Pathology - small tubes Flashcards
1
Q
diarrhoea steatorrhoea weight loss weakness vitamin def mineral def
A
malabsorption
2
Q
causes of malabsorption
A
celiac disease disaccharide deficiency pancreatic insufficiency tropical sprue whiple disease
3
Q
northern European
malabsorption
A
celiac disease
4
Q
population with highest incidence of celiac disease
A
infants when first fed grain
5
Q
what is celiac disease
A
autoimmune-mediated intolerance of gliadin
6
Q
where do you find gliadin
A
rye, wheat, barley
7
Q
HLA associations with celiac disease please
A
HLA-DQ2
HLA-DQ8
8
Q
I say dermatitis herptiformis you think
A
celiac disease
9
Q
I say acanthosis nigricans you think
A
gastric cancer
10
Q
autoabs of celiac disease pelase
A
Ig G and IgA anti-transtissue glutaminase
IgA anti endomysial
igA and IgG antigliadin
11
Q
anti-endomysial
anti-gliadin
anti-trans tissue glutaminase
A
celiac disease
12
Q
blunt villi
lymphocytes in lamina propria
A
celiac disease
13
Q
consequnces of celiac
A
malabsorption
slight increased risk ofT cell lymphoma
14
Q
what portion of the git does celiac hit?
A
mucosal absorption primarily in the distal duodenum and or proximal jejunum.
15
Q
anaemia dermatitis herpetiforms osteoporosis seizures depression infertility
A
consequences of celiac disease
16
Q
describe what dermatiformis herptiformus looks like
A
erythema on extensor surfaces of forearm CELIAC DISEASE (version with low auto abs)
17
Q
what is most common dissacharide deficiency
A
lactase deficiency
18
Q
who is most likely to be lactase deficient?
A
native americans
Asians
blacks
19
Q
describe the histopathos of lactase deficieinc
A
normal villi
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
21
Q
what can casue self limited lactase deficiency
A
injury to tip of villi where lactase is located ie viral enteriitis
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
23
Q
what can cause pancreatic insufficiency
A
cystic fibrosis
obstructing cancer
chronic pancreatitis
24
Q
what is most common cause of pancreatic insufficiency
A
chronic pancreatitis
25
what type of malabsorption does pancreatic insufficiency cause
fats
ADEk
proteins
not carbs
26
how to diagnose pancreatic insufficiency
increased neutral fat in stool
| normal urinary excretion of D-xylose
27
what is the D-xylose absorption test used for?
will be normal in pancreatic insufficiency
| will have decreased absorption with intestinal mucosa defects of bacterial overgrowth
28
how to tell if intestinal mucosa defect is cause of malabsorption
D-xylose absorption test
29
how to tell if bacterial overgrowth is cause of malabsorptiong
D-xylose absorption test
30
where does tropical sprue affect usÉ
small bowel, like celiac (distal duo or proxy jejunum)
31
typical patient for tropical sprue
residents of or recent visitors to the tropics
32
```
steatorrhoea
fever
recurrent polyarthritis
generalized painful lymphadenopathy
male
middle- older ages
increased skin pigmentation
```
whipple disease
33
the bug responsible for whipple disease please
tropheryma whipplei
34
histopathos of whipple disease
look for foamy macrophages in the lamina propria of the intestine
blunting of villi
increased epithelail lymphocytes
crypt hyperplasia
35
blunting of villi
increased epithelial lymphocytes
crypt hyperplasia
whipple disease
36
common symptoms of whipple diease
```
fever
steatorrhoea
recurrent polyarthritis
increased pigmentation of skin
cardac
arthritis
neuro symptoms
generalized painful lympadenophaty
foamy whipped cream in a can
```
37
what is the reason tropheryma whipplei causes malabsorptionÉ
foamy macrophages obstruct lymphatics and reabsorption fo chylomicrons - malabsorption of fats
38
smoking makes UC or Chrons better?
UC
39
where does chrons disease occur
anywhere
rectal sparing
most commonly at terminal ileum and colon (hence RLQ presentation of pain)
40
where does UC occur
continuous from rectum up. usually just descending
41
what type of inflammation occurs in chrons?
transmural
42
what type of inflammation occurs in UC?
submucosal and mucosal only
43
imaging of UC
lead pipe - loss of haustra
44
imaging of chrons
string sign: bowel wall thickening, cobblestone mucosa and creeping fat
45
gross morphology of chrons
cobblestone mucosa, creeping fat, bowel wall thickening, linear ulcers, fissures
46
gross morphology of UC please
friable mucosal pseudopolyse with freely hanging mesentery
| loss of haustra
47
micro morphos of chrons please
noncaseating granulomans and lymphoid aggregates
48
micro morphos of UC please
crypt abscesses and ulcers
bleeding
no granulomas
49
TH1 mediated irritable bowel disease
chrons - granulomas
50
TH2 mediated irritable bowel disease
UC - no granulomas
51
recurrent polymicrobial UTIs IBD?
chrons due to fistula -- enterovesical fistulae
52
gallstones IBD?
chrons
53
strictures IBD?
chrons
54
perianal disease IBD?
chrons
55
which IBD is more likely to see nutritional deplection and malabsorptiong?
chrons
56
complications of UC?
sclerosing cholangitis
malnutrition
colorectal carcinoma
toxic megacolon
57
sclerosing cholangitis
UC
58
toxic megacolon
UC
59
IBD with bloody diarrhoea
UC
60
IBD with diarrheoa of lower volume and yes or no blody
chrons
61
IBD more likely to have uveitis
chrons
62
first presenting sign of chrons
aphthous ulcers
63
extraintestinaly manifestations of chrons
```
migrating polyarthritis
erythema nodosum
anklyosing spondylitis
[yoderma gangrenosum
aphthous ulcers
uveitis
kidney stones
```
64
extraintestinal manifestation of UC
```
pyoderma gangrenosum
erythema nodosum
primary sclerosing cholangitis
ankylosing spondylitis
aphthous ulcers
uveitis
```
65
what are the extraintestinal manifestaions that chrons has that UC dosent
migrating polarthirtiis
| kidney stones
66
what are the extraintestinal manifestations in UC that aren't associated with chrons
primary sclerosing cholangitis
67
IBD with higer risk fo colorectal cancer
UC
68
```
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
```
irritable bowel syndrome
69
risk factors for irritable bowel syndrome
```
abuse in childhood
personality disorder
domestic abuse
increased stress
depression
```
70
histopathos in irritable bowel syndrome
no changes
71
what is irritable bowel syndrome
a chorinc intrinsic colonic motility disorder
72
males or femals for irritable bowel syndrome
feemmalleess
73
disease that mimic the presentation of appendicitis please
```
viral gastroenteritis
meckel diverticulum
ruptured follicular cyst
ruptured ectopic pregos
mesenteric lymphadenopathy
Yersinia enterocolitis
```
74
what causes acute appendicitis in adults
fecolith -- increase intraluminal pressure -- musical inflammation and bacterial invasion
75
what causes acute appendicitis in children
LYMPHOID HYPERPLASIA
76
what bugs are associated with acute appendicitis in children
adenovirus
| measles infection and immunization
77
presentation of acute appendicitis please
periumbilical diffuse pain initially -- migrates to Mc Burngy point
78
```
nausea
feaver
lymphocytosis
positive psoas, obturator and rovsign
guarding
tenderness
```
acute appendicitis
79
where is mc burneys point
1/3 way from right ASIS to umbilicus
80
physical exam positives in acute appendicitis please
```
psoas sign
obturator sign
guarding
rovsings
rebound tenderness
```
81
what to expect in elderly with presentation of acute appendicitis
diverticulitis
82
what to expect in young adult female/teen with acute appendicitis presentation
ectopic pregos rupture
83
how do you ddx between ectopic pregos rupture and acute appendicitis
beta hCG it up
84
what are two most common bacteria to cause actue appendicitis
bacteroides fragilis
| e coli
85
pathologies that would predispose a patient to have diverticular of the git
marfan
ehlers danlos
ADPKD
86
what is a diverticulum
a blind pouch protruding from the alimentary tract that communicates with the lumen of the guy
87
where can diverticulum be found in the git?
esophagus
stomach
duodenum
colon
88
are diverticulum of the git true or false
falllsseeee - no muscular externa
89
where do you most often find diverticulum amongst the git?
sigmoid colon
90
what is an example fo a true diverticulum
meckels
91
what layers are present in a false diverticulum
mucosa and submucosa
92
what predisposes a certain area to a diverticulum to form?
where vasa recta perforate muscularis externa
93
where vasa recta perforate musclaris externa you would expect?
diverticulum formation
94
what is diverticulosis
when pt has MANY false diverticula of the colon, most common in the sigmoid colon
95
what causes diverticulosis
increased intraluminal pressure and focal weakness in colonic wall
associated with low fibre diets
constipation is most common cause
96
what are complicatiosn of diverticulosis
diverticulitis
| fistulas
97
how does diverticulosis present
often asymptomatic or associated with vague discomfort
| but also, a common cause of hematochezia
98
what is diverticulitis
inflammation of diverticula
99
LLQ pain
fever
leukocytosis
diverticulitis
100
what are complicatiosn of diverticulitis
```
peritonitis
absecess formation
bowel stenosis
PNEUMATURIA
via colovesicla distula
```
101
what two pathos do you worry about fistuals with the baldder and recurrent UTIs
chrons and diverticulitis
102
pneumaturia
diverticulitis
103
left sided appendicitis
diverticulitis - similar clinical presentation
LLQ pain
fever
leukocytosis
104
what type of diverticulum is Zenkers
false
105
what type of cancer does Zenkers predispose to?
squamous cell carcinoma of esophagus
106
what is Zenkers diverticulum
a pharnygoesophagel false diverticulum
107
where to zenkers diverticulum usually occur?
tis a herniation of mucosal tissue at KILLIAN TRINAGLE betweent eh thyropharyngeal and crichoparhyngeal parts of the inferior pharyngeal constricturs
108
dysphagia
obstriucgion
halitosis
older man
zenker diverticulum
109
anterior or posterior esophagus for zenker diverticulum
posterior
110
halitosis
zenker diverticulum
111
two pathos where you see regurg food
achalasia
| zenker diverticulum
112
what type of diverticulum is meckels
tis true
113
what causes meckels diverticulum
persistence of the vitelline duct
114
what type of clinical presentation does meckels diverticulum have
mimics appendicitis
115
how do you diagnose a meckels?
using 99mTc-pertechnate - detects ectopic gastric mucosa
116
what type of tissue can be in a meckels
ectopic gastric or pancreatic -- bleeding
117
what is an omphalomesenteric cyst
cystic dilation fo vitelline duct
118
```
melana
RLQ pain
intussusception
volvulus
obstruction near terminal ileum
```
meckels
119
what are complciations possible from meckels
RLQ pain
melana
intusscesception
120
RULE OF TWOs please
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
when does meckel usually present
within first 2 years of life
122
what is most common cause of iron deficiency in children
a meckels.
123
what happens if midgut rotation around the SMA goes astray in fetal development
mallrootattioonn with LADD BANDS between the bowel that is improperly positioned.
124
complications of malrotation please
volvulus
| duodenal obstruction
125
what causes a volvulus
twisting of a portion of bowel around its mesentery
126
consqeunces of volvulus
obstruction and infacrtion
127
what type of volvulus is most common in elderly
siggmooid
if patient is old, assume sigmoid apparently
128
what type of volvulus is most common in infants/chillen
midgut (Caecum)
129
flushing
wheezing
diarrhoea
carcinoid syndrome
facial telangiectasia
tricuspid regur and pulm stenosis
130
incread 5HIAA in urine
carcinoid syndrome
131
what type of heart issues associated with carcinoid syndrome
tricuspid regur
| pulm stenosis
132
what is intussusception
telescoping of proximal bowel segment into distal
133
where does intissusception usually occur?
ileocecal junction
134
current jelly stools
intussusception
135
when do you see intussesception in an adult
rarely.
| associatwe with intraluminal mass or tumor that acts as lead point that is pulle inot the lumen
136
what is intisseception associated with in child
recent enteric or respiratory viral infection
137
adenoviris, measles or vaccination?
acute appendicitis
138
bulls eye appearance on ultrasound
intussesception
139
what is hirschsprung disease
congenital megacolon with lack of ganglion cells/enteric nervous plexues ie auerbach and meisseners in a segment of the colon.
140
what gene associated with hirschsprung disease
RET gene
141
what goes wrong to cause hirschsrung
failure of neural crest cell migration
142
what poirtion of colon is always involved in hirschsprung
rectumm
143
bilious emesis
abdominal distension
failure to pass meconieum
chronic constopation
hirschsrpung disease
144
toxic megacolon
UC
| hirschsprung
145
rectal suction biopsy dx?
hirshsprung disease
146
genetic syndrome associated with hirschsrpung
down syndrome
147
```
sudden onset of diffuse abdominal pain
bowel distension
bloody diarrhoea
no bowel sounds/ileus
no rebound tenderness early
profound PMN leukocytosis
positive stool guiac
```
small bowel infarct
148
thumb sign
small bowel infarct
149
what is acute mesenteric iscahemia
critical blockage of intestinal blood flow
150
what is a common cause of acute mesenteric iscahemia
embolic blockage
| atrial fib
151
currant jelly stools in child
| currant jelly stools in a fib
intussesception
| acute mesenteric infarction
152
describe an adhesion
fibrous band of scar tissue common after surgery or with mets to small bowel
153
what is the most common cause of small bowel obstruction
adhesions
154
what causes adhesiosn
surgery
mets to small bowel
endometriosis
radiation
155
what is an angiodysplasia
tortuous dilation of vessels
156
where do you find angiodysplasia
cecum
terminal ileus
ascending colong
RIGHT SIDE
157
how does angiodysplasia present
hematochezia (also diverticulitis)
158
early bilious vomiting
| procimal stomach distension
duodenal atresia
159
genetic syndrome associated with duodenal atresia
down syndrome
160
double bubble on xray
duodenal atresia
161
cause of duodenal atresia
failure of small bowel to recanalize
162
what is ileus
intestinal hypomotility without obstruction
163
constipation
decreased flatus
distended/tympanic abdomen
decreased bowel sounds
illeeuss
intestinal hypomotility without obstruction
164
what is ileus associated wtih
abdominal surgeris
opiates
HYPOKALEMIA
sepsis
165
treatment of ileus
bowel rest
electrolyte correction (associated with hypokalemia)
cholinergic drugs to stimulate motlility
166
name an antibiotic that can be used to stimulated intestinal motility
erythromycin
167
what is sicehmic colitis
reduction in intestinal blood flow == ischemai
168
pain after eating in LUQ
elderly patient
weight loss
ischaemic colitis
169
where does ischaemic colitis usually occur?
watershed areas - spenic flexure and distal colon
170
no stool passage at birth
| genetic
meconium ileus
cystic fibrosis
meconium plu obstructs intestine
171
presentation of ileus
constipation
decreased flatus
distended/tympanic abdomen with decreased bowel soudns
172
causes of ileus
opiates
hypokalemia
sepsis
abdominal surgeries
173
git disorder seen in preterm babies fed with only formulat
necrotizing enterocolitis
174
what is necrotozign enterocolitis
necrosis of intestinal muclsa - primarily colonic with possible perforatmion
175
complications of necrotizing enterocolitis
usually in colon
erofroatiomn -- pneumatosis intestinalis
free air in abdomen
portal venous gas
176
pneumoatosis intestinalis
free air in abdowmn
portal venous gas
necrotizing enterocolitis
177
free air under diaphragm
duodenal ulcer anterior perforation
178
pneumaturia
diverticulitis
179
disease associated with free air in places it shouldn't be
necrotozing enterocolitis - pneumatosis intestinalis, free air in abdomen, portal venous gass
duodenal ulcer anterior perforation - free air under diaphragm
diverticulitis - neumaturia
