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GI > Small Intestine and Colon Pathology 2 > Flashcards

Small Intestine and Colon Pathology 2 Flashcards

1
Q

What is the most common cause of acute diarrhea?

A

Infectious diarrhea

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2
Q

C. difficile associated colitis sx spectrum?

A

Mild diarrhea to fully developed pseudomembranous colitis to fulminant disease w/perforation or toxic megacolon

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3
Q

C. difficile associated colitis pathology

A

Colonize human GI tract after normal flora altered by antibiotic therapy

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4
Q

Pseudomembranous colitis

A

Necrotic crypt cells with mucin, fibrin, and neutrophils and production of a pseudomembrane

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5
Q

Diagnostic test for C. difficile

A

Stool PCR assay to detect toxin producing C. Difficile strains

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6
Q

Inflammatory bowel disease

A
  • -Composed of chronic ulcerative colitis and Crohn’s disease
  • -Inappropriate immune reactions to luminal bacteria that activates mucosal immunity and suppresses immunoregulation
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7
Q

Age range that IBD often presents

A

15-30 and 50-80 yrs

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8
Q

Long-term complication of IBD

A

Intestinal adenocarcinoma (colitis associated dysplasia)

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9
Q

Ulcerative colitis

A
  • -MUCOSAL DISEASE
  • -Limited to colon and rectum in continuous fashion
  • -“Left-sided disease of colon”
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10
Q

Ulcerative colitis where only the rectum is involved

A

Ulcerative proctitis

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11
Q

What is basal plasmacytosis associated with?

A

Chronic cholitis

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12
Q

Pathology of ulcerative colitis

A
  • -Shallow ulcers with residual pseudopolyp mucosa

- -Lymphoplasmacytic inflammation

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13
Q

What is architectural distortion associated with?

A

Chronic inflammatory process

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14
Q

What does it mean when neutrophils perforate the crypt epithelium (neutrophilic cryptitis)?

A

Acute inflammation occurring and colitis considered active

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15
Q

Clinical manifestations of ulcerative colitis

A
  • -Bloody diarrhea w/mucus discharge
  • -Lower abdominal pain and cramps
  • -Tenesmus (secondary to proctitis)
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16
Q

Diagnostic test for ulcerative colitis

A

pANCA +

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17
Q

Complications of ulcerative colitis

A

Fulminant colitis w/toxic megacolon–> can cause perforation

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18
Q

Crohn’s disease

A
  • -Transmural inflammatory changes (more layers than mucosa)
  • -Can involve any layer of the inflammatory tract
  • -Skip lesions (not continuous)
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19
Q

Pathology of Crohn’s disease

A
  • -Typically involves ileum
  • -Inflammatory polyps
  • -Can present as aphthous ulcers
  • -Extends into submucosa and underlying muscle wall
  • -Cobblestone appearance of mucosa
  • -“Creeping fat”
  • -Fistula tract may be present
  • -Non-caseating granulomas may be present
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20
Q

Clinical manifestations of Crohn’s disease

A
  • -Variable

- -Usually starts with bouts of mild diarrhea, fever, abdominal pain

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21
Q

What can sometimes trigger Crohn’s disease

A

Cigarettes

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22
Q

What do 10-20% of patients with Crohn’s disease have?

A

–Extra-intestinal disease (primary sclerosing cholangitis, erythema nodosum, pyoderma gangrenosum, iritis/uveitis, HLA B27+ sacroiliitis/arthritis)

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23
Q

Diagnostic test for Crohn’s disease

A

ASCA +

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24
Q

Complications of Crohn’s disease

A

Small bowel strictures, bowel obstruction, bowel perforation w/fistula formation

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25
Q

Indeterminate colitis

A

Pathological overlap between UC and CD. Serologic studies may help

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26
Q

Quiescent colitis

A
  • -Following therapy

- -Persistent crypt architectural distortion w/o inflammation

27
Q

Diversion colitis

A
  • -Colitis developing in blind distal segment of colon (excluded from fecal stream)
  • -Following surgery w/formation of diverting ostomy
28
Q

Diversion colitis cause

A

–Deficiency in short-chain fatty acids

29
Q

Pathology of diversion colitis

A
  • -Mucosal erythema
  • -Friability
  • -Nodularity
30
Q

Tx of diversion colitis

A

Re-anastomosis w/return to normal fecal stream or SCFA enemas

31
Q

Radiation entercolitis

A
  • -Occurs when GI tract irradiated
  • -Epithelial damage acutely
  • -Chronic injury ischemic from vascular injury
32
Q

Pathology of radiation enterocolitis

A
  • -Ulcers, strictures, fistulas, serosal adhesions
  • -Patchy erythema, secondary to mucosal telangiectasias w/blood vessel hyalinization and thickened walls.
  • -Radiation fibroblasts may be present
33
Q

Neonatal necrotizing enterocolitis

A
  • -Can develop during 1st week in premature infants
  • -Small and large bowel necrosis (can become transmural)
  • -Bacterial overgrowth produces gas in intestinal wall
34
Q

Pneumatosis intestinalis

A
  • -Bacterial overgrowth causing gas in intestinal wall

- -Can be seen in neonatal necrotizing enterocolitis

35
Q

Microscopic colitis

A
  • -Chronic watery diarrhea
  • -Normal colonoscopy w/intact crypt architecture
  • -Though to be autoimmune mechanism
  • -Associated with Celiac disease
  • -Tx: glucocorticoids
36
Q

2 types of microscopic colitis

A

Lymphocytic colitis

Collagenous colitis

37
Q

Lymphocytic colitis

A
  • -Increased lamina propria chronic inflammation
  • -Increased plasma cells
  • -Increased intraepithelial lymphocytes
  • -Increased surface epithelial damage
38
Q

Collagenous colitis

A
  • -Band of subepithelial collagen in addition to changes seen in lymphocytic colitis
  • -Increased lamina propria chronic inflammation
  • -Increased plasma cells
  • -Increased intraepithelial lymphocytes
  • -Increased surface epithelial damage
39
Q

Classes of drugs implicated in drug induced enterocolitis

A

NSAIDs
Chemotherapeutic lesions
Antibiotics

40
Q

Irritable bowel syndrome

A
  • -Chronic, relapsing abdominal pain or discomfort, bloating and change in bowel habits (diarrhea or constipation)
  • -Absence of any known causative agent that could explain the sx (diagnosis of exclusion)
41
Q

Endoscopic and colonoscopic findings of IBS

A

No abnormalities

42
Q

Prevalence of IBS

A

5-10%

43
Q

Pathogenesis of IBS

A
  • -Not known
  • -May be related to increased/decreased colonic contraction/transit rates, excess bile acid synthesis, malabsorption of bile acids, disturbance in enteric nervous system function, immune activation, shift in gut microbiome
44
Q

Ischemic bowel disease causes

A
  • -Arterial obstruction/thrombosis
  • -Mesenteric venous thrombosis
  • -Hypoperfusion
45
Q

Bowel segments affected in ischemic bowel disease

A

–Segments located near end of arterial supply (splenic flexure, sigmoid colon, rectum)

46
Q

Complications of transmural bowel necrosis

A
  • -Sepsis
  • -Septic shock
  • -Death
47
Q

Presentation of acute mesenteric ischemia w/transmural necrosis

A
  • -Sudden onset abdominal pain
  • -Loss of bowel sounds
    • N and V
  • -Bloody diarrhea (melanotic, dark, tarry stool)
48
Q

Diagnosis of acute mesenteric ischemia w/transmural necrosis

A

High level of suspicion and demonstration of vascular obstruction

49
Q

Presentation of chronic mesenteric ischemia

A
  • -Abdominal pain following eating (mesenteric angina)
  • -Bouts of bloody diarrhea may occur
  • -Sx can mimic inflammatory bowel disease
50
Q

Angiodysplasia

A

Lesion consisting of malformed submucosal and mucosal blood vessels. Dilated tortuous capillaries in mucosa

51
Q

Clinical presentation of Angiodysplasia

A

Occurs in cecum and R colon in older adults. Bleeding can be acute and massive or chronic and intermittent

52
Q

Ischemic bowel disease population?

A

Generally older individuals w/coexisting CV disease

53
Q

Pathology of ischemic bowel disease

A
  • -Mucosal ischemic injury–> atrophy/loss of surface epithelium, hemorrhagic and hyalinized lamina propria, crypt atrophy
  • -Severe injury leads to coagulative necrosis of bowel layers
54
Q

Prevalence and etiology of angiodysplasia

A
  • -Prevalence: 1%

- -Etiology: uncertain, may be acquired and incidence increases with age

55
Q

Complication of angiodysplasia

A

Hematochezia

56
Q

Diagnosis of angiodysplasia

A

Colonoscopy and angiography

57
Q

Sigmoid diverticulitis

A

Formation of multiple diverticulae in sigmoid colon that are inflamed

58
Q

Pathology of sigmoid diverticulitis

A
  • -Elevated intraluminal pressure in sigmoid colon
  • -Focal discontinuities of inner muscular coat
  • -Can can outpouchings of mucosa and formation of diverticulae
59
Q

Common complications of sigmoid diverticulitis

A
  • -Abscess
  • -Obstruction
  • -Perforation
  • -Fistula
60
Q

Treatment of sigmoid diverticulitis

A

–Clear liquid diet and antibiotic followed by high fiber diet. If complicated, may need surgery

61
Q

Solitary rectal ulcer syndrome

A

–Malfunction of puborectalis muscle–> excessive straining on defecation–> can lead to mucosal prolapse that can ulcerate and form polypoid abscesses

62
Q

Who do you usually see solitary rectal ulcer syndrome in?

A

Relatively young, healthy adults w/blood in stools, pain with defecation, alternating constipation/diarrhea

63
Q

What can solitary rectal ulcer syndrome mimic?

A

Adenocarcinoma or ulcers seen in Crohn’s disease

64
Q

Morphology of solitary rectal ulcer syndrome?

A

Fibromuscular hyperplasia of lamina propria, inflammation and ulceration, reactive crypt hyperplasia

GI (12 decks)

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