
obstructing cancer
chronic pancreatitis

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24
Q

what is most common cause of pancreatic insufficiency

A

chronic pancreatitis

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25
Q

what type of malabsorption does pancreatic insufficiency cause

A

fats
ADEk
proteins
not carbs

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26
Q

how to diagnose pancreatic insufficiency

A

increased neutral fat in stool

normal urinary excretion of D-xylose

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27
Q

what is the D-xylose absorption test used for?

A

will be normal in pancreatic insufficiency

will have decreased absorption with intestinal mucosa defects of bacterial overgrowth

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28
Q

how to tell if intestinal mucosa defect is cause of malabsorption

A

D-xylose absorption test

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29
Q

how to tell if bacterial overgrowth is cause of malabsorptiong

A

D-xylose absorption test

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30
Q

where does tropical sprue affect usÉ

A

small bowel, like celiac (distal duo or proxy jejunum)

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31
Q

typical patient for tropical sprue

A

residents of or recent visitors to the tropics

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32
Q 
steatorrhoea
fever
recurrent polyarthritis
generalized painful lymphadenopathy
male
middle- older ages
increased skin pigmentation
A

whipple disease

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33
Q

the bug responsible for whipple disease please

A

tropheryma whipplei

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34
Q

histopathos of whipple disease

A

look for foamy macrophages in the lamina propria of the intestine
blunting of villi
increased epithelail lymphocytes
crypt hyperplasia

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35
Q

blunting of villi
increased epithelial lymphocytes
crypt hyperplasia

A

whipple disease

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36
Q

common symptoms of whipple diease

A 
fever
steatorrhoea
recurrent polyarthritis
increased pigmentation of skin
cardac
arthritis
neuro symptoms
generalized painful lympadenophaty
foamy whipped cream in a can
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37
Q

what is the reason tropheryma whipplei causes malabsorptionÉ

A

foamy macrophages obstruct lymphatics and reabsorption fo chylomicrons - malabsorption of fats

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38
Q

smoking makes UC or Chrons better?

A

UC

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39
Q

where does chrons disease occur

A

anywhere
rectal sparing
most commonly at terminal ileum and colon (hence RLQ presentation of pain)

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40
Q

where does UC occur

A

continuous from rectum up. usually just descending

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41
Q

what type of inflammation occurs in chrons?

A

transmural

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42
Q

what type of inflammation occurs in UC?

A

submucosal and mucosal only

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43
Q

imaging of UC

A

lead pipe - loss of haustra

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44
Q

imaging of chrons

A

string sign: bowel wall thickening, cobblestone mucosa and creeping fat

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45
Q

gross morphology of chrons

A

cobblestone mucosa, creeping fat, bowel wall thickening, linear ulcers, fissures

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46
Q

gross morphology of UC please

A

friable mucosal pseudopolyse with freely hanging mesentery

loss of haustra

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47
Q

micro morphos of chrons please

A

noncaseating granulomans and lymphoid aggregates

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48
Q

micro morphos of UC please

A

crypt abscesses and ulcers
bleeding
no granulomas

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49
Q

TH1 mediated irritable bowel disease

A

chrons - granulomas

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50
Q

TH2 mediated irritable bowel disease

A

UC - no granulomas

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51
Q

recurrent polymicrobial UTIs IBD?

A

chrons due to fistula – enterovesical fistulae

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52
Q

gallstones IBD?

A

chrons

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53
Q

strictures IBD?

A

chrons

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54
Q

perianal disease IBD?

A

chrons

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55
Q

which IBD is more likely to see nutritional deplection and malabsorptiong?

A

chrons

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56
Q

complications of UC?

A

sclerosing cholangitis
malnutrition
colorectal carcinoma
toxic megacolon

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57
Q

sclerosing cholangitis

A

UC

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58
Q

toxic megacolon

A

UC

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59
Q

IBD with bloody diarrhoea

A

UC

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60
Q

IBD with diarrheoa of lower volume and yes or no blody

A

chrons

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61
Q

IBD more likely to have uveitis

A

chrons

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62
Q

first presenting sign of chrons

A

aphthous ulcers

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63
Q

extraintestinaly manifestations of chrons

A 
migrating polyarthritis
erythema nodosum
anklyosing spondylitis
[yoderma gangrenosum
aphthous ulcers
uveitis
kidney stones
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64
Q

extraintestinal manifestation of UC

A 
pyoderma gangrenosum
erythema nodosum
primary sclerosing cholangitis
ankylosing spondylitis
aphthous ulcers
uveitis
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65
Q

what are the extraintestinal manifestaions that chrons has that UC dosent

A

migrating polarthirtiis

kidney stones

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66
Q

what are the extraintestinal manifestations in UC that aren’t associated with chrons

A

primary sclerosing cholangitis

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67
Q

IBD with higer risk fo colorectal cancer

A

UC

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68
Q 
recurrent abdominal pain associated with >2 of
* pain improves with defecation
* changes in stool frequency
* change in appearance of stool
constipation of diarrhoea or both
A

irritable bowel syndrome

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69
Q

risk factors for irritable bowel syndrome

A 
abuse in childhood
personality disorder
domestic abuse
increased stress
depression
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70
Q

histopathos in irritable bowel syndrome

A

no changes

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71
Q

what is irritable bowel syndrome

A

a chorinc intrinsic colonic motility disorder

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72
Q

males or femals for irritable bowel syndrome

A

feemmalleess

73
Q

disease that mimic the presentation of appendicitis please

A 
viral gastroenteritis
meckel diverticulum
ruptured follicular cyst
ruptured ectopic pregos
mesenteric lymphadenopathy
Yersinia enterocolitis
74
Q

what causes acute appendicitis in adults

A

fecolith – increase intraluminal pressure – musical inflammation and bacterial invasion

75
Q

what causes acute appendicitis in children

A

LYMPHOID HYPERPLASIA

76
Q

what bugs are associated with acute appendicitis in children

A

adenovirus

measles infection and immunization

77
Q

presentation of acute appendicitis please

A

periumbilical diffuse pain initially – migrates to Mc Burngy point

78
Q 
nausea
feaver
lymphocytosis
positive psoas, obturator and rovsign
guarding
tenderness
A

acute appendicitis

79
Q

where is mc burneys point

A

1/3 way from right ASIS to umbilicus

80
Q

physical exam positives in acute appendicitis please

A 
psoas sign
obturator sign
guarding
rovsings
rebound tenderness
81
Q

what to expect in elderly with presentation of acute appendicitis

A

diverticulitis

82
Q

what to expect in young adult female/teen with acute appendicitis presentation

A

ectopic pregos rupture

83
Q

how do you ddx between ectopic pregos rupture and acute appendicitis

A

beta hCG it up

84
Q

what are two most common bacteria to cause actue appendicitis

A

bacteroides fragilis

e coli

85
Q

pathologies that would predispose a patient to have diverticular of the git

A

marfan
ehlers danlos
ADPKD

86
Q

what is a diverticulum

A

a blind pouch protruding from the alimentary tract that communicates with the lumen of the guy

87
Q

where can diverticulum be found in the git?

A

esophagus
stomach
duodenum
colon

88
Q

are diverticulum of the git true or false

A

falllsseeee - no muscular externa

89
Q

where do you most often find diverticulum amongst the git?

A

sigmoid colon

90
Q

what is an example fo a true diverticulum

A

meckels

91
Q

what layers are present in a false diverticulum

A

mucosa and submucosa

92
Q

what predisposes a certain area to a diverticulum to form?

A

where vasa recta perforate muscularis externa

93
Q

where vasa recta perforate musclaris externa you would expect?

A

diverticulum formation

94
Q

what is diverticulosis

A

when pt has MANY false diverticula of the colon, most common in the sigmoid colon

95
Q

what causes diverticulosis

A

increased intraluminal pressure and focal weakness in colonic wall
associated with low fibre diets
constipation is most common cause

96
Q

what are complicatiosn of diverticulosis

A

diverticulitis

fistulas

97
Q

how does diverticulosis present

A

often asymptomatic or associated with vague discomfort

but also, a common cause of hematochezia

98
Q

what is diverticulitis

A

inflammation of diverticula

99
Q

LLQ pain
fever
leukocytosis

A

diverticulitis

100
Q

what are complicatiosn of diverticulitis

A 
peritonitis
absecess formation
bowel stenosis
PNEUMATURIA
via colovesicla distula
101
Q

what two pathos do you worry about fistuals with the baldder and recurrent UTIs

A

chrons and diverticulitis

102
Q

pneumaturia

A

diverticulitis

103
Q

left sided appendicitis

A

diverticulitis - similar clinical presentation
LLQ pain
fever
leukocytosis

104
Q

what type of diverticulum is Zenkers

A

false

105
Q

what type of cancer does Zenkers predispose to?

A

squamous cell carcinoma of esophagus

106
Q

what is Zenkers diverticulum

A

a pharnygoesophagel false diverticulum

107
Q

where to zenkers diverticulum usually occur?

A

tis a herniation of mucosal tissue at KILLIAN TRINAGLE betweent eh thyropharyngeal and crichoparhyngeal parts of the inferior pharyngeal constricturs

108
Q

dysphagia
obstriucgion
halitosis
older man

A

zenker diverticulum

109
Q

anterior or posterior esophagus for zenker diverticulum

A

posterior

110
Q

halitosis

A

zenker diverticulum

111
Q

two pathos where you see regurg food

A

achalasia

zenker diverticulum

112
Q

what type of diverticulum is meckels

A

tis true

113
Q

what causes meckels diverticulum

A

persistence of the vitelline duct

114
Q

what type of clinical presentation does meckels diverticulum have

A

mimics appendicitis

115
Q

how do you diagnose a meckels?

A

using 99mTc-pertechnate - detects ectopic gastric mucosa

116
Q

what type of tissue can be in a meckels

A

ectopic gastric or pancreatic – bleeding

117
Q

what is an omphalomesenteric cyst

A

cystic dilation fo vitelline duct

118
Q 
melana
RLQ pain
intussusception
volvulus
obstruction near terminal ileum
A

meckels

119
Q

what are complciations possible from meckels

A

RLQ pain
melana
intusscesception

120
Q

RULE OF TWOs please

A

meckels
2’’ long
2’ from ileocecal valve
2% of population
2 types of ectopic tissue: gastric, pancreatic
presents most commonly in first 2 years of life

121
Q

when does meckel usually present

A

within first 2 years of life

122
Q

what is most common cause of iron deficiency in children

A

a meckels.

123
Q

what happens if midgut rotation around the SMA goes astray in fetal development

A

mallrootattioonn with LADD BANDS between the bowel that is improperly positioned.

124
Q

complications of malrotation please

A

volvulus

duodenal obstruction

125
Q

what causes a volvulus

A

twisting of a portion of bowel around its mesentery

126
Q

consqeunces of volvulus

A

obstruction and infacrtion

127
Q

what type of volvulus is most common in elderly

A

siggmooid

if patient is old, assume sigmoid apparently

128
Q

what type of volvulus is most common in infants/chillen

A

midgut (Caecum)

129
Q

flushing
wheezing
diarrhoea

A

carcinoid syndrome
facial telangiectasia
tricuspid regur and pulm stenosis

130
Q

incread 5HIAA in urine

A

carcinoid syndrome

131
Q

what type of heart issues associated with carcinoid syndrome

A

tricuspid regur

pulm stenosis

132
Q

what is intussusception

A

telescoping of proximal bowel segment into distal

133
Q

where does intissusception usually occur?

A

ileocecal junction

134
Q

current jelly stools

A

intussusception

135
Q

when do you see intussesception in an adult

A

rarely.

associatwe with intraluminal mass or tumor that acts as lead point that is pulle inot the lumen

136
Q

what is intisseception associated with in child

A

recent enteric or respiratory viral infection

137
Q

adenoviris, measles or vaccination?

A

acute appendicitis

138
Q

bulls eye appearance on ultrasound

A

intussesception

139
Q

what is hirschsprung disease

A

congenital megacolon with lack of ganglion cells/enteric nervous plexues ie auerbach and meisseners in a segment of the colon.

140
Q

what gene associated with hirschsprung disease

A

RET gene

141
Q

what goes wrong to cause hirschsrung

A

failure of neural crest cell migration

142
Q

what poirtion of colon is always involved in hirschsprung

A

rectumm

143
Q

bilious emesis
abdominal distension
failure to pass meconieum
chronic constopation

A

hirschsrpung disease

144
Q

toxic megacolon

A

UC

hirschsprung

145
Q

rectal suction biopsy dx?

A

hirshsprung disease

146
Q

genetic syndrome associated with hirschsrpung

A

down syndrome

147
Q 
sudden onset of diffuse abdominal pain
bowel distension
bloody diarrhoea
no bowel sounds/ileus
no rebound tenderness early 
profound PMN leukocytosis
positive stool guiac
A

small bowel infarct

148
Q

thumb sign

A

small bowel infarct

149
Q

what is acute mesenteric iscahemia

A

critical blockage of intestinal blood flow

150
Q

what is a common cause of acute mesenteric iscahemia

A

embolic blockage

atrial fib

151
Q

currant jelly stools in child

currant jelly stools in a fib

A

intussesception

acute mesenteric infarction

152
Q

describe an adhesion

A

fibrous band of scar tissue common after surgery or with mets to small bowel

153
Q

what is the most common cause of small bowel obstruction

A

adhesions

154
Q

what causes adhesiosn

A

surgery
mets to small bowel
endometriosis
radiation

155
Q

what is an angiodysplasia

A

tortuous dilation of vessels

156
Q

where do you find angiodysplasia

A

cecum
terminal ileus
ascending colong
RIGHT SIDE

157
Q

how does angiodysplasia present

A

hematochezia (also diverticulitis)

158
Q

early bilious vomiting

procimal stomach distension

A

duodenal atresia

159
Q

genetic syndrome associated with duodenal atresia

A

down syndrome

160
Q

double bubble on xray

A

duodenal atresia

161
Q

cause of duodenal atresia

A

failure of small bowel to recanalize

162
Q

what is ileus

A

intestinal hypomotility without obstruction

163
Q

constipation
decreased flatus
distended/tympanic abdomen
decreased bowel sounds

A

illeeuss

intestinal hypomotility without obstruction

164
Q

what is ileus associated wtih

A

abdominal surgeris
opiates
HYPOKALEMIA
sepsis

165
Q

treatment of ileus

A

bowel rest
electrolyte correction (associated with hypokalemia)
cholinergic drugs to stimulate motlility

166
Q

name an antibiotic that can be used to stimulated intestinal motility

A

erythromycin

167
Q

what is sicehmic colitis

A

reduction in intestinal blood flow == ischemai

168
Q

pain after eating in LUQ
elderly patient
weight loss

A

ischaemic colitis

169
Q

where does ischaemic colitis usually occur?

A

watershed areas - spenic flexure and distal colon

170
Q

no stool passage at birth

genetic

A

meconium ileus
cystic fibrosis
meconium plu obstructs intestine

171
Q

presentation of ileus

A

constipation
decreased flatus
distended/tympanic abdomen with decreased bowel soudns

172
Q

causes of ileus

A

opiates
hypokalemia
sepsis
abdominal surgeries

173
Q

git disorder seen in preterm babies fed with only formulat

A

necrotizing enterocolitis

174
Q

what is necrotozign enterocolitis

A

necrosis of intestinal muclsa - primarily colonic with possible perforatmion

175
Q

complications of necrotizing enterocolitis

A

usually in colon
erofroatiomn – pneumatosis intestinalis
free air in abdomen
portal venous gas

176
Q

pneumoatosis intestinalis
free air in abdowmn
portal venous gas

A

necrotizing enterocolitis

177
Q

free air under diaphragm

A

duodenal ulcer anterior perforation

178
Q

pneumaturia

A

diverticulitis

179
Q

disease associated with free air in places it shouldn’t be

A

necrotozing enterocolitis - pneumatosis intestinalis, free air in abdomen, portal venous gass
duodenal ulcer anterior perforation - free air under diaphragm
diverticulitis - neumaturia

Gastrointestinal - step (10 decks)

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