Gi - Khin: Pathology Of Si

Front 1

atresia

Back 1

absence of nL opening or failure of tubular structure

Front 2

stenosis

Back 2

narrowing of lumen

Front 3

diverticula

Back 3

- jejunum, ilium
- in mesenteric border at sites of penetration of blood vessels

Front 4

why is there bacT overgrowth in diverticula?

Back 4

overgrowth in content "stasis" b/c content doesn't move around

Front 5

other things that happen w/ diverticula?

Back 5

stenosis
ulcer
bleeding

Front 6

Meckel diverticulum

Back 6

- ileum
- persistent vitelline duct
- 1-3 ft?? from ileocecal valve

Front 7

what abnL tissue may be present in meckel diverticulum?

Back 7

heterotropic gastric mucosa

Front 8

heterotrophic pancreatic tissue**

Back 8

abnL in size
may be mistaken for a TUMOR

Front 9

malabsorption syndromes

Back 9

- whatever you need is not absorbed and it is excreted out

Front 10

what happens w/ excretion in malabsorption syndrome?**

Back 10

steatorrhea - bulky, greasy, foul smelling feces
--> fat, vitamins, mineral, carbohydrates, proteins

Front 11

what defects cause malabsorption?

MCC in US?**

Back 11

digestion, absorption, transport

- Celiac ds and Crohn's ds

Front 12

specific abnLs that cause malabsorption?"

Back 12

Crohns
Whipple
Lymphoma
TB
Diverticulosis
Blind loop syndrome

Front 13

clinical features of malabsorption

Back 13

steatorrhea
weight change, abd distention
skeletal changes
dermatitis, peripheral neuro
excessive diarrhea

Front 14

celiac ds

Back 14

- villous atrophy of jejunal mucosa
- improvement w/ w/d of gluten containing food

Front 15

patho of celiac ds

Back 15

- immune rxn to gliadin
- T cell mediated
- gluten -> ab -> t cell -> t cells + ab react to cells -> destruction -> villous atrophy

Front 16

celiac ds:
genetic predisposition
MCC of...**
complications

Back 16

- clustering HLA-B8, DQ2
- flat biopsy
- MC - lymphoma

Front 17

tropical sprue

Back 17

- MC in 3rd world
- enterotoxigenic E. coli
- possible villous atrophy
- folate/B12 def common

Front 18

Whipple ds

Back 18

- multi-system***
- M:F 10:1; 40-50
-***foamy macro w/ granules in villi
- *tropheryma hippelii - gram + actinomycete; PAS stain

Front 19

what 3 things is whipple ds a/w?

Back 19

1. lactase deficiency
2. bacT overgrowth
3. abetalipoproteinemia

Front 20

lactase def

Back 20

- seen in whipple ds
- diarrhea & malabsorp
- common in black americans

Front 21

bacT overgrowth

Back 21

- seen in whipple ds
- abnL large pop of bacT in jejunum
- due to lumenal stasis
- a/w hypochlorihydria & achlorhydria

Front 22

abetalipoproteinemia

Back 22

- familial, inborn error
- (-) lipoprotein transport
- lipid vacuolation of mucosal cells
- failure to absorb essential FA

Front 23

MCC causes of obstruction**

what % of cause?

Back 23

1. hernia
2. adhesions
3. intussusception
4. volvulus

80%

Front 24

how are intestinal obstructions mostly acquired?

Back 24

surgery

Front 25

hernia

Back 25

usually in inguinal canal; femoral canal; umbilicus; sx scar; defect in post wall
- incarceration -> obstruction
- pressure -> venous -> arterial -> strangulation -> gangrene

Front 26

adhesions

Back 26

- after peritonitis or hx of operations
- congenital fibrous bands from Meckel diverticulum

Front 27

intussusception**

Back 27

- invag of proximal intestine to distal
- drags mesentery and vessels --> strangulation --> infarction
- MC in children
- adults: tumor mass is leading

Front 28

volvulus

Back 28

twisting of loop of bowel
in SI or sigmoid colon

Front 29

Ischemic bowel ds:
- cause
- acute
- chronic

Back 29

- dec blood flow to SI
- MCC of occlusive ischemic BD-> mucosal necrosis ->transmural infarction
- less common, atherosclerosis

Front 30

A.I.I.:
MCC
other causes

Back 30

SMA occlusion
- thrombosis, embolism
- nonocclusive ischemia - hypoperfusion
- hypotension
- ischemia ->necrosis -> infarction

Front 31

AII:
mesenteric venous thrombosis

Back 31

- portal venous thrombosis
-**pylephlebitis -> inflamm of portal vein

Front 32

AII:
secondary to
morphology
micro

Back 32

- intestinal obstruction
- dusky, purple-red, moist, easily torn
- inflamm along margin of infarct; perforation risk high for 3 d

Front 33

nonocclusive hypoperfusion

Back 33

only mucosal infarction; corrected w/ inc blood flow and totally reversible

Front 34

acute abd

Back 34

- abrupt onset pain
- anginia
- perforation and shock common

Front 35

Chronic intestinal ischemia

Back 35

atherosclerosis
recurrent pain - celiac compression syndrome

Front 36

IBD

Back 36

1. infectious ds
2. noninfectious conditions
3. idiopathic IBD

Front 37

how is idiopathic IBD dx'd?

Back 37

dx of exclusion: exclude infectious and noninfectious conditions

Front 38

epidemiology of IBD

Back 38

- freq in US, Britian, Scandinavia
- increase incidence in US
- common in 20-30s
- white 5x more susceptible
- UC > CD

Front 39

CD and UC

Back 39

10-20% can't be differentiated --> indeterminate colitis

Front 40

CD

Back 40

- mouth -> anus; MC in terminal ileum
- **discontinuous lesions

Front 41

CD:
morphology**

Back 41

skip areas
creeping fat
wall thickening w/ inflamm
string sign

Front 42

string sign

Back 42

narrowing of gut lumen, w/ mucosal edema, ulceration and sloughing --> fibrous strictures

Front 43

CD extra intestinal manifestations

Back 43

pericholangitis
amylodidosis
stomatis
arthritis
iritis

Front 44

CD MC site
UC MC site

Back 44

- terminal ileus (regional ileitis) and colon (Granulomatous Colitis)
- colon and rectum

Front 45

UC:
sites
morphology**

Back 45

- colon & rectum; continuous lesions
- rectum -> colon
- backwash ileitis
- proctitis (confined to rectum)
- pancolitis (up to R colon)

Front 46

UC:
backwash ileitis

Back 46

- UC that involves terminal ileum (10%)

Front 47

UC:
clinical
complications

Back 47

-bloody d
- severe chronic ulceration -> colonic dilatation-> systemic toxicity -> toxic megacolon***

- development to carcinoma in 1% in 10 yrs; >30% in 30 yrs

Front 48

CD vs. UC ddx

Back 48

CD: **fistula, **skip lesions, **transmural inflamm (fissures/granulomas), **fibrous strictures
UC: **rare fistulas, **cont. lesions, **submucosal inflamm, **strictures rare

Front 49

rat tailing effect

Back 49

skip areas --> wall thickening w/ nL segments in between
results in areas of narrow and nL areas

Front 50

tumors in SI:
benign

Back 50

- rare
- **Peutz-Jeghers syndrome - hereditary GI polyposis a/w excessive melanin pig.

Front 51

tumors in SI:
malignant

Back 51

- carcinoid, lymphoma, adenocarcinoma

Front 52

Carcinoid tumor

Back 52

* NE tumor
- from NE cells of GIT mucosa; *low malignancy
- **can give you carcinoid syndrome
- locally invasive, ICS (ileum, colon, stomach)
- freq metastasize

Front 53

carcinoid syndrome:
general

symptoms

Back 53

- R heart then lungs
- not L heart b/c of monoimunoxidase destruction of serotonin

-> flush, bronchoconst, inc urine 5-HIAA

Front 54

serotonin in carcinoid syndrome

Back 54

send urine to lab --> serotonin decarboxylated in liver to 5-HIAA and excreted in urine**