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63 Cards in this Set
- Front
- Back
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rare congenital anomalies
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duplication, malrotation, omphalocele, gastroschisis
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teloscoping of one intestinal segment within another
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intussusceptions
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failure of the cloacal diaphragm to rupture
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imperforate anus
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failure of involution of the vitelline duct
contains all three layers of the normal bowel wall ulceration may result in intestinal bleeding or symptoms like appendicitis |
Meckel diverticulum
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Arrest of neural crest cell migration above the level of the anus or premature neural cell death
Functional obstruction/intestinal dilation Rectum is always affected colonic wall becomes markedly thinned and my rupture usually near the cecum |
Hirschsprung disease
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Absence of ganglion cells and ganglia in affected segment of the colon
Male predominance, associated with Down Syndrome and serious neurologic abnormalities usually manifests in immediate neonatal period (failure to pass meconium, obstructive constipation) |
Hirschsprung disease
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Causes of acquired megacolon
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Chagas disease, organic obstruction, toxic megacolon complicating UC or crohns, functional psychosomatic disorder
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low volume, painful, bloody diarrhea
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dysentery
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output of more than 500 mL of fluid stool per day
isotonic with plasma persistence with fasting |
secretory diarrhea
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output of more than 500 mL per day
abates upon fasting stool exhibits osmotic gap |
osmotic diarrhea
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mucosal destruction
output of pyrulent, bloody stools that persist on fasting |
exudative disease
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improper gut neuromuscular function
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deranged motility
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voluminous, bulky stools with increased osmolarity combined with excess stool fat
abates on fasting |
malabsorption
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virus that targets children 6 to 24 months of age
Selectively infects and destroys mature enterocytes in the small intestine w/o infecting crypt cells Repopulation by immature secretory cells; may produce a flat mucosa resembling celiac sprue net secretion of water and electrolytes; osmotic diarrhea most frequent at the time of weaning |
rotovirus
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moderate gastroenteritis with diarrhea and vomiting lasting for a week to 10 days
1 week incubation period atrophy of villi and compensatory hyperplasia of crypts malabsorption and fluid loss |
Adenovirus
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prototype is responsible for majority of non bacterial food-borne illness
diarrhea, nausea, vomiting exposure of multiple individuals to one source 1 to 2 day incubation followed by 12 to 60 hours of symptoms |
Norwalk virus
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Starlike virus that primarily affects children
anorexia, headache, fever |
astrovirus
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properties of bacteria that contribute to enterocolitis
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ability to adhere
ability to elaborate enterotoxin capacity to invade |
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prototype secretogogue toxin that causes increased levels of intracellular calcium resulting in dysfunction of fluid and electrolyte transport
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Cholera toxin/vibrio cholerae
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Heat labile E. coli
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LT; similar to cholera toxin
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Heat stable E. coli
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ST; induces cyclic guanosine monophosphate
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Shiga toxins
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cause direct tissue damage through epithelial cell necrosis
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bacteria that pass quickly through intestinal epithelial cells with minimal damage
sometimes cause typhoid fever, meningitis, endocarditis, and oseomylitis (commonly with sickle cell) |
Salmonella
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bacteria that penetrates ileal mucosa and multiplies within Peyer patches and regional lymph nodes
bacteremia is rare and usually occurs with Fe overload |
Yersinia eneterocolitica
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cause of bacillary dysentery
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Shigella dysenteriae, shigella flexneri, Shigella boydii, and shigella sonnei and O type enteroxic E. coli
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major cause of endemic bacillary dysentery
locations of poor hygiene |
Shigella flexneri
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fecal oral transmission
invasion of intestinal mucosal cells but do not go beyond lamina propria hemorrhagic colitis adn hemolytic-uremic syndrome |
bacterial dysenteria
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Chronic arthritis secondary to S. flexneri infection
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Reiter syndrome
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fece contaminated beef or chicken that is insufficiently washed and cooked
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salmonella
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bacteria that have humans as their only host
shed in feces, urine, vomitus, and oral secretions of acutely ill persons; in feces of carriers developing countries bacteremia, fever, and chills during first week; mononuclear phagocyte involvement with rash, abdominal pain, and prostration in second week; adn ulceration of Peyer patches with intestinal bleeding and shock in the third week |
Typhoid fever
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comma shaped flagellated G-
improperly cooked chicken or contact with infected dogs unpasteurized milk or contaminated water diarrhea, dysentery, and enteric fever may cause reactive arthritis or Guillain-Barre |
Campylobacter Enterocolitis
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Comma shaped G- bacteria
severe, watery diarrhea NO invasion of the epithelium; stay in the lumen and secrete an enterotoxin rice water stools with flecks of mucus; up to 14L a day |
Cholera
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Toxin composed of 5 binding peptides B and catalatic peptide A
A1 interacts with ADP ribosylation factor ARF-A1 catalyzes ADP ribosylation of G s alpha Binding of NAD and GTP generates activated G s alpha which stimulates adenylate cyclase (persistent activation) this causes high levels of intracellular cAMP which stimulates Cl- and bicarb secretion followed by osmosis |
cholera toxin
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adherent layer of inflammatory cells and debris overlying sites of mucosal injury (pseudomembrane); usually caused by C. diff
background of chronic enteric disease relapse occurs in 25% of patients |
antiobiotic associated colitis/pseudomembraneous colitis
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non-specific pattern of damage to the surface epithelium, decreased epithelial cell maturation and increased mitotic rate, hyperemia and edema of the lamina propria, and variable neutrophilic infiltration
modest villus blunting; preservation of colon mucosal architecture; regenerative change and lymphoplasmacytic infiltration of the lamina propria erosion, ulceratio, and severe submucosal inflammation |
bacterial enterocolitis
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bacterial enterocolitis that affects the distal colon
hyperemia and edema; enlargement of mucosal lymphoid nodules patchy and then confluent purulent exudate |
Shigella bacterial enterocolitis
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bacterial enterocolitis affecting ileum and colon
blunted vlli, vascular congestion, and mononuclear inflammation ulceration with linear ulcers |
salmonella
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peyer patches in the terminal ileum become sharply delineated, plateau-like, with enlargement of draining mesenteric lymph nodes
oval ulcers with their long axes along the axis of ileum; machrophages containing bacteria, RBC, nuclear debris enlarge spleen; parenchymal necrosis of the liver |
S. typhi bacterial enterocolitis
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bacterial enterocolitis that involve the entire intestine from the jejunum to the anus
decrease in villus to crypt ratio multiple superficial ulcers, mucosal inflammation and purulent exudate |
Cmpylobacter jejuni
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bacterial enterocolitis involving the ileum, appendix, and colon
mucosal hemorrhage and ulceration, bowel wall thickening peyer patch and mesenteric lymph node hypertrophy with necrotizing granulomas systemic spread with peritionitis, pharyngitis, and pericarditis |
Yersinia enterocolitica/Y. pseudotuberculosis
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bacterial enterocolitis affecting the proximal small intestine
mucosa essentially intact with mucus depleted crypts |
vibrio cholerae
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pseudomembrane formation
superficially damaged crypts distended by mucopurulent exudate which erupts and forms mushroom cloud that adheres to the damaged surface |
Clostridium (C. diff)
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contaminated meat
Shiga-like toxins which damage enterocytes adn vascular endothelial cells abdominal pain, diarrhea, hemolytic uremic syndrome |
Enteropathogenic E. coli (EHEC)
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renal failure, anemia, and thrombocytopenia
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clinical triad of hemolytic anemia
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gastric hypoacidity, immunologic defciencies, and intestinal dysmotility with stasis
chronic diarrhea, abdominal pain, malabsorption, weight loss |
Bacterial overgrowth syndrome
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fecal oral ingestion of eggs; eggs hatch in intestine and larvae penetrate intestinal mucosa (jejunum to liver to lung); migrate up trachea and are swallowed
become mature in intestine and may obstruct intestine or biliary tree |
Ascaris lumbricoides (nematode)
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penetrate unbroken skin; migrate through lungs generating pulmonary infiltrates wit eosinophilia
mature in intestine; ability to autoinfect strong esinophilic reaction |
Strongyloides (nematode)
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larva penetration through skin
development in the lungs; climb up bronchial tree to be swallowed and access the duodenum multiple superficia erosions, focal hemorrhage, inflammatory infiltrates iron deficiency anemia |
hookworms ( necator duodenale and ancylostoma duodenale)
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nematodes that do not live their entire life within the intestinal lumen
fecal oral contamination perineal pruritis viable to external environment |
pin worms (enterobius vermicularis)
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worms that do not penetrate the intestinal mucosa and rarely cause serious disease
common in children may cause bloody diarrhea and rectal prolapse |
trichuris trichura (whip worm)
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worms that reside in the intestinal lumen
ingestion of raw or undercooked meat nutrients derived from food stream enlarges by formation of egg filled proglottids; shed with feces |
cestodes (tape worms)
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dysentery caused by fecal oral
common in developing countries (India, Mexico, and Columbia) liver abcess, resistant to gastric acid flask shaped ulcer with narrow neck invade using cysteine proteinases, lectin, and a channel forming protein |
amebiasis
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involvement of the cecum and ascending colon
invasion through crypt epithelium and burrowing into mucosa and submucosa; causes neutrophilic reaction flask shaped ulcer; extensive liquefactive necrosis may cause colonic stricture liver abscess with inflammatory reaction at their margins and shaggy fibrin lining; filled with chocolate colored, odorless, pasty material abdominal pain, bloody diarrhea, or weight loss |
amebiasis
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most common pathogenic parasitic infection in humans
frequent in mental institutions and day-care centers pear shaped and binucleate; sickle shaped trophozoites, marked blunting of small intestinal villi with mixed inflammatory infiltrate in the lamina propria malabsorptive diarrhea |
Giardiasis
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acute, necrotizing inflammation of the small and large intestine with severe transmural necrosis of intestinal segments
neonates that are premature or of low birth weight; peak incidenc when neonates are started on oral foods (2-4 days old) |
necrotizing enterocolitis
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chronic watery diarrhea with bandlike patches of collagen directly under the surface epithelium
strong association with autoimmune diseases 3-20 nonbloody watery bowel movements with cramping and abdominal pain daily |
collagenous colitis
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chronic watery diarrhea and prominent intraepithelial infiltrate of lymphocytes
3 to 20 nonbloody watery bowel movements with cramping and abdominal pain daily strong association with autoimmune diseases |
lymphocytic colitis
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malabsorptive syndrome with mall intestinal villus atrophy or a colitic syndrome resembling ulcerative colitis in the absence of demonstrable pathogens
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AIDS related diarrhea
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focal crypt cell necrosis; debris from necrotic cells occupies lacunae within the epithelial layer with minimal to absent inflammatory response in the lamina propria
toxic injury to small intestinal mucosa evident as villus blunting, degeneration adn flattening of crypt cells, decreased mitosis, and atypia of cell nuclei |
transplantation associated diarrhea (esp bone marrow)
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impairment of the normal proliferative activity of the small intestinal and colonic mucosal epithelia
anorexi, abdominal cramps, malabsorptive diarrhea may be accompanied by ischemic fibrosis and stricture |
radiation enterocolitis
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severe acute and chronic inflammation of the cecal and appendiceal region
impaired mucosal immunity in combination with compromised blood flow in the cecal region |
neutropenic colitis (typhlitis)
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inflammatory mucosal lesion occuring in segments of the colon that have been surgically isolated
colonic mucosa becomes susceptible to nutritional deprivation restoration of fecal flow or enemas containing short chain fatty acids permits mucosal recovery |
diversion colitis
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inflammatory condition of the rectum due to motor dysfunction of the anorectal musculature
impaired relaxation of the anorectal sling may create sharp angulation of teh anterior rectal shelf abrasion of the overlying rectal mucosa creates oval ulcer inflammatory polyp, rectal bleeding, mucus discharge from the anus, and superficial ulceration of the anterior rectal wall |
solitary rectal ulcer syndrome
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