Sm Intestine Colon Path- Nelson

Question 1

What are the major differences between ulcerative colitis and crohn’s disease?

Answer 1

UC:

• inflammation of mucosa (maybe submucosa- NOT transmural)
• Involves rectum and maybe colon
• Continuous

Crohns:

• transmural inflammation
• Can involve anywhere in the GI tract
• Skip lesions

Question 2

What is inflammatory bowel disease?

Answer 2

Inappropriate mucosal immune reaction to luminal bacteria (in genetically susceptible individuals!)

Question 3

Most common cause of acute diarrhea?

Answer 3

Infectious diarrhea!!!

Question 4

How do you diagnosis clostridium Difficile?

Answer 4

Stool PCR assay to look for toxin-producing strains

Question 5

What type of colitis is associated with C. diff?

Answer 5

psuedomembrane colitis - mucosal surface EXUDATE of necrotic epithelial cells, neutrophils, mucin, and fibrin

Question 6

For indeterminate colitis, how would would one distinguish UC from CD?

Answer 6

Serologic studies!

CD = ASCA positive
UC = pANCA positive

Question 7

Name some gross features of crohn’s disease?

Answer 7

Transmural inflammation:
Cobblestone mucosa
Creeping Fat
Bowel wall thickening

Question 8

Gross morphology of ulcerative colitis?

Answer 8

Mucosal and submucosal inflammation only:

Psuedopolyps!

Question 9

Non-caseating granulomas is associated with which inflammatory bowel disease?

Answer 9

CROHNS!

Question 10

What is a long term complication of both CD and UC?

Answer 10

Development of intestinal adenocarcinoma

Question 11

Diversion colitis

Answer 11

• Colitis in a blind distal segment of the colon (excluded from fecal stream)
• Following surgery that made a diverting ostomy
• Due to deficiency of short-chain fatty acids (normally produced from fermentation of dietary starches by normal colonic bacterial flora)
• These starches are absent in the diverted segment, due to changes in the luminal microbiota and diversion of the normal fecal stream

Question 12

Clinical presentation for microscopic colitis?

Answer 12

Chronic watery diarrhea

NORMAL colonoscopic exam

Question 13

Two types of microscopic colitis?

Answer 13

• Lymphocytic colitis

- Collagenous colitis

Question 14

Lymphocytic colitis

Answer 14

• Increased lamina propria chronic inflammation
• Increased intra-epithelial lymphocytes
• Surface epithelial damage

Question 15

Collagenous colitis

Answer 15

Band of sub-epithelial collagen is seen in addition to inflammatory changes

Question 16

Radiation enterocolitis

Answer 16

Occurs when GI tract is irradiated

Can be acute or chronic

Can develop ulcers, strictures, fistula, serosal adhesions

Question 17

Neonatal necrotizing enterocolitis

Answer 17

First week of life in premature infants

Small and large bowel with transmural necrosis

Question 18

What class of drugs is commonly implicated in drug-induced enterocolitis?

Answer 18

NSAIDS!

Question 19

Chronic, replapsing abdominal pain or discomfort
Bloating
Changes in bowel habits (diarrhea or constipation)

Absence of any known causative agent that could explain symptoms

Answer 19

Irritable bowel sydnrome

Question 20

Irritable bowel syndrome is most common in which population?

Answer 20

Middle-aged women!

Question 21

List some causes of ischemic bowel disease

Answer 21

Acute arterial obstruction/thrombosis = atherosclerosis, aortic aneurysm, etc

Mesenteric venous thrombosis = portal hypertension, trauma, neoplasms, etc.

Hypoperfusion = cardiac failure, shock, vasoconstrictive drugs, etc.

Question 22

What are the bowel segments most likely to be affected by ischemia?

Answer 22

Splenic flexure (SMA and IMA watershed zone)

Sigmoid Colon

Rectum (IMA, pudendal artery, iliac artery watershed zone)

Question 23

Complication of transmural bowel necrosis?

Answer 23

Sepsis due to break down of mucosal barriers (w/ septic shock/death)

Question 24

What is angiodysplasia?

Answer 24

malformed submucosal and mucosal blood vessels

Question 25

Possible complications of sigmoid diverticulitis?

Answer 25

Abscess
Obstruction
Perforation
Fistula

Question 26

How do you treat sigmoid diverticulitis?

Answer 26

Clear liquid diet (bowel rest)
Antibiotics
Followed by high fiber diet

Question 27

Define solitary rectal ulcer syndrome

Answer 27

Disorder caused by malfunction of the puborectalis muscle, leading to excessive straining on defecation