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MHD > Small and Large Intestine > Flashcards

Small and Large Intestine Flashcards

1
Q

What histological features distinguish the duodenum? Jejunum? Ileum?

A

Duodenum - Brunner’s glands in the submucosa

Ileum - Peyer’s patches

Jejunum - neither

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2
Q

What is the function of Brunner’s glands?

A

Secrete mucus and HCO3- to neutralize acid coming into duodenum from stomach

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3
Q

What is the function of Peyer’s patches?

A

Large aggregates of lymphoid cells used for host defense

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4
Q

What is the function of Paneth cells?

A

Contain pink granules with lysozymes, defensins, and other things to aid digestion and help regulate microbiota of small intestine

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5
Q

Where in the GI tract are ganglion cells located?

A

Submucosa (Meissner’s/submucosal plexus)

Between the inner circular muscle and outer longitudinal muscle of the muscularis propria (Auerbach/myenteric plexus)

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6
Q

What is the main difference between gastroschisis and omphalocele?

A

Gastroschisis has exposure of abdominal contents without the peritoneum

Omphalocele has abdominal contents surrounded by the peritoneum and the amnion of the cord

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7
Q

What is intussusception?

A

Telescoping of one part of bowel into another (often part of small intestine inside large intestine)

Could cause obstruction of blood vessels and of the food bolus moving through intestines

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8
Q

What is volvulus?

A

Twisting of bowel around its mesentery, leading to obstruction and infarction

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9
Q

What is necrotizing enterocolitis?

A

Acute necrotizing inflammation of small and/or large intestines

Edema -> necrosis -> gangrenous bowel

Most common acquired GI emergency in premie or low birth weight neonate

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10
Q

Meckel Diverticulum

What is the pathologic issue?

A

Persistence of the vitelline duct

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11
Q

Meckel Diverticulum

Known as disease of 2’s because…

A

2% of population, mostly asymptomatic

2 inches long
Within 2 feet of ileocecal valve in small intestine
2:1 M:F ratio

2 major complications:
Pain with inflammation
Hemorrhage with ulcer

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12
Q

Hirschsprung Disease

What is the basic pathologic issue?

A

Absence of ganglion cells

Death of neural crest cells from cecum to rectum

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13
Q

Hirschsprung Disease

How is it diagnosed?

A

Suction biopsy needed to get a biopsy deep enough to include submucosa and muscularis propria

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14
Q

Hirschsprung Disease

What do you expect to see on histology?

A

Lack of ganglion cells in the myenteric plexus

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15
Q

Hirschsprung Disease

Treatment

A

Resection of the portion of bowel without the neurons

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16
Q

What are some general symptoms of malabsorption?

A

Chronic diarrhea
Weight loss
Abdominal pain
No villi -> steatorrhea

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17
Q

What are some signs of pancreatic insufficiency?

A

Increased neutral fat

Normal D-xylose absorption test (urinary excretion)

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18
Q

Disaccharidase Deficiency

What is the most common deficiency?

A

Lactase deficiency (Lactose intolerance)

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19
Q

What happens when a person with lactose intolerance eats lactose?

A

Due to lack of lactase enzyme, the intestines cannot digest lactose. Lactose remains in intestinal lumen, pulling water into the lumen via osmotic forces and causing an osmotic diarrhea

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20
Q

Abetalipoproteinemia

What is the basic issue?

A

Low synthesis of apolipoprotein B, which is required for chylomicron generation

Results in decreased secretion of cholesterol and fat accumulation in enterocytes

Presents as failure to thrive in early childhood

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21
Q

Celiac Disease

What is the basic issue?

A

Autoimmune disorder resulting in damage to small intestine lining when foods containing gluten are eaten

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22
Q

Celiac Disease

Diagnosis

A

Serum test
Look for IgA/IgG to tissue transglutaminase (tTG), deaminated gliadin, HLA DQ2 or DQ8

Biopsy
Look for increased intraepithelial lymphocytes and flattening of the villi

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23
Q

Celiac Disease

Clinical Features in Infants

A 
Diarrhea
Failure to thrive
Abdominal distension
Anorexia
Weight loss
Irritability
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24
Q

Celiac Disease

Clinical Features in Older Children and Adults

A

Abdominal pain
Nausea
Vomiting
Bloating/Constipation

Diarrhea
Flatulence
Weight loss
Anemia
Fatigue
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25
Q

Celiac Disease

Describe Dermatitis Herpetiformis

A

Skin blistering disease caused by IgA deposition in the dermal papillae

Can cause obstruction of blood vessels in dermis, causing epidermis to separate and blister

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26
Q

Tropical Sprue

What is it caused by? Where? How to treat?

A

Similar findings to celiac disease, caused by an unknown infectious agent

Seen in Caribbean

Treat with antibiotics

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27
Q

Bacterial Infectious Enterocolitis

What is seen on histology?

A

Acute inflammation of the colon with many PMNs in the epithelium and lamina propria

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28
Q

List two common viral causes of enterocolitis

A

Noravirus

Rotavirus

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29
Q

List the two common protozoan causes of enterocolitis

A

Giardia - commonly from drinking freshwater streams

Entamoeba Histolytica - causes flash shaped ulcer on histology

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30
Q

Pseudomembranous Colitis

What often precedes the development of this disease?

A

Course of broad spectrum ABX

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31
Q

Pseudomembranous Colitis

Gross appearance of colon

A

Yellow-green false membrane of mucus and PMNs

See mushroom shaped pseudomembrane on histology

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32
Q

What organism is associated with Pseudomembranous Colitis?

A

Clostridium difficile

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33
Q

Collagenous Colitis

Who commonly gets this? What is the main symptom?

A

Middle aged females with watery diarrhea

34
Q

Collagenous Colitis

What is seen histologically?

A

Lymphocytes in the epithelium

Subepithelial deposition of collagen

35
Q

Lymphocytic Colitis

What is the primary symptom? What is seen histologically?

A

Chronic watery diarrhea

Intraepithelial lymphocytes are present, but there is no subepithelial collagen

36
Q

Whipple Disease

Describe the basic pathogenesis

A

Organism: Tropheryma whippleli
Macrophages engulf the organism, distend the villi, congest blood vessels and lymphatics

May cause enterocyte necrosis or poor absorption

37
Q

What are two main types of IBD?

A

Crohn’s Disease

Ulcerative Colitis

38
Q

Crohn’s Disease

Symptoms

A

Diarrhea (non-bloody)
Cramping abdominal pain (RLQ)
Low grade fever

Asymptomatic periods (skip periods) with recurrent attacks or flare ups

39
Q

Crohn’s Disease

Complications and extra-intestinal manifestations

A

Erythema nodosum (subcutaneous nodules on lower extremities)
Pyoderma gangrenosum
Uveitis
Kidney stones

40
Q

Crohn’s Disease

Gross appearance

A

Fissure moving through entire wall into the muscularis propria and serosa

Narrowing of lumen (stricture)

41
Q

Crohn’s Disease

Histology

A

Non caseating granulomas
Transmural inflammation

See many PMNs in the crypt

42
Q

Ulcerative Colitis

Symptoms

A

Bloody diarrhea

Recurring with asymptomatic intervals

43
Q

Ulcerative Colitis

Complications

A

Primary sclerosing cholangitis

44
Q

Ulcerative Colitis

Pathogenesis

A

Inflammation involving only the colon, spreading up from rectum through colon.

Pseudopolyps are seen grossly (normal areas surrounded by ulcerated areas)

45
Q

Ulcerative Colitis

Histology

A

Crypts filled with PMNs is primary feature

More superficial process than Crohn’s – Ulcerative Colitis only involves the mucosa and submucosa

46
Q

Crohn’s vs. Ulcerative Colitis

Which is continuous?

A

Ulcerative colitis involves rectum and colon continuously

Crohn’s has skip areas

47
Q

Crohn’s vs. Ulcerative Colitis

Which involves the full thickness of the wall?

A

Crohn’s is transmural

Ulcerative Colitis is only mucosa and submucosa

48
Q

Crohn’s vs. Ulcerative Colitis

What are the extraintestinal involvements of each?

A

Crohn’s - migratory polyarthritis and kidney stones

Ulcerative Colitis - Primary sclerosing cholangitis

49
Q

Diverticulum

Where are they most common?

A

Sigmoid colon

50
Q

Diverticulum

Difference between true and false diverticula

A

True - involving mucosa, submucosa, and muscularis propria

False- involving mucosa and submucosa only

51
Q

Diverticulum

How does diverticulitis develop?

A

Diverticulum is a blind outpouching of the colon where fecal matter can get stuck, cause inflammation, thus causing diverticulitis

52
Q

Where are direct hernias found? What about above and below those?

A

Hasselbach’s triangle

Above - indirect
Below- Femoral

53
Q

Ischemic Bowel Disease

Symptoms

A 
Severe abdominal pain
Tenderness
Bloody diarrhea
Melena
Could lead to sepsis, shock, death
54
Q

Ischemic Bowel Disease

What is the watershed zone?

A

Splenic flexure

Area furthest away from blood supply, so it is at higher risk for ischemia

55
Q

Ischemic Bowel Disease

Pathogenesis

A

Something causes hypoxic or reperfusion injury to the colon

Athersclerosis, AAA, hypercoagulable state, oral contraceptives, embolization, cardiac failure, shock, dehydration, vasoconstrictive drugs, vasculitis

56
Q

What are Hemorrhoids?

A

Anal varices
Dilated anal and perianal collateral vessels

Causes pain and some abdominal bleeding

57
Q

What is the difference between internal and external hemorrhoids?

A

Internal - above pectinate line; receive visceral innervation and are NOT painful

External- below pectinate line; receive somatic innervation and are painful

58
Q

Inflammatory Polyp

What syndrome is it associated with?

A

Solitary Rectal Ulcer Syndrome

59
Q

Hamatomatous Polyp

What syndrome is it associated with?

A

Peutz-Jeghers syndrome

60
Q

Peutz-Jeghers Syndrome

What is the inheritance? What are the symptoms?

A

Autosomal dominant

Hyperpigmented melanotic macules of mouth, lips, genitals, hands

61
Q

Peutz-Jeghers syndrome

What are patients at risk for?

A

Polyps themselves are not malignant, but there is increased risk of CRC and other malignancies (pancreas, breast, lung, ovary, uterus, testes)

62
Q

Hyperplastic Polyp

What is the appearance on histology?

A

Proliferation of mature goblet cells

Serrated/sawtooth appearance of goblet cells stacking on one another

63
Q

Adenomatous Polyp

What are the two broad classifications of it’s gross appearance? Which is more dangerous?

A

Pedunculated (on a stalk)

Sessile (growing directly out of intestinal wall)

Sessile is more dangerous

64
Q

Adenomatous Polyp

Tubular vs. Villous appearance - Which is more dangerous?

A

Villous is more likely to grow into an adenocarcinoma

65
Q

Sessile Serrated Adenoma

Where do they mostly occur?

A

Adenomatous polyp in the RIGHT colon

Sawlike serrated areas

66
Q

Familial Adenomatous Polyposis

What is the inheritance? How is it treated?

A

Autosomal dominant
Defect in APC gene on chromosome 5

Treated with prophylactic colectomy for APC mutations

67
Q

Gardner Syndrome

What are the symptoms?

A

Polyps similar to FAP

Osteomas of mandible, skull

Fibromatosis- non-neoplastic fibroblast proliferation

68
Q

Turcots Syndrome

What are the symptoms?

A

FAP with CNS tumors
Medulloblastomas
Glioblastomas

69
Q

HNPCC

What is the defect? Inheritance?

A

Autosomal dominant defect in DNA mismatch repair, leading to increased risk of many cancers

70
Q

Describe the function of the APC gene product. What happens when it is knocked out?

A

APC binds beta-catenin and prevents it from activating transcription of many tumor promoting genes.

When APC is knocked out (2 hits needed), Beta-catenin is free to activate transcription of MYC, cyclin D1, others to promote tumors

71
Q

DNA mismatch repair defects are seen (mostly) in what disorders?

A

HNPCC and sessile serrated adenomas

72
Q

APC mutations are seen mostly in what disorders?

A

FAP or sporadic CRC

73
Q

DNA mismatch repair defects may be caused in mutations in what genes?

A 
MLH1
MSH2
MSH6
PMS1
PMS2
74
Q

Colon Cancer

How will it appear on imaging?

A

Apple core lesion on barium X ray because tumor is compressing and narrowing lumen

75
Q

Colon Cancer

How are the shapes of R sided and L sided colon cancers different?

A

R sided - tumor grows on one side of lumen and obstructs (exophytic tumor)

L sided - “Napkin ring” lesion that causes obstructive symptoms much more quickly

76
Q

Which side of the colon has a larger diameter?

A

Right, so R sided colon tumors take longer to cause obstruction

77
Q

What are the general presenting symptoms of R and L sided colon cancers?

A

R sided - iron deficiency anemia

L sided - obstruction

78
Q

What types of cancers are likely to be seen in the rectum and anus?

A

Rectum = adenocarcinoma

Anus = squamous cell carcinoma

79
Q

List the stages of colon cancer progression

A

T is – intraepithelial or lamina propria

T1- submucosa
T2- muscularis externa
T3- serosa
T4- peritoneum, other organs, perforation

80
Q

Appendicitis

Symptoms

A

Nausea/vomting
Periumbilical pain localizing to RLQ
Obstruction leading to impaired blood flow and bacterial contamination

81
Q

Appendicitis

Gross appearance

A

Appendix is enlarged with yellow-green exudate (pus)

82
Q

Appendicitis

Histology

A

Transmural inflammation

Lots of PMNs and eosinophils

MHD (57 decks)

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