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GI II Block 1 > SI and Colon Path > Flashcards

SI and Colon Path Flashcards

1
Q

Intestinal Obstruction Symptoms (4) and Causes (4)

A

Abdominal pain
Distension
Vomiting
Constipation

Hernias: most common worldwide
Adhesions: most common in US
Intussusceptions: most common in babies
Volvulus: mostly in sigmoid colon

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2
Q

Melena vs Hematochezia Characteristics (2 each)

A

Melena
Coffee ground stool
Upper GI bleeds

Hematochezia
Bright Red Blood Per Rectum (BRBPR)
Colon bleeds

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3
Q

Ischemic Bowel Disease

Population (3) Presentation (3) and Worst Vessel to Occlude

A

People over 70 with comorbid Cardiac or Vascular disease

Cramping abdominal pain
Need to defecate
Hematochezia

Superior Mesenteric Artery

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4
Q

Other Causes of Intestinal Bleeding with Descriptions (3)

A

Necrotizing Enterocolitis
Premie infants once oral feeding starts**

Angiodysplasia
Malformed cecum/Ascending colon vessels**

Radiation Enterocolitis
See radiation fibroblasts in stroma

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5
Q

Malabsorptive Diarrhea

Most Common Causes (3) and Presentation (5)

A

Pancreatic Insufficiency (Cystic Fibrosis patients)
Celiac’s Disease
Crohn’s Disease

Steatorrhea***
Flatus
Abdominal pain
Borborygmi (growling sound)
Anorexia/WL/Muscle Wasting
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6
Q

4 Types of Diarrhea with Descriptions

A

Secretory
Isotonic stool, persists during fasting

Osmotic
Hypertonic stool, abates while fasting

Malabsorptive
Steatorrhea, abates while fasting

Exudative
Purulent and bloody, continues while fasting

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7
Q

Celiac’s Disease

Pathogenesis (2), Morphology, Diagnosis (6), Clinical (4)

A

MHC II molecules with HLA-DQ2/DQ8 polymorphism interact with gliadin molecules
NKG2D expressing T cells activated

Villous atrophy causing flattened mucosa

Biopsy: increased CD8+ T cells, Villous atrophy and Crypt hyperplasia
Serology: IgA Abs to tTG or Gliadin
IgG Abs to DGP

Dermatitis Herpetiformis
Chronic malabsorptive diarrhea
Iron deficiency anemia
Increased risk of enteropathy associated T cell lymphoma

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8
Q 
Environmental Enteropathy (Tropical sprue)
Populations (2) Clinical Features (4)
A

Present in populations with poor santiation and developing nations

Malabsorption (malnutrition)
Stunted Growth
Defective intestinal mucosa immune function
Cognitive deficits

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9
Q

Autoimmune Enteropathy
Genetics (1), Presentation (2)
Severe Form Characteristics (4)

A

X Linked Disorder
Severe Persistent Diarrhea
Presents in young children

IPEX:
Immune dysregulation (FOXP3 mutation)
Polyendocrinopathy
Enteropathy
X Linked
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10
Q

Lactase Disaccharidase Deficiency

Presentation (3) and Types (2)

A

Explosive watery diarrhea
Frothy stool
Abdominal distension

Congenital: Autosomal recessive enzyme deficiency
Acquired: Downregulated lactase gene post infection

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11
Q

Abetalipoproteinemia

Pathogenesis (2) and Presentation (5)

A

Autosomal recessive mutation of microsomal triglyceride transfer protein
Causes inability to absorb essential fatty acids

Presents in infancy with:
Failure to thrive
Steatorrhea
Acanthocytic red cells (Burr cells)
Fat soluble vitamin deficiency
Lipid membrane defects
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12
Q 
Irritable Bowel Syndrome
Clinical Features (4)
A

Chronic relapsing abdominal pain
Abdominal distension
Changes in bowel habits
No pathological abnormalities

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13
Q 
Crohn's Disease
Gross Features (4) and Histology (5)
A

Skip lesions
Cobblestone mucosa
Apthous ulcers coalescing into serpentine Ulcers
Affects whole GI, rectum spared

Transmural inflammation
Paneth cell metaplasia
Noncaseating granulomas
Metastatic Crohn disease (lymph node granulomas)

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14
Q 
Ulcerative Colitis 
Gross Features (5) and Histology (2)
A 
Broad based ulcers
Continuous lesions
Pseudopolyps creating mucosal bridges
Toxic megacolon
Affects colon and rectum

Diffuse inflammation of mucosa/superficial submucosa
Crypt abscesses
NO granulomas

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15
Q 
Diversion Colitis
Clinical Setting (3) and Histology (3)
A

Post-surgery for Ulcerative colitis, Hirschsprung disease and others requiring colostomy

Mucosal erythema
Mucosal Friability
Development of lymphoid follicles

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16
Q

Microscopic Colitis

Presentation (3) Collagenous (2) and Lymphocytic (3)

A

Chronic, nonbloody watery diarrhea without weight loss

Collagenous: Thickened subepithelial collagen and increased inflammatory cells

Lymphocytic: normal collagen layer and greatly increased immune cells
Associated with Celiacs and autoimmune diseases

17
Q

Graft vs Host Disease

Clinical Setting and Histology

A

Post hematopoietic stem cell transplantation

Epithelial apoptosis of crypt cells

18
Q 
Colonic Diverticular Disease
Clinical Features (5) and Morphological Features (4)
A 
Very common in people over 60
Intermittent cramping
Continuous lower abdominal discomfort
Constipation/Distention
Mostly asymptomatic

Flask-like outpouchings along teniae coli
Mostly in sigmoid colon
Atrophic mucosa
Absent muscularis propria

19
Q

Hamartomatous Polyps

Causes (3) and Complications

A

Can arise sporadically
Genetic or Acquired syndromes
Germline mutations in tumor suppressor or proto-oncogenes

Extra-intestinal manifestations
Risk of cancer (considered pre-neoplastic lesions)

20
Q

Peutz-Jeghers Syndrome

Age, Genes, Location, Extraintesinal Manifestations (2)

A

10-15 years
STK11 mutation

Arborizing polyps mainly in Small intestine

Mucocutaneous Hyperpigmentation*
Colon, Breast, Lung, Pancreatic, Thyroid Cancers

21
Q

Juvenile Polyposis

Age, Genes (2), GI Complications (4), Extraintesinal Manifestation

A

Age < 5 years
SMAD4 and BMPR1A

Increased risk of adenocarcinoma in:
Stomach, Small Intestine, Colon, Pancreas

Digital clubbing

22
Q

Familial Adenomatous Polyposis

Age, Genes, GI Complications, Extraintesinal Manifestation

A

10-15 years
APC mutation

Multiple adenomas
Retinal pigment epithelium hypertrophy*

23
Q 
Sporadic Colorectal Neoplasia
Molecular Defects (3), Target Genes (3), Side, Tumor Types (2)
A

Wnt pathway, Microsatellite instability, Beta-catenin

APC, MSH2, MLH1

Mostly right sided

Sessile serrated adenoma
Mucinous adenocarcinoma

24
Q

Hereditary Nonpolyposis Colorectal Cancer (HNPCC)

Molecular Defect, Target Genes (2), Inheritance, Side, Tumor Types (2)

A

DNA mismatch repair

MSH2 and MLH1 defects

Autosomal dominant inheritance

Right sided

Sessile serrated adenoma
Mucinous adenocarcinoma

25
Q

Colonic Adenocarcinoma

Epidemiology (2), Genetics (2), Morphology (2)

A

Most common GI malignancy
Highest incidence in US

APC/Beta-catenin pathways

Proximal colon: polypoid, exophytic masses
Distal colon: annular lesions (napkin ring obstruction)

26
Q 
Colonic Adenocarcinoma
Prognostic Features (2), Metastasis Site and Right/Left Sided Presentations
A

Prognosis based on depth and LN metastasis

Most commonly metastasizes to liver

Right: Iron deficiency anemia (fatigue, weak)
Left: Occult bleeding, BM changes, LLQ discomfort

27
Q

What are TNM and AJCC used for in colon cancer?

A

TNM is original prognostic classification

AJCC is newer system for staging tumors

GI II Block 1 (12 decks)

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