Gi 12

Front 1

What are the 2 "boxes" of bowel inflammation?

Back 1

1. Ulcerative Colitis, Crohn's Disease, Lymphocytic Colitis, Celiac

2. Infection, "Self Limited", Ischemia, Trauma

Front 2

What are 6 GI embryologic abnormalities?

Back 2

1. Meckel's Diverticulum

2. Omphacele

3. Malrotation

4. Atresia

5. Heterotopias

6. Hirshsprungs mega Colon

Front 3

What Meckel's diverticulum?

Back 3

Persistence of a vestige of the omphalomesenteric duct giving rise to solitary diverticulum (outpouching of a hollow structure in the body)

Front 4

In the colonic blood supply, what are "watershed" areas?

Back 4

Areas that are most tenuous in their blood supply

Front 5

What is the term for the rich vascular system that supplies the colon?

Back 5

Rich ARCADE system

Front 6

Why is it diffuclt to have rectal ischemia?

Back 6

Due to the rectum's rich blood supply and rich venous capillary bed

Front 7

Why is segmented ischemia seen in the colon?

Back 7

Due to the parallel arterial arcades which do NOT have cross feeding amongst vessles

Front 8

How does the ischemic portion of the gut appear grossly appear?

Back 8

Appears dark and dusky

Front 9

What is troublesome about how bowel ischemia can present?

Back 9

Can present as severe abdominal pain but have a "normal" PE (physical exam)

Front 10

How could a larger, more confluent area of ischemia develop in the colon?

Back 10

If a large artery/vessel is occluded

Front 11

Which cell layer in the colon is most sensitive to ischemia?

Back 11

Epithelium - due to high proliferation, high metabolism

Front 12

What is the first epithelium to be injured in ischemia?

Back 12

Surface epithelium because it's the furthest away

Front 13

What is the classical radiologic and histologic sign of ischemic colon?

Back 13

"Thumbprinting"

Front 14

Which comparment is the most sensitive to ischemic injury?

Back 14

Mucosal compartment

Front 15

Mucosal erosions and ulcerations may be repaired by what?

Back 15

re-epithelialization

Front 16

What are the 3 severities of ischemia?

Back 16

1. Mild

2. Moderate

3. Severe

(don't hurt yourself thinking too hard on that one)

Front 17

Mild ischemia may result in what 2 items?

Back 17

1. Edema

2. Mild acute inflammatory infiltrate

Front 18

With increasing severity of ischemia, what happens?

Back 18

The mucosa becomes ulcerated

Front 19

What is a sigmoid volvulus?

Back 19

Twisting of the mesentery of the decending and sigmoid colon that results in ischemia

Front 20

What is a Ladd band?

Back 20

Band of fibrosis that "tack down" the gut in incorrect locations

Front 21

What can develop due to a ladd band?

Back 21

Ladd bands may serve as a rotation point for the gut that results in obstruction and ischemia

Front 22

What else can be a cause of adhesions which allow the bowel to twist on itself?

Back 22

Peritonitis (inflammation)

Front 23

What are the 2 types of idiopathic inflammatory bowel disease?

Back 23

1. Ulcerative colits

2. Chrohn's Disease

Front 24

What are the 4 factors related to the pathogenesis of ulcerative colitis and crohn's?

Back 24

1. Disruption in immune system

2. Genetics

3. Environment

4. Gut Flora

Front 25

Before making a diagnosis of IBD, what must be ruled out?

Back 25

Infection

Front 26

What are the 2 location characteristics of cronh's disease?

Back 26

1. Geographically indiscriminate, can skip around to different locations

2. Can progress transmurally, from outer lumen to inner mucosa

Front 27

What are the 2 location characterisitcs of ulcerative colitis?

Back 27

1. Very orderly progression from DISTAL --> Proximal (only in colon)

2. Affects mucosa ONLY

Front 28

Transmural inflammation in crohn's can lead to what 2 items?

Back 28

1. Fistulae

2. Strictures

Front 29

How is the incidence of IBD changing in the world?

Back 29

Either stable or increasing

Front 30

What are the 3 genetic components in the pathogenesis of crohn's disease?

Back 30

1. Autophagy

2. Intracellular Bacterial Sensing (NOD2)

3. ER Stress

Front 31

What is the environmental component of the pathogenesis of crohn's disease?

Back 31

Altered gut flora

Front 32

NOD2 is important in the development of what?

Back 32

In the development of Paneth cells

Front 33

What are the 3 major consequences of a NOD2 mutation?

Back 33

1. Abnormal granules in Paneth cells (decrease killing of luminal pathogens)

2. Defective Sensing and clearing of intracellular bacteria (increased load and inflammatory cascade)

3. Prevents p38 mediated phosphorylation of the transcription factor nuclear protein hnRNP-41 (Decreased synthesis of anto-inflammatory cytokine IL10)

Front 34

NOD2 induces what ?

Back 34

NF-kB which controls immune response to infection

Front 35

What is RICK?

Back 35

a protein kinase that activates Nf-kB

Front 36

What are the major steps in the pathogeneis of Crohns?

Back 36

1. NOD2 mutations and genetic predispostion leads to malformed paneth cells and leaky cell-cell junctions

2. Presence of invasive E. Coli (AIEC)

3. Macrophages can't produce IL-10 or clear bacteria

4. TNF (produced by macrophage) feeds back and INHIBITS autophagy of bacteria

Front 37

Muscle hypertrophy and carcinomas in crohn's can cause what?

Back 37

Strictures

Front 38

What is the gross appearance of crohn's?

Back 38

"Creeping Fat", fat located in abnormal position

Front 39

Is the ileum involved in Ulcerative colitis?

Back 39

NO

Front 40

Crypt distortion is seen with what

Back 40

Chronic mucosal damage

Front 41

Why is the finding of crypt distortion on a biopsy a very powerful feature?

Back 41

helps to diagnose IBD

Helps to disringuish between acute vs. Chronic inflammation

Front 42

Does crypt distortion help to differentiate between UC and CD?

Back 42

NO

Front 43

In C. Diff infection, what causes the damage?

Back 43

C. Diff produces toxin that causes injury

Front 44

What is NOT seen in a C. Diff infection?

Back 44

Bleeding