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GI > SM_140b: Pathology of Small Intestine Disorders > Flashcards

SM_140b: Pathology of Small Intestine Disorders Flashcards

1
Q

Small intestine mucosa consists of ___ and ___

A

Small intestine mucosa consists of villi and crypts

  • Villi: absorptive and goblet cells line villi
  • Crypts: contain undifferentiated / stem cells, Paneth cells, neuroendocrine cells, and goblet cells
  • Function: digestion and absorption of food
  • Crypt:villi is 1:3-4 height-wise
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2
Q

Small bowel cell types include ____, ____, ____, and ____

A

Small bowel cell types include villi, crypts, goblet / mucous cells of crypts and villi, specific receptors on surface epithelial cells

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3
Q

Peyer’s patches are unique to the ___

A

Peyer’s patches are unique to the ileum

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4
Q

____ is the most common non-neoplastic disease affecting the small bowel

A

Peutz-Jeghers polyp is the most common non-neoplastic disease affecting the small bowel

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5
Q

____ are a haphazard arrangement of stromal and epithelial elements (non-neoplastic)

A

Hamartamous polyps are a haphazard arrangement of stromal and epithelial elements (non-neoplastic)

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6
Q

___ is characterized by intestinal polyposis and mucocutaneous melanin pigmentation

A

Peutz-Jeghers Syndrome is characterized by intestinal polyposis and mucocutaneous melanin pigmentation

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7
Q

Peutz-Jeghers syndrome presents in ____ with ____, ____, and ____

A

Peutz-Jeghers syndrome presents in 2nd-3rd decade with abdominal pain, intussusception, and bleeding

  • Almost all with small intestinal polyps
  • Polyps throughout GI tract
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8
Q

Most patients with Peutz-Jegher’s syndrome have a mutation in ____

A

Most patients with Peutz-Jegher’s syndrome have a mutation in STK11 / LKB1 gene

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9
Q

Peutz-Jeghers syndrome histology includes ____ and ____

A

Peutz-Jeghers syndrome histology includes branching bundles of smooth muscle spread through the polyp and a complex mass of disorganized and hyperplastic mucosal glands containing absorptive, mucous, and Paneth cells

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10
Q

Hyperplastic mucinous epithelium is indicative of ____

A

Hyperplastic mucinous epithelium is indicative of Peutz-Jeghers syndrome

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11
Q

Peutz-Jeghers syndrome is associated with ____

A

Peutz-Jeghers syndrome is associated with cancer

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12
Q

____ is a rare systemic bacterial infection by Tropheryma Whippelii

A

Whipple’s disease is a rare systemic bacterial infection by Tropheryma Whippelii

  • Gram + rod
  • Fecal-oral transmission
  • Bacteria enter body via small intestine
  • Spread via lymphatic and blood to heart valves, lungs, and CNS
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13
Q

Describe symptoms of Whipple’s disease

A

Whipple’s disease symptoms

  • Malaise
  • Weight loss
  • Malabsorption
  • Diarrhea
  • Arthritis
  • Pleuritis
  • Sometimes symptoms last years before diagnosis
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14
Q

Describe pathology of Whipple’s disease

A

Whipple’s disease pathology

  • Intestine is dilated, thickened, and rigid
  • Variable degree of mucosal atrophy
  • Lamina propria contains macrophages filled with bacteria (non-specific)
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15
Q

Jejunum showing white plaque lesions is ____

A

Jejunum showing white plaque lesions is Whipple’s disease

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16
Q

Tons of foamy histiocytes in lamina propria is ____

A

Tons of foamy histiocytes in lamina propria is Whipple’s disease

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17
Q

Lamina propria macrophages filled with bacteria is ____

A

Lamina propria macrophages filled with bacteria is Whipple’s disease

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18
Q

___ is gluten-sensitivity enteropathy

A

Celiac disease is gluten-sensitivity enteropathy

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19
Q

Celiac disease results from ____

A

Celiac disease results from gluten and gluten breakdown products leading to mucosal damage

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20
Q
A
21
Q

Celiac disease pathogenesis is ____ and ____

A

Celiac disease pathogenesis is cell-mediated and antibody-mediated

  • Cell-mediated: direct damage caused by mucosal T cells
  • Antibody-mediated: antibodies secreted by plasma cells leading to cell-mediated cytotoxic reaction against mucosal cells
22
Q

Celiac disease classically presents with ____, ____, and ____

A

Celiac disease classically presents with abdominal discomfort, diarrhea, and steatorrhea

  • In adults with occult celiac: complaints of fatigue -> undiagnosed iron deficiency anemia discovered -> correct diagnosis of celiac disease
23
Q

Cutaneous manifestation of celiac disease is ____

A

Cutaneous manifestation of celiac disease is dermatitis herpetiformis

24
Q

Serologic testing for celiac disease should be performed when the patient is ____

A

Serologic testing for celiac disease should be performed when the patient is on a gluten-inclusive diet

  • Disease specific antibodies: deamidated antigladin antibodies, tissue transglutaminase antibody
  • Antiendomysial antibody
25
Q

Celiac disease associated with ____

A

Celiac disease associated with MHC class II

(HLA-DQ2 or HLA-DQ8 but both non-specific)

26
Q

Celiac disease gross finding is that ___

A

Celiac disease gross finding is that mucosa loses ridges and becomes flat

27
Q

Describe histology of celiac disease

A

Celiac disease histology

  • Shortening and broadening of villi followed by loss of villi
  • Increased intraepithelial lymphocytes
  • Increased inflammation in lamina propria
  • Elongation of crypts
28
Q

Celiac disease complications are ____, ____, and ____

A

Celiac disease complications are refractory sprue, ulcerative jejuno-ileitis, and overt neoplasms

  • Refractory sprue: no resolution even w/ gluten-free diet
  • Ulcerative jejuno-ileitis: ulcerated lesions, essentially a low-grade lymphoma
  • Overt neoplasm: predominantly T-cell lymphoma and rarely adenocarcinoma
29
Q

____ may cause enteropathy-associated T-cell lymphoma

A

Celiac disease may cause enteropathy-associated T-cell lymphoma

30
Q

Types of irritable bowel disease are ____, ____, and ____

A

Types of irritable bowel disease are Crohn’s disease, ulcerative colitis, or type-indeterminant

31
Q

Crohn’s disease has increased incidence in ____

A

Crohn’s disease has increased incidence in Ashkenazi Jews

(genetic component and environmental component)

32
Q

Interaction of ____ and ____ is vital to the pathogenesis of Crohn’s disease

A

Interaction of T-cells and antigen-presenting cells is vital to the pathogenesis of Crohn’s disease

33
Q

Crohn’s disease presents with ____, ____, and ____

A

Crohn’s disease presents with diarrhea ± blood, weight loss, and fever

  • Presentation depends on severity and location of disease
  • Extra-intestinal manifestations (6-25%): athropathies, peripheral arthralgias, granulomatous vasculitis, oral aphthous ulcers
34
Q

Characteristics of pathology of Crohn’s disease include ____ and ____

A

Characteristics of pathology of Crohn’s disease include chronicity and activity

  • Activity goes away first and then chronicity after treatment
  • Chronic changes may regress
35
Q

Describe the pathology of Crohn’s disease

A

Crohn’s disease pathology

  • Segmentsal distribution (skip lesions)
  • Transmural inflammation
  • Non-caseating granulomas (50-60%)
  • Strictures, ulcers, and fistulas
  • Creeping fat on serosa (secondary to transmural inflammation)
  • Cobblestoning of mucosa (secondary to mucosal damage)
36
Q

These are indicative of ____

A

These are indicative of Crohn’s disease

37
Q

Complications of Crohn’s disease include ____, ____, ____, and ____

A

Complications of Crohn’s disease include strictures leading to intestinal obstruction, perforation and fistula formation, toxic megacolon, and dysplasia -> adenocarcinoma

38
Q

___ is the most common acute abdominal emergency in children and young adults

A

Acute appendicitis is the most common acute abdominal emergency in children and young adults

(results from underlying cecal tumor in elderly)

39
Q

Pathogenesis of acute appendicitis includes ____ followed by ____

A

Pathogenesis of acute appendicitis includes an initial insult to the mucosa resulting from luminal obstruction by a fecalith / fragment of undigested food / lymphoid hyperplasia / tumor followed by a bacterial infection that progressively spreads outward from the mucosa and into / through the wall of the organ

40
Q

Acute appendicitis presents with ____, ____, ____, and ____

A

Acute appendicitis presents with RLQ periumbilical pain, anorexia, nausea, and mild fever / leukocytosis / elevated CRP

(peritonitis if perforation occurs)

41
Q

Gross findings of acute appendicitis are ____, ____, and ____

A

Gross findings of acute appendicitis are swelling / hyperemia, serosa covered with fibrin / pus, and dilated lumen

42
Q

Microscopic findings of acute appendicitis include ____ and ____

A

Microscopic findings of acute appendicitis include mucosal ulceration and suppurative acute inflammation involving all layers of the appendix

43
Q

Complications of acute appendicitis are ____, ____, ____, and ____

A

Complications of acute appendicitis are perforation, periappendiceal abscess, diffuse peritonitis, and fistula formation

  • Fistula formation (between appendix and intestine and bladder)
44
Q

Gut endocrine cells are ____ in origin

A

Gut endocrine cells are endodermal in origin

45
Q

Tumors arising from gut endocrine cells are classified as ____

A

Tumors arising from gut endocrine cells are classified as carcinoids

46
Q

Neuroendocrine tumors of the gut occur in the ____, ____, and ____

A

Neuroendocrine tumors of the gut occur in the foregut, midgut, and hindgut

  • 60-80% in midgut (mostly appendix and terminal ileum)
  • 10-25% arise in hindgut (mostly rectum)
  • 10% arise in foregut (stomach, duodenum)
47
Q

Neuroendocrine tumor cells generally have ____

A

Neuroendocrine tumor cells generally have salt and peper chromatin (very fine, granular quality)

48
Q

This is a ____

A

This is a neuroendocrine tumor

49
Q

Describe syndromes associated with neuroendocrine tumors

A

Syndromes associated with neuroendocrine tumors

  • Clinically symptomatic: carcinoid syndrome, Zollinger-Ellison, somatostatinoma, Cushing’s syndrome
  • Familial: MEN1, VH1L, tuberous sclerosis, NF-1

GI (40 decks)

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