SM_140b: Pathology of Small Intestine Disorders Flashcards
Small intestine mucosa consists of ___ and ___
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
Small bowel cell types include ____, ____, ____, and ____
Small bowel cell types include villi, crypts, goblet / mucous cells of crypts and villi, specific receptors on surface epithelial cells
Peyer’s patches are unique to the ___
Peyer’s patches are unique to the ileum
____ is the most common non-neoplastic disease affecting the small bowel
Peutz-Jeghers polyp is the most common non-neoplastic disease affecting the small bowel
____ are a haphazard arrangement of stromal and epithelial elements (non-neoplastic)
Hamartamous polyps are a haphazard arrangement of stromal and epithelial elements (non-neoplastic)
___ is characterized by intestinal polyposis and mucocutaneous melanin pigmentation
Peutz-Jeghers Syndrome is characterized by intestinal polyposis and mucocutaneous melanin pigmentation
Peutz-Jeghers syndrome presents in ____ with ____, ____, and ____
Peutz-Jeghers syndrome presents in 2nd-3rd decade with abdominal pain, intussusception, and bleeding
- Almost all with small intestinal polyps
- Polyps throughout GI tract
Most patients with Peutz-Jegher’s syndrome have a mutation in ____
Most patients with Peutz-Jegher’s syndrome have a mutation in STK11 / LKB1 gene
Peutz-Jeghers syndrome histology includes ____ and ____
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
Hyperplastic mucinous epithelium is indicative of ____
Hyperplastic mucinous epithelium is indicative of Peutz-Jeghers syndrome
Peutz-Jeghers syndrome is associated with ____
Peutz-Jeghers syndrome is associated with cancer
____ is a rare systemic bacterial infection by Tropheryma Whippelii
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
Describe symptoms of Whipple’s disease
Whipple’s disease symptoms
- Malaise
- Weight loss
- Malabsorption
- Diarrhea
- Arthritis
- Pleuritis
- Sometimes symptoms last years before diagnosis
Describe pathology of Whipple’s disease
Whipple’s disease pathology
- Intestine is dilated, thickened, and rigid
- Variable degree of mucosal atrophy
- Lamina propria contains macrophages filled with bacteria (non-specific)
Jejunum showing white plaque lesions is ____
Jejunum showing white plaque lesions is Whipple’s disease
Tons of foamy histiocytes in lamina propria is ____
Tons of foamy histiocytes in lamina propria is Whipple’s disease
Lamina propria macrophages filled with bacteria is ____
Lamina propria macrophages filled with bacteria is Whipple’s disease
___ is gluten-sensitivity enteropathy
Celiac disease is gluten-sensitivity enteropathy
Celiac disease results from ____
Celiac disease results from gluten and gluten breakdown products leading to mucosal damage
Celiac disease pathogenesis is ____ and ____
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
Celiac disease classically presents with ____, ____, and ____
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
Cutaneous manifestation of celiac disease is ____
Cutaneous manifestation of celiac disease is dermatitis herpetiformis
Serologic testing for celiac disease should be performed when the patient is ____
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
Celiac disease associated with ____
Celiac disease associated with MHC class II
(HLA-DQ2 or HLA-DQ8 but both non-specific)
Celiac disease gross finding is that ___
Celiac disease gross finding is that mucosa loses ridges and becomes flat
Describe histology of celiac disease
Celiac disease histology
- Shortening and broadening of villi followed by loss of villi
- Increased intraepithelial lymphocytes
- Increased inflammation in lamina propria
- Elongation of crypts
Celiac disease complications are ____, ____, and ____
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
____ may cause enteropathy-associated T-cell lymphoma
Celiac disease may cause enteropathy-associated T-cell lymphoma
Types of irritable bowel disease are ____, ____, and ____
Types of irritable bowel disease are Crohn’s disease, ulcerative colitis, or type-indeterminant
Crohn’s disease has increased incidence in ____
Crohn’s disease has increased incidence in Ashkenazi Jews
(genetic component and environmental component)
Interaction of ____ and ____ is vital to the pathogenesis of Crohn’s disease
Interaction of T-cells and antigen-presenting cells is vital to the pathogenesis of Crohn’s disease
Crohn’s disease presents with ____, ____, and ____
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
Characteristics of pathology of Crohn’s disease include ____ and ____
Characteristics of pathology of Crohn’s disease include chronicity and activity
- Activity goes away first and then chronicity after treatment
- Chronic changes may regress
Describe the pathology of Crohn’s disease
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)
These are indicative of ____
These are indicative of Crohn’s disease
Complications of Crohn’s disease include ____, ____, ____, and ____
Complications of Crohn’s disease include strictures leading to intestinal obstruction, perforation and fistula formation, toxic megacolon, and dysplasia -> adenocarcinoma
___ is the most common acute abdominal emergency in children and young adults
Acute appendicitis is the most common acute abdominal emergency in children and young adults
(results from underlying cecal tumor in elderly)
Pathogenesis of acute appendicitis includes ____ followed by ____
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
Acute appendicitis presents with ____, ____, ____, and ____
Acute appendicitis presents with RLQ periumbilical pain, anorexia, nausea, and mild fever / leukocytosis / elevated CRP
(peritonitis if perforation occurs)
Gross findings of acute appendicitis are ____, ____, and ____
Gross findings of acute appendicitis are swelling / hyperemia, serosa covered with fibrin / pus, and dilated lumen
Microscopic findings of acute appendicitis include ____ and ____
Microscopic findings of acute appendicitis include mucosal ulceration and suppurative acute inflammation involving all layers of the appendix
Complications of acute appendicitis are ____, ____, ____, and ____
Complications of acute appendicitis are perforation, periappendiceal abscess, diffuse peritonitis, and fistula formation
- Fistula formation (between appendix and intestine and bladder)
Gut endocrine cells are ____ in origin
Gut endocrine cells are endodermal in origin
Tumors arising from gut endocrine cells are classified as ____
Tumors arising from gut endocrine cells are classified as carcinoids
Neuroendocrine tumors of the gut occur in the ____, ____, and ____
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)
Neuroendocrine tumor cells generally have ____
Neuroendocrine tumor cells generally have salt and peper chromatin (very fine, granular quality)
This is a ____
This is a neuroendocrine tumor
Describe syndromes associated with neuroendocrine tumors
Syndromes associated with neuroendocrine tumors
- Clinically symptomatic: carcinoid syndrome, Zollinger-Ellison, somatostatinoma, Cushing’s syndrome
- Familial: MEN1, VH1L, tuberous sclerosis, NF-1
