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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
What is the typical history of a patient with tropical sprue? By what is it typically preceded?
* History * Visited / lived in tropical area * Preceded by infectious diarrhea
26
What part of the GIT is most commonly affected by Tropical Sprue?
Distal small bowel | (Jejunum, Ileum)
27
What disease process is pictured below?
Celiac Sprue
28
What disease process is pictured below?
Tropical Sprue
29
Irritable Bowel Syndrome * Definition * Characteristics * Long term effects * Diagnosis
* 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!
30
What histological changes are present in patients with IBS?
None
31
What population is most affected by IBC (Crohns and Ulcerative Colitis)?
Females, teens and early 20s
32
NOD2, ATG16L1, and IRGM genes are linked to development of what disease? What are their function?
Crohn's Disease * Function * recognition, response, and clearance of intracellular pathogens
33
Polymorphisms in which interleukin is protective in Crohn's disease and Ulcerative Colitis?
IL-23
34
What is the primary treatment for IBD?
Immunosuppression
35
Defects in what epithelial characteristics are found in Crohn's Disease?
1. Tight junctions * associations with NOD2 polymorphisms 2. Antibacterial peptides * Abnormal defensins in Paneth cells
36
Defects in what epithelial characteristics are found in Ulcerative Colitis?
1. Extracellular mucin/matrix barrier 2. Intestinal barrier
37
What is the proposed model for UC and CD development?
* Flux of bacteria across epithelium * Activation of immune response (w/ genetic susceptibility) * Release of TNF * increased permeaility at tight junctions * Further influx * CYCLE!!
38
What does "Metastatic Crohn Disease refer to?
Granulomas in the mesenteric lymph nodes associated with Crohns
39
What features of colitis cause an increased risk of neoplasia?
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
What are the characteristics of Diversion Colitis? What is the cure?
* Characteristics * temp or permanent ostomy * Numerous lymph nodules * Cure * Reanastomosis of diverted segment
41
What disease process is pictured below?
Collagenous colitis * Inflammatory infiltrate in lamina propria * Subepithelial collagen layer
42
What disease process is pictured below?
Lymphocytic colitis
43
What disease process is pictured below?
Crohn Disease
44
What disease process is pictured below?
Ulcerative Colitis * Inflammation limited to submucosa
45
What disease process is pictured below?
Crohn Disease * "String sign"
46
What are the histologic differences between Crohns and Ulcerative Colitis?
Also, Granuloma, creeping fat, and wall thickening with Crohn Disease
47
What disease process is pictured below?
Hyperplastic polyps
48
What disease process is pictured below?
Inflammatory Polyps
49
What disease process is pictured below?
Juvenile form of hamartomatous polyps
50
What disease process is pictured below?
Peutz-Jeghers type Hamartomatous Polyps
51
What disease process is pictured below?
Tubular Adenomatous Polyps
52
What disease process is pictured below?
Villous Adenomatous Polyps
53
What disease process is pictured below?
Sessile-Serrated Adenomatous Polyps
54
MYH-associated polyposis * Mutations * Polyp characteristics * Cancer risk
* 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
What disease process is pictured below?
Familial adenomatous polyposis
56
MYH-associated polyposis has a defect in a gene with what function?
Base excision repair
57
Hereditary Nonpolyposis Colorectal Cancer Syndrome has a mutation in genes with what function?
DNA mismatch repair
58
What is the APC pathway to carcinoma and what is the starting mass/structure?
* Starts with adenoma * Path * APC * beta-catenin * KRAS * TP53 * Telomerase
59
What mutation pathways / cellular processes lead sessile serrated adenomas to become carcinomas?
* Mixture of: * Microsatellite instability * Increased CpG island methylation * May be one, the other, or both together
60
What gene is expressed in 90% adenocardinomas and 40-90% adenomas?
COX-2
61
Describe the staging (T) of colorectal cancer:
62
What is iron deficient anemia in older men or women until proven otherwise?
Colorectal cancer!!!
63
What is the presentation of tumors of the anal canal?
* Bleeding * Pain * More common in women and homosexual men
64
What is the pathogenesis of squamous tumors of the anal canal?
* HPV is the cause (squamous type) * Precursor lesion: Condyloma accuminatum
65
What is the anatomical separation between internal and external hemorrhoids?
* Pectinate line
66
Strongyloides * Route of infxn * ​Characteristics of infxn * Diagnosis
* 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
Necator dudenale * Route of infxn * Symptoms * Diagnosis
Hookworm * Route of infxn * Larva penetrate skin * Symptoms * Suck blood from intestines * Erosions, hemorrhage, iron defi * Diagnosis * eggs in fecal smear
68
Ancylostoma dudenale
Hookworm * Route of infxn * Larva penetrate skin * Symptoms * Suck blood from intestines * Erosions, hemorrhage, iron defi * Diagnosis * eggs in fecal smear
69
Enterobius vermicularis * Transmission * Symptoms * Diagnosis
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
Trichuris trichiura * Transmission * Symptoms * Diagnosis
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
Schistosomiasis * Location of parasite * Symptoms * Diagnosis
Fluke * Location of parasite * mesenteric veins * Histo * granuloma formation * egg deposition in mucosa/submucosa * Symptoms * Bleeding * Obstruction * Diagnosis * eggs in feces
72
Hymenolepsis nana * Transmission * Path * Symptoms * Diagnosis
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
What disease process is pictured below?
Cryptosporidium Trophozoite embedded in a vacuole of microvillus
74
What disease process is pictured below?
Entamoeba histolytica
75
What disease process is pictured below?
Giardia lamblia Trophozoites Pear-shaped, two nuclei, 4 pairs of flagelli

Pathology (27 decks)

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