Gi 1130 Non-Neoplastic Bowel Conditions

Front 1

How do bowel duplications present?

Back 1

abdominal mass, bouts of pain due to obstruction, intussusception, perforation

Front 2

What happens with bowel duplication?

Back 2

cystic or saccular masses attached to mesenteric side fo bowel

Front 3

Where is the most common site of bowel duplication?

Back 3

ileocecal valve

Front 4

Why does malrotation of the gut happen?

Back 4

disordered/interrupted rotation of the gut around SMA

Front 5

How does malrotation of the gut present?

Back 5

signs and symptoms of bowel obstruction

Front 6

What causes an omphalocele?

Back 6

anterior ab wall fails to develop, born with abdominal contents outside of ab cavity, viscera covered with peritoneal membrane

Front 7

What happens in gastroschisis?

Back 7

part of abdominal wall doesn't develop abdominal organs outside of peritoneal cavity, uncovered by peritoneal membrane

Front 8

What is heterotopia?

Back 8

development of normal tissue in abnormal areas

Front 9

What happens if you have ectopic gastric tissue?

Back 9

ulceration and intestinal bleeding

Front 10

What is atresia?

Back 10

complete obstructiono f the lumen

Front 11

What causes imperforate anus?

Back 11

failure of cloacal diaphragm to completely regress

Front 12

What causes Mecke's diverticulum?

Back 12

failure of vitelline duct to completely involute

Front 13

What is in Meckels?

Back 13

3 layers of gut

Front 14

Where do you find Meckels?

Back 14

ntimesenteric side of the bowel proximal to ileocecal valve

Front 15

What are the complications of Meckels?

Back 15

heterotopic gastric mucosa causing ulceration and bleeding

Front 16

Who gets Hirschsprung?

Back 16

males iwth Down syndrome

Front 17

What causes Hirschsprung?

Back 17

migration of neural crest cells stops before reaching distal gut or anus, defective innervation, lack of motility of affect segment

Front 18

What happens in Hirschsprung disease?

Back 18

functional obstruction, dilation of gut proximal to denervated segmetn

Front 19

Who gets pseudomembranous colitis?

Back 19

adults iwth acute/chronic diarrhea without preexisting bowel disease, have received one course of broad spectrum antibiotics

Front 20

What causes pseudomembranous colitis?

Back 20

antibiotics that allow overgrowth of resistant organisms in the colon

Front 21

Which pathogens cause pseudomembranous colitis?

Back 21

C dif, slamonella, C perfringens, staph aureus

Front 22

What does C dif make?

Back 22

toxins A & B, damage colonic mucosa stimulate fibrinopurulent exudate

Front 23

What does pseudomembranous colitis look like grossly?

Back 23

yellow shaggy exudate on reddish mucosa

Front 24

What does pseudomembranous colitis look like microscopically?

Back 24

pseudomembranes adherent to surface of the mucosa, looks like erupting volcano, lamina propria has neutrophilic infiltrate with fibrin thrombi in capillary vessels

Front 25

How do you treat peudomembranous colitis?

Back 25

antibiotic against C dif

Front 26

What causes inflammatory bowel disease?

Back 26

uncertain, abnormal immune regulation maybe

Front 27

What does Crohn's diease involve?

Back 27

mouth to anus

Front 28

What are the hallmarks of Crohn's?

Back 28

granulomas, transmural inflammation, skip lesions

Front 29

What is the hygiene hypothesis?

Back 29

food processing decreased enteric infections, mucosal immune system can't regulate reaction to intestinal flora, overreaction of the immune response

Front 30

Who gets Crohns?

Back 30

white Jewish, women

Front 31

What reactivates Crohns?

Back 31

stress, diet, cigarettes

Front 32

Where are the gross features of Crohns?

Back 32

segmental involvement of the gut, linear ulcers that start as punctate ulcers, thickened inflexible small bowel wall with narrowed lumen, progressive fibrosis, thickening of bowel wall, get "creeping fat"

Front 33

What do you see with colonic Crohns?

Back 33

no thickened wall

Front 34

Waht is the microscopic pathology of Crohns?

Back 34

transmural inflammation, non-casesating grnaulomas, dilation of lymphatics, lymphoid aggregates in all layers of hte bowel, thickened nerve bundles in sub-mucosa, maintained surface mucus production

Front 35

What are the local complications of Crohns?

Back 35

fistulas, hemorrhage, stricture, malignancy

Front 36

What are the systemic complications of Crohns?

Back 36

hepatic inflammation, arthritis, ocular inflammation, erythema nodosum of skin, nutritional problems

Front 37

Where does ulcerative colitis affect?

Back 37

large bowel, never small intestine

Front 38

What are the major gross features of ulcerative colitis?

Back 38

lesions begin in the rectum, spread proximally, mucosal ulceration with inflammatory pseudopolyps, surface of mucosa looks polypoid, mild bowel wall thickening

Front 39

What is backwash ileitis?

Back 39

inflammatory reaction in terminal ileum

Front 40

What does UC look like microscopically?

Back 40

microabscesses in crypts that develop into ulcerations, only mucosa involved
wall can become fibrotic later, pseudopolyps are frequently present

Front 41

What are the local complications of UC?

Back 41

toxic megacolon, hemorrhage, stricture, carinoma

Front 42

What are the systemic complications of UC?

Back 42

hepatitis and pericholangitis, hemolytic anemia, ankylosing spondylitis, migratory large joint arthritis, thromboembolism, uveitis, erythema nodosum, pyoderma gangrenosum

Front 43

What features of UC make carincoma more likely?

Back 43

long duration, chronic symptoms with multiple recurrences

Front 44

What ist he difference in rectal involvement with UC and CD?

Back 44

100% of UC, 17% of CD

Front 45

What is the difference in distribution with UC and CD?

Back 45

UC diffuse, continuous
CD focal, skip areas

Front 46

What is the difference in serosa with UC and CD?

Back 46

UC normal
CD fat-wrapping vascular congestion

Front 47

What is the difference in bowel wall thickness with UC and CD?

Back 47

UC normal
CD increased in small intestine

Front 48

What is the difference in mucosa between UC and CD?

Back 48

UC varies with activity, intense hyperemia pseudopolyps
CD serpiginous ulcers, longitudinal fissures, "cobblestones"

Front 49

What is the difference in small bowel between UC and CD?

Back 49

UC "backwash ileitis"
CD involved 85% of the time, stricture formation

Front 50

What is the difference in inflammation between UC and CD?

Back 50

UC diffuse mucosal and submucosal
CD focal transmural

Front 51

What microscopic findings do you not necessarily have in CD?

Back 51

mucosal atrophy, crypt distortion

Front 52

What microscopic findings do you not necessarily find in UC?

Back 52

granulomas, lymphoid aggregates, aphthoid ulers, neutral hypertrophy

Front 53

What complications do you get in UC but not really in CD?

Back 53

toxic megacolon, carcinoma risk

Front 54

What complications do you get in CD but not really in UC?

Back 54

fistulas, strictures

Front 55

What findings do you have in UC but not necessarily in CD?

Back 55

rectal involvement, bleeding, remissions, exacerbations

Front 56

What findings do you have in CD but not necessarily in UC?

Back 56

segmental disease, fistulas, anal disease

Front 57

What microscopic findings do you definitely have in UC?

Back 57

crypt abscesses, decreased mucin, vascular congestion, mucosal atrophy, crypt distortion

Front 58

What microscopic findings do you defintiely have in CD?

Back 58

granulomas, lymphoid aggregates, aphthoid ulcers, neural hypertrophy

Front 59

What is the large intestine inflammatory difference between UC and CD?

Back 59

UC mucosal and submucosal inflammation
CD transmural inflammation, wall not thickened

Front 60

What is the large intestine submucosa difference?

Back 60

UC width of submucosa normal or reduced
CD width of submucosa normal or increased, prominent nerve bundles

Front 61

What is the large intestine lymphoid hyperplasia difference?

Back 61

UC focal lymphoid hyperplasia in mucosa and superficial submucosa
CD focal lymphoid hyperplasia in mucosa, submucosa, serosa, pericolic, regional lymph nodes

Front 62

What is the difference in "crypt abscesses?"

Back 62

UC crypt abscesses very common
CD fewer crypt abscesses

Front 63

What is the difference in large intestine mucus secretion?

Back 63

UC grossly impaired mucus secretion
CD slightly impaired mucus secretion

Front 64

What is the difference in paneth cell metaplasia in the large intestine?

Back 64

UC paneth cell metaplasia common
CD paneth cell metaplasia uncommon

Front 65

What is the difference in sarcoid granulomas in the large intestine?

Back 65

UC usually absent from bowel and lymph nodes
CD 35% of patients have sarcoid-type granulomas in bowel and lymph nodes

Front 66

What's the difference in large intestine fissuring between UC and CD?

Back 66

UC absent
CD very common

Front 67

What's the difference in precancerous large intestinal changes in UC and CD?

Back 67

UC precancerous epithelial change
CD increased incidence of carcinoma, no precancerous change described

Front 68

What's the difference in anal lesions in UC and CD?

Back 68

UC nonspecific anal inflammation
CD granulomatous foci often present

Front 69

What is diversion colitis?

Back 69

surgical treatment on intestinal disease leads to creation of a segment of bowel from which fecal stream has been diverted
affected segment has mucosal friability, inflammation, lymphoid hyperplasia that resolve if segment is reconnected and fecal stream returns

Front 70

What is microscopic colitis?

Back 70

older patients who presentw ith watery diarrhea
normal studies
show increased intra-epithelial lymphocytes, mixed inflammatory infiltrate in lamina propria

Front 71

What is collagenous colitis?

Back 71

type of microscopic colitis with a thickened subepithelial collagen layer with separation of overlying epithelium

Front 72

Who gets collagenous colitis?

Back 72

older females

Front 73

What is lymphocytic colitis?

Back 73

type of microscopic colitis with a normal sub-epithelial collagen layer, more intraepithelial lymphocytes

Front 74

What is associated with lymphocytic colitis?

Back 74

celiac disease, lymphocytic thyroiditis, arthritis, autoimmune gastritis

Front 75

What causes intestinal graft-versus-host disease?

Back 75

donor T cells targeting antigens on epithelial cells throughout the GI tract following allogenic bone marrow transplantation

Front 76

What causes transmural infarction?

Back 76

occlusion of a major artery

Front 77

What is angiodysplasia?

Back 77

acquired malformation of hte submucosal and mucosal blood vessels

Front 78

Where does angiodysplasia usually occur?

Back 78

right colon and cecum

Front 79

What causes angiodysplasia?

Back 79

mechanical factors and wall tension are highest in cecum, dilated vessels in mucosa are close to the surface

Front 80

What are hemorrhoids?

Back 80

varicose veins in anal venous plexus, may be due to distal displacement of anal cushions, when supporting tissue of anal cushion disintegrates or deteriorates

Front 81

What can cause hemorrhoids?

Back 81

straining, pregnanacy, portal hypertension

Front 82

What causes diverticular disease?

Back 82

high fat, low fiber diet, decreased amount of residue in gut, increased transit time of the stool

Front 83

What are diverticula?

Back 83

herniations of the mucosa through muscularis at the point of weakness

Front 84

Where is the most common site of diverticular disease?

Back 84

mesenteric side of sigmoid colon

Front 85

What does diverticulitis look like?

Back 85

herniations of the mucosa through the muscularis at teh points of weakness

Front 86

What are the complications of diverticulitis?

Back 86

ifnlammation, fistula, obstruction, bleeding

Front 87

Where do intestinal obstructions occur?

Back 87

small bowel

Front 88

What casues a mechanical adhesion?

Back 88

fibrous bands form between bowel segments or abdominal wall

Front 89

What can cause adhesions?

Back 89

hernias, volvus, intussusception, functional adhesions