Small Intestine/Colon Path 2+3 - Nelson

Question 1

Why is ulcerative colitis often considered a “left-sided” disease of the colon?

Answer 1

ALWAYS begins int eh rectum and can then extend proximally all the way to the cecum, usually does not involve the whole colon

Question 2

What is the difference between the wall involvement in UC vs CD?

Answer 2

UC affects the mucosa and submucosa only. Whereas CD has transmural involvement - full thickness inflammation with knife-like fissures

Question 3

What locations int he bowel does CD affect?

Answer 3

Can be anywhere from mouth to anus. Terminal ileum is most common, rectum least common.

SKIP LESIONS - not continuous like UC

Question 4

How do symptoms differ between UC and CD?

Answer 4

UC -
LLQ pain, bloody and mucus-ey diarrhea with tenesmus and rectal inflammation

CD -
RLQ pain, mild non-bloody diarrhea, symptoms variable

Question 5

How does smoking affect risk for UC and CD?

Answer 5

UC - smoking is protective

CD - smoking increases risk

Question 6

You are looking through a microscope at a specimen of bowel from a pt with IBD. You see crypt abscesses with neutrophils and lymphocytes.
UC or CD?

Answer 6

Ulcerative Colitis!

Question 7

How do you differentiate ASCA and pANCA using UC and CD?

Answer 7

pANCA = UC
ASCA = CD

Question 8

What is the classical gross appearance that you see in Crohn’s disease?

Answer 8

Cobblestone mucosa!
(Remember: That old Crohn walking down the cobblestone street)
Strictures causes by wall hypertrophy!
Creeping fat!
Patchiness!

Question 9

What are the worrisome complications of UC and CD?

Answer 9

UC

• Toxic Megacolon
• Risk for dysplasia —> adenocarcinoma

CD

• Malabsorption
• Fistula formation to bladder, rectum, between bowel, etc
• Carcinoma in colon
• Obstruction (from strictures)

Question 10

a 30 yr old patient of yours has had a fairly recent surgery to form a diverting ostomy. He begins experiencing diversion colitis. What is the patholgical cause behind this problem?

Answer 10

The blind segment of colon is not longer receiving stool. This causes this part of the bowel to have a deficiency in short chain fatty acids

Tx with return of fecal stream or enemas containing SCFA’s

Question 11

In a patient undergoing radiation therapy for prostate cancer, what might you be worried about in his Gi tract?

Answer 11

radiation enterocolitis

Can be MISDIAGNOSED as dysplasia, looks just like it, but will return to normal faster and doesn’t have the same risk of cancer

Question 12

Feeding a premie baby orally is a bad idea why?

Answer 12

Neonatal necrotizing enterocolitis can occur.
Occurs in 1st week of premature infant life while their GI defense are impaired

• Small and large bowels exhibit transmural necrosis
• air bubbles form in intestinal wall

Question 13

Which class of drug in commonly implicated in drug-induced enterocolitis?

Answer 13

NSAIDS

chemo agents can cause ulcers in entire Gi tract

Question 14

Use like 2 sentences to describe irritable bowel syndrome:

Answer 14

Chronic, relapsing, abdominal pain, bloating, and either diarrhea or constipation WITHOUT any known cause.

There are no pathologic changes seen and symptoms often improve after defecation

Question 15

What’s the difference between diverticulosis and diverticulitis?

Answer 15

Diverticula are outpouching of mucosa (not true diverticula) often located in the sigmoid colon.
Mutliple diverticula make diverticulosis
Diverticulitis occurs when they become inflamed, often with bacteria

Question 16

Malfunction of the puborectalis muscle can lead to excess straining on defecation and rectal prolapse. Inflammatry polyps and ulcerations then form on the anterior rectal wall.

What is this syndrome called?

Answer 16

Solitary rectal ulcer syndrome

Question 17

When you first started learning about polyps, you thought a juvenile polyps were rebellious polyps that enjoyed staying out late and not cleaning their rooms.
Now you understand this was a terrible joke from a medical student friend of yours. So what is it really?

Answer 17

Call it juvenile because it happens in kids and adults (most common that you see in kids)

It’s a hamartomatous polyp, which means it’s made of a disordered collection of normal tissue. Can sometimes cause rectal bleeding

Question 18

A 12 year old boy presented with intussusception and Gi bleeding. After resolving the intussusception, colonoscopy and capsular endoscopy revealed numerous polyps in the large and small intestine. The polyps were found to be hamartomatous and the patient has a strong family history of cancer. You also notice the boy has some odd mucocutaneous hyperpigmentation….
What is the diagnosis?
Root cause?

Answer 18

Peutz-Jegher’s Synrome

Caused by autosomal dominant loss of STK11 tumor suppressor gene

Question 19

Name of the most common adult, usually harmless polyp?

Answer 19

Hyperplastic polyp

Question 20

What is melanosis coli?

Answer 20

Colon mucosa is brown. Lipofuscin-like pigment is deposited in macrophages

Question 21

What is lymphomatosis polyposis?

Answer 21

Mantle cell lymphoma in colon. Results in tumor cells with irregular nuclear contours

Question 22

What is the general pathophysiology behind acute appendicitis?

Answer 22

• Obstruction
• Venous outflow compromised by intraluminal pressure
• ischemic injury occurs
• Accute inflammation

Question 23

Typical clinical presentation for appendicitis?

Answer 23

Periumbilical pain localized in RLQ with tenderness over McBurneys point

Pain-induced nausea/vomiting

Question 24

What are anal hemorrhoids?

Answer 24

Anal varices from ectasia of rectal venous plexus due to elevated venous pressure

Caused by straining, pregnancy, prolonged sitting

Question 25

What exactly is an anal fissure?

Answer 25

Linear separation of tissue of anal canal through the mucosa. Caused by firm stools

90% are posterior

Question 26

What virus is associated with Anal Carcinoma?

Answer 26

HPV

most common type is squamous cell carcinoma