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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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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
Celiac disease associated with \_\_\_\_
Celiac disease associated with MHC class II (HLA-DQ2 or HLA-DQ8 but both non-specific)
26
Celiac disease gross finding is that \_\_\_
Celiac disease gross finding is that mucosa loses ridges and becomes flat
27
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
28
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
29
\_\_\_\_ may cause enteropathy-associated T-cell lymphoma
Celiac disease may cause enteropathy-associated T-cell lymphoma
30
Types of irritable bowel disease are \_\_\_\_, \_\_\_\_, and \_\_\_\_
Types of irritable bowel disease are Crohn's disease, ulcerative colitis, or type-indeterminant
31
Crohn's disease has increased incidence in \_\_\_\_
Crohn's disease has increased incidence in Ashkenazi Jews (genetic component and environmental component)
32
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
33
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
34
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
35
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)
36
These are indicative of \_\_\_\_
These are indicative of Crohn's disease
37
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
38
\_\_\_ 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)
39
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
40
Acute appendicitis presents with \_\_\_\_, \_\_\_\_, \_\_\_\_, and \_\_\_\_
Acute appendicitis presents with RLQ periumbilical pain, anorexia, nausea, and mild fever / leukocytosis / elevated CRP (peritonitis if perforation occurs)
41
Gross findings of acute appendicitis are \_\_\_\_, \_\_\_\_, and \_\_\_\_
Gross findings of acute appendicitis are swelling / hyperemia, serosa covered with fibrin / pus, and dilated lumen
42
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
43
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)
44
Gut endocrine cells are ____ in origin
Gut endocrine cells are endodermal in origin
45
Tumors arising from gut endocrine cells are classified as \_\_\_\_
Tumors arising from gut endocrine cells are classified as carcinoids
46
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)
47
Neuroendocrine tumor cells generally have \_\_\_\_
Neuroendocrine tumor cells generally have salt and peper chromatin (very fine, granular quality)
48
This is a \_\_\_\_
This is a neuroendocrine tumor
49
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

GI (40 decks)

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