Colon And Anus Path

Front 1

Hematochezia

Back 1

Bright Red Stool
Usually associated as Distal GI Bleed or bleeding too quickly to not be broken down

Front 2

Melana

Back 2

Dark Stool
Digestion/Oxidation of hemoglobin
Upper GI Bleed or small amounts of blood

Front 3

Congenital Anorectal malformations

Back 3

Anorectal Agenesis
Rectal Atresia
Imperforate Anus
Anal Stenosis
Fistulas

Front 4

Hirschsprung's Disease

Back 4

-'Congenital Megacolon' or 'Congenital Aganglionosis'
-intestinal obstruction
-Constipation/Stenosis
-Rectal Biopsy
-Absence of Submucosal Enteric Ganglion Cells
-Compensatory HYPERTROPHY of non-enteric PSNS nerve fibers
-RET gene loss-of-function mutations

Front 5

What is the most common Functional GI tract disorder?

Back 5

Irritable Bowel Syndrome
-ROME III criteria (must present >3 months with symptoms)
-Bristol Stool Chart
-Unknown pathophys

Front 6

Diverticulosis vs Diverticulitis... etiology?

Back 6

-osis: d/t prolonged intralumenal pressure (low dietary fiber)
-itis: inflammation of the diverticula

Front 7

Complications of Diverticulitis?

Back 7

-can destroy/weaken wall of colon
-Abscess formation (contains neutrophils)

Front 8

Location of diverticular disease?

Back 8

can be all through GI tract but occurs mostly in the distal colon d/t the reabsorption of water --> hard stool forms --> pressure on wall of colon

Front 9

Pseudomembranous colitis..presentation on colonoscopy?

Back 9

mucosal surface is hyperemic and partially covered by YELLOW-GREEN EXUDATE

Front 10

Most likely pathogen for Pseudomembranous Colitis?

Back 10

C difficile (post Abx therapy when normal colonic flora is inhibited and C difficile can grow rapidly)

Front 11

Inflammatory Bowel Disease has one vague overlying cause ....

Back 11

-pronounced inflammatory process is occurring (persistent inappropriate immunologic response to GI lumenal Ag's)

Front 12

Name of IBD where you cannot distinguish between Crohn's disease and Ulcerative colitis...

Back 12

Indeterminant colitis

Front 13

Major characteristics of Crohn's disease..

Back 13

-very high C reactive protein levels
-anywhere within GI tract (mouth --> anus)
-Skip lesions
-'cobblestoning' mucosal pattern
-'creeping fat'
-NON-caseating granuloma with multinucleated giant cells
-Transmural inflammation (Full thickness of the gut wall)
-Perianal Fistulas
-Th1 cells are active
-'string sign' found by radiologist
-Nephrolithiasis may occur (along with other extra-intestinal manifestations)
-Colonic carcinoma is less of a risk than UC

Front 14

Major characteristics of Ulcerative colitis..

Back 14

-elevated C reactive protein (less severe than CD though)
-Begins at the Rectum and moves proximally (more definite location --> can tx surgically)
-continuous lesions
-smoking PREVENTS UC
-Partial thickness of gut wall
-Crypt Abscesses
-'lead pipe' (radiology)
-inflammatory pseudopolyps
-higher risk of colonic carcinoma!!! compared to CD

Front 15

Which is more apt to have systemic inflammatory processes - UC or CD?

Back 15

UC

Front 16

Important aspect to Microscopic colitis?

Back 16

It appears normally but if you look at microscopically --> increase in inflammatory cells
-Collagenous colitis
-Lymphocytis colitis

Front 17

Are Sporadic (isolated) Juvenile Polyps malignant?

Back 17

NO!
-most common childhood polyp

Front 18

Does Hereditary Juvenile Polyposis Syndrome have a risk for GI carcinoma?

Back 18

Yes!

Front 19

Extra-GI manifestations of Cowden's disease?

Back 19

Mucocutaneous Lesions

Front 20

Extra-GI manifestations of Peutz-Jeghers polyposis?

Back 20

Mucosal Pigmentation (on buccal mucosa, lips)

Front 21

What do Cowden's disease and Peutz-Jeghers Polyposis have in common?

Back 21

-have increased risk of malignancy (Cowden = breast, thyroid; Peutz-Jeghers = gastric, small intestines, CRC, pancreas, breast, lung, ovary)
-Autosomal Dominant
-pt < 15 yo at presentation (Peutz-Jeghers is 10-15 yo; Cowden's is <15 yo)

Front 22

Characteristics of Hyperplastic Polyps..

Back 22

-pts > 50 yo
-Asymptomatic
-do NOT grow and get larger
-usually benign with little malignant potential
-Hyperplastic + Adenomatous features = Serrated Adenoma

Front 23

Tubular Adenoma

Back 23

Neoplastic (benign, pre-invasive)

ROUND!

Lower risk of dev into invasive Adenocarcinoma

Front 24

Villous Adenoma

Back 24

Higher risk of developing into Invasive Adenocarcinoma

Large Villous Adenomas = Watery, Secretory Diarrhea

Front 25

What is the genetic component to Familial Adenomatous Polyposis?

Back 25

APC gene is inactivated

Front 26

When is FAP usually diagnosed or found (with colonoscopy)?

Back 26

10-20 yo

NOTE: when younger and family hx of FAP --> genetic testing for APC gene

Front 27

Important aspect to FAP...

Back 27

hundreds --> thousands of polyps form

Polyps themselves have malignant potential

May develop into malignancy by 30s-40s

Tx: prophylactic colectomy

1% of Colorectal Carcinomas = d/t FAP

Front 28

Gardner's Syndrome =

Back 28

FAP + osteomas, desmoid tumors

Front 29

Turcot's Syndrome =

Back 29

FAP + CNS tumors

Front 30

HNPCC =

Back 30

Hereditary Non-Polyposis Colon Cancer

5-15% of Colorectal Carcinomas = d/t HNPCC

Genetics = DNA mismatch repaid genes with MSI (microsatellite instability); MSH2 and MLH1

Lynch Syndrome

Front 31

Adenocarcinoma sequence

Back 31

-The accumulation of mutations is more important than their actual sequence

-APC Gene is mutated FIRST (birth or later in life) --> K-RAS --> p53

Front 32

Where else is K-RAS gene effected (beyond Adenocarcinoma sequence)?

Back 32

Pancreatic Ductal Carcinoma

Front 33

Left-sided colon cancer..location/size/shape?

Back 33

-nearer to rectum

-SMALLER (d/t smaller diameter of bowel wall)

-usually develops as a ring

Front 34

Rigth-sided colon cancer..size/shape?

Back 34

-LARGER (d/t larger bowel diameter size)

-Polypod shape

Front 35

Which has more bleeding..left or right sided colon cancer?

Back 35

Right-sided colon cancer has MORE bleeding --> pt can have Melana in feces and may develop Iron Def Anemia

Front 36

Where do Left-sided colon cancers and Right-sided colon cancers metastasize to?

Back 36

LIVER, Lungs, Brain, Bone

Front 37

Three common forms of Anorectal Neoplasms?

Back 37

Basaloid Carcinoma
Adenocarcinoma
Squamous Cell Carcinoma (HPV 16 and 18)

Front 38

External Hemorrhoids

Back 38

PAINFUL!

-Inferior Rectal Vein

Front 39

Internal Hemorrhoids

Back 39

PainLESS!

-Superior Rectal Vein

-may lead to External Thrombosis

Front 40

Appendiceal Mucocele.. characteristics?

Back 40

Dilated, mucin-filled Appendix

May be Mucinous Cystadenoma or Mucinous Cystadenocarcinoma (difficult to tell the difference)

Front 41

Appendiceal Carcinoids

Back 41

Neuroendocrine Tumor

TIP if Appendix

Good Prognosis

Front 42

What can develop between Taenia coli?

Back 42

Diverticula