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Small and Large Intestine Flashcards

1
Q

What disease process is pictured below?

A

Meckel’s Diverticulum

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2
Q

What part of the colon is most susceptible to transmural infarction?

A

Splenic flexure

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3
Q

What layers of the bowel are involved in the following infarctions?

  • Mucosal
  • Mural
  • Transmural
A
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4
Q

What disease process is pictured below?

A

Ischemic Bowel Disease

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5
Q

What anatomic complications can result from ischemic bowel disease?

A
  • Fibrosis
  • Strictures
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6
Q

What life-threatening complication can arise in transmural bowel infarction?

A

Shock and vascular collapse

Happens rapidly (hours)

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7
Q

What is the most common acquired GI emergency of premature or low birth weight neonates?

A

Necrotizing enterocolitis

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8
Q

What disease process is pictured below?

A

Angiodysplasia

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9
Q

What is the most common presentation for malabsorption syndromes?

A

Chronic diarrhea

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10
Q

What are the most common causes of malabsorption syndromes in the US?

A
  1. Celiac
  2. Pancreatic insufficiency
    • including cystic fibrosis
  3. Crohn disease
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11
Q

What is characterized by low volume, painful, bloody diarrhea?

A

Dysentery

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12
Q

What is characterized by voluminous, frothy diarrhea that is greasy and yellow in color? In which disease type is this most commonly found?

A

Steatorrhea

***Hallmark of malabsorption disease***

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13
Q

What type of diarrhea is isotonic and persists during fasting? What are its causes?

A

Secretory diarrhea

  • Causes:
    • enterocolitis (bacterial, viral)
    • Cholera
    • Excessive laxative use
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14
Q

What type of diarrhea is characterized by high osmolality and abates with fasting? What are its causes?

A

Osmotic diarrhea

  • Causes:
    • Malabsorption
      • Lactase deficiency
    • Antacids
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15
Q

What type of diarrhea is characterized by purulent, bloody stool and persists with fasting? What are its causes?

A

Exudative diarrhea

  • Causes:
    • Infectious!!
    • Shigella
    • Salmonella
    • Campylobacter
    • Entamoeba histolytica
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16
Q

What peptide is unable to be digested in Celiac sprue?

A

the amino acid alpha-gliadin

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17
Q

Which HLA genes are associated with Celiac Sprue?

A

DQ2

DQ8

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18
Q

How do adults present with Celiac Disease? What long-term complications may arise?

A
  • Adult Presentation
    • Anemia (malabsorption)
    • Chronic diarrhea
    • Bloating
    • Dermatitis herpetiformis (blistering rash)
  • Complications
    • Lymphocytic gastritis
    • Lymphocytic colitis
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19
Q

How do Peds patients present with Celiac Sprue? At what age does it normally present?

A
  • Presentation
    • Anorexia
    • Abdominal distention
    • Chronic diarrea
    • Muscle wasting
    • Failure to thrive
  • Age:
    • 6-24 months
    • age at which gluten is added to diet
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20
Q

What are the nonclassic symptoms of Celiac Sprue? When does this normally present?

A
  • Nonclassic symptoms:
    • Abdominal pain
    • Vomiting
    • Bloating
    • Constipation
    • Extraintestinal: arthritis, seizure, anemia, puberty delay
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21
Q

Celiac Sprue is most associated with which types of cancer?

A
  1. Enteropathy-associated T-cell lymphoma
  2. Small Intestinal Adenocarcinoma
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22
Q

What parts of the GIT are most exposed to gluten?

A

Duodenum

Proximal jejunum

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23
Q

What histology is associated with Celiac sprue?

A
  • Increased cells:
    • CD8+
    • CD4+
    • Plasma cells
  • Loss of brush border
  • Loss of villi
  • Crypt hyperplasia
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24
Q

What is the histology of Tropical sprue?

A

Villus atrophy (but normally not complete)

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25
Q

What is the typical history of a patient with tropical sprue? By what is it typically preceded?

A
  • History
    • Visited / lived in tropical area
  • Preceded by infectious diarrhea
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26
Q

What part of the GIT is most commonly affected by Tropical Sprue?

A

Distal small bowel

(Jejunum, Ileum)

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27
Q

What disease process is pictured below?

A

Celiac Sprue

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28
Q

What disease process is pictured below?

A

Tropical Sprue

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29
Q

Irritable Bowel Syndrome

  • Definition
  • Characteristics
  • Long term effects
  • Diagnosis
A
  • Diagnosis:
    • Abdominal pain at least 3 days/month over 3 months
    • Change in stool (frequency or form)
  • Characteristics
    • May have diarrhea, constipation, or both
  • Long term effects
    • None
  • Diagnosis:
    • must rule out other causes!
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30
Q

What histological changes are present in patients with IBS?

A

None

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31
Q

What population is most affected by IBC (Crohns and Ulcerative Colitis)?

A

Females, teens and early 20s

32
Q

NOD2, ATG16L1, and IRGM genes are linked to development of what disease? What are their function?

A

Crohn’s Disease

  • Function
    • recognition, response, and clearance of intracellular pathogens
33
Q

Polymorphisms in which interleukin is protective in Crohn’s disease and Ulcerative Colitis?

34
Q

What is the primary treatment for IBD?

A

Immunosuppression

35
Q

Defects in what epithelial characteristics are found in Crohn’s Disease?

A
  1. Tight junctions
    • associations with NOD2 polymorphisms
  2. Antibacterial peptides
    • Abnormal defensins in Paneth cells
36
Q

Defects in what epithelial characteristics are found in Ulcerative Colitis?

A
  1. Extracellular mucin/matrix barrier
  2. Intestinal barrier
37
Q

What is the proposed model for UC and CD development?

A
  • Flux of bacteria across epithelium
  • Activation of immune response (w/ genetic susceptibility)
  • Release of TNF
    • increased permeaility at tight junctions
  • Further influx
  • CYCLE!!
38
Q

What does “Metastatic Crohn Disease refer to?

A

Granulomas in the mesenteric lymph nodes associated with Crohns

39
Q

What features of colitis cause an increased risk of neoplasia?

A
  1. 8-10 year duration
  2. Pancolitis (vs left-sided disease)
  3. Increased frequency or severity of inflammation
  4. Primary sclerosing cholangitis as a side effect
40
Q

What are the characteristics of Diversion Colitis? What is the cure?

A
  • Characteristics
    • temp or permanent ostomy
    • Numerous lymph nodules
  • Cure
    • Reanastomosis of diverted segment
41
Q

What disease process is pictured below?

A

Collagenous colitis

  • Inflammatory infiltrate in lamina propria
  • Subepithelial collagen layer
42
Q

What disease process is pictured below?

A

Lymphocytic colitis

43
Q

What disease process is pictured below?

A

Crohn Disease

44
Q

What disease process is pictured below?

A

Ulcerative Colitis

  • Inflammation limited to submucosa
45
Q

What disease process is pictured below?

A

Crohn Disease

  • “String sign”
46
Q

What are the histologic differences between Crohns and Ulcerative Colitis?

A

Also, Granuloma, creeping fat, and wall thickening with Crohn Disease

47
Q

What disease process is pictured below?

A

Hyperplastic polyps

48
Q

What disease process is pictured below?

A

Inflammatory Polyps

49
Q

What disease process is pictured below?

A

Juvenile form of hamartomatous polyps

50
Q

What disease process is pictured below?

A

Peutz-Jeghers type Hamartomatous Polyps

51
Q

What disease process is pictured below?

A

Tubular Adenomatous Polyps

52
Q

What disease process is pictured below?

A

Villous Adenomatous Polyps

53
Q

What disease process is pictured below?

A

Sessile-Serrated Adenomatous Polyps

54
Q

MYH-associated polyposis

  • Mutations
  • Polyp characteristics
  • Cancer risk
A
  • Mutations
    • MYH gene (Base excision repair)
    • KRAS mutation (if serrated)
  • Polyp characteristics
    • Less than 100
    • Serrated have KRAS mutation
    • Develop at later ages
  • Cancer risk
    • age 50 or later
55
Q

What disease process is pictured below?

A

Familial adenomatous polyposis

56
Q

MYH-associated polyposis has a defect in a gene with what function?

A

Base excision repair

57
Q

Hereditary Nonpolyposis Colorectal Cancer Syndrome has a mutation in genes with what function?

A

DNA mismatch repair

58
Q

What is the APC pathway to carcinoma and what is the starting mass/structure?

A
  • Starts with adenoma
  • Path
    • APC
    • beta-catenin
    • KRAS
    • TP53
    • Telomerase
59
Q

What mutation pathways / cellular processes lead sessile serrated adenomas to become carcinomas?

A
  • Mixture of:
    • Microsatellite instability
    • Increased CpG island methylation
    • May be one, the other, or both together
60
Q

What gene is expressed in 90% adenocardinomas and 40-90% adenomas?

61
Q

Describe the staging (T) of colorectal cancer:

62
Q

What is iron deficient anemia in older men or women until proven otherwise?

A

Colorectal cancer!!!

63
Q

What is the presentation of tumors of the anal canal?

A
  • Bleeding
  • Pain
  • More common in women and homosexual men
64
Q

What is the pathogenesis of squamous tumors of the anal canal?

A
  • HPV is the cause (squamous type)
  • Precursor lesion: Condyloma accuminatum
65
Q

What is the anatomical separation between internal and external hemorrhoids?

A
  • Pectinate line
66
Q

Strongyloides

  • Route of infxn
  • ​Characteristics of infxn
  • Diagnosis
A
  • Route of infxn
    • Fecally contaminated soil
    • penetrates unbroken skin
  • ​Characteristics of infxn
    • Autoinfection
    • hatches in intestine, penetrates mucosa
  • Diagnosis
    • Larvae in feces
    • Serodiagnosis with ELISA
67
Q

Necator dudenale

  • Route of infxn
  • Symptoms
  • Diagnosis
A

Hookworm

  • Route of infxn
    • Larva penetrate skin
  • Symptoms
    • Suck blood from intestines
    • Erosions, hemorrhage, iron defi
  • Diagnosis
    • eggs in fecal smear
68
Q

Ancylostoma dudenale

A

Hookworm

  • Route of infxn
    • Larva penetrate skin
  • Symptoms
    • Suck blood from intestines
    • Erosions, hemorrhage, iron defi
  • Diagnosis
    • eggs in fecal smear
69
Q

Enterobius vermicularis

  • Transmission
  • Symptoms
  • Diagnosis
A

Pinworms

  • Transmission
    • Fecal oral
  • Symptoms
    • Rectal and perianal pruritis
      • due to perianal egg deposits
  • Diagnosis
    • Scotch tape test of perianal region

**Does not invade intestinal wall

70
Q

Trichuris trichiura

  • Transmission
  • Symptoms
  • Diagnosis
A

Whipworms

  • Transmission
    • engestion of plant material with eggs
  • Symptoms
    • bloody diarrhea
    • rectal prolapse
    • (heavy infestation only)
  • Diagnosis
    • Eggs in feces

**Does not invade intestinal wall

71
Q

Schistosomiasis

  • Location of parasite
  • Symptoms
  • Diagnosis
A

Fluke

  • Location of parasite
    • mesenteric veins
  • Histo
    • granuloma formation
    • egg deposition in mucosa/submucosa
  • Symptoms
    • Bleeding
    • Obstruction
  • Diagnosis
    • eggs in feces
72
Q

Hymenolepsis nana

  • Transmission
  • Path
  • Symptoms
  • Diagnosis
A

Cestode/Tapeworm

  • Transmission
    • Ingestion of undercooked meet
  • Path
    • Resides in lumen
    • Attaches to wall by scolex
    • Releases proglottids
  • Symptoms
    • Diarrhea
    • Nausea
    • NO eosinophilia
  • Diagnosis
    • Ova in stools
73
Q

What disease process is pictured below?

A

Cryptosporidium

Trophozoite embedded in a vacuole of microvillus

74
Q

What disease process is pictured below?

A

Entamoeba histolytica

75
Q

What disease process is pictured below?

A

Giardia lamblia

Trophozoites

Pear-shaped, two nuclei, 4 pairs of flagelli

Pathology (27 decks)

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