Gi Week 3 Objective 3

Front 1

What is the risk of cancer complicating a case o f ulcerative colitis?

Back 1

5%, not that the prognosis of cancer associated with ulcerative colitis is usually worse than for sporadic cancers.

Front 2

A IBD that starts in the rectum and speads proximally is:

Back 2

Ulcerative colitis (note may extend 2-3cm into the terminal ileum)

Front 3

You view a CT scan noting a transmural lesion, you confidently remember the table highlighting the differences between ulcerative colituis and crohn’s and conclude that you are viewing a crohn’s lesion, what will your attending say:

Back 3

You are right Crohn’s is a transmural disease, however, you also must consider the possibility of fulminent colitis as it extends beyond the mucosa.

Front 4

Complete the following for Ulcerative colitis and Crohn’s disease:
Rectal bleeding:

Back 4

Rectal bleeding:
UC: very common
CD: uncommon

Front 5

Complete the following for Ulcerative colitis and Crohn’s disease:
Diarrhea:

Back 5

Diarrhea:
UC: Earl Sx, frequent, small stools
CD: les prevalent or absent

Front 6

Complete the following for Ulcerative colitis and Crohn’s disease:
Abdominal pain:

Back 6

Abdominal pain:
UC: predefecatory, urgency
CD:colicky, postprandial

Front 7

Complete the following for Ulcerative colitis and Crohn’s disease:
Fever:

Back 7

Fever:
UC: uncommon
CD: frequent

Front 8

Complete the following for Ulcerative colitis and Crohn’s disease:
Palpable mass:

Back 8

Palpable mass:
UC: rare
CD: frequent in RLQ

Front 9

Complete the following for Ulcerative colitis and Crohn’s disease:
Post resection recurrence:

Back 9

Post resection recurrence:
UC: never
CD: frequent

Front 10

Complete the following for Ulcerative colitis and Crohn’s disease:
Clinical course:

Back 10

Clinical course:
UC: relapse/remission 65%; chronic/continuous 20-30%; Acute 5-8%
CD: slowly progresses

Front 11

Complete the following for Ulcerative colitis and Crohn’s disease:
Endoscopic features:

Back 11

Endoscopic features:
UC: diffuse pinpoint ulcerations, continous lesions
CD: Discrete aphthoid ulcerations, patchy lesions

Front 12

Complete the following for Ulcerative colitis and Crohn’s disease:
Distribution:

Back 12

Distribution:
UC: continuous
CD: discontinuous

Front 13

Complete the following for Ulcerative colitis and Crohn’s disease:
Strictures:

Back 13

Strictures:
UC: rare
CD: frequent

Front 14

Complete the following for Ulcerative colitis and Crohn’s disease:
Fistulas:

Back 14

Fistulas:
UC: rare
CD: frequent

Front 15

Complete the following for Ulcerative colitis and Crohn’s disease:
Histological Distribution:

Back 15

Histological Distribution:
UC: mucosal
CD: transmural

Front 16

Complete the following for Ulcerative colitis and Crohn’s disease:
Cellular infiltrates:

Back 16

Cellular infiltrates:
UC: PMN
CD: lymphocytes

Front 17

Complete the following for Ulcerative colitis and Crohn’s disease:
Gland involvement:

Back 17

Gland involvement:
UC: mucin depleted, gland destruction, crypt abscesses
CD: gland preservation

Front 18

Complete the following for Ulcerative colitis and Crohn’s disease:
Special features:

Back 18

Special features:
UC: none
CD: granulomas, aphthoid ulcers

Front 19

A radiologist reports the presence of an aphthoid ulcer on a barium contrast x-ray of the colon. What is an aphthoid ulcer, what is its significance?

Back 19

Aphthoid ulcers are small ulcers overlying a lymphoid follicle, they are a strong indication and the earliest radiographic sign of Crohn's colitis. Aphthoid ulceration has been demonstrated prior to the onset of bowel symptoms, and several years before the advent of severe colonic disease.

Front 20

Why is diarrhea symptom of Celiac Sprue?

Back 20

Damage or loss of the villi decreases the intestinal epithelium’s absorption ability thereby shifting the balance towards secretion which occurs in the preserved crypts.

Front 21

What pathologic feature of intestinal epithelium other than villi damage contributes to diarrhea?

Back 21

Hypertyrphy of the Crypts of Lieberkuhn in Celiac Sprue results in excessive secretion leading to osmotic diarrhea

Front 22

List the common gluten containing grains associated with Celiac’s Disease:

Back 22

Wheat, barley, and rye.

Front 23

What is the gluten-derived peptide which are process by the human leukocyte antigen (HLA) responsible for iniciating the immune cascade in Celiac’s disease?

Back 23

Gliaden

Front 24

List the common symptoms a patient may present with that would prompt you to add Celiac’s Disease to your differential? How is the presentation different between adults and children?

Back 24

Adults: diarrhea, steatorrhea, weight loss
Children: Failure to thrive

Front 25

Dr. Hegele has invited you to work with him in his pathology lab in Vancouver. Upon viewing your first slide you immediately think, Celiac’s disease, what mucosal histological finding would you use to validate your case?

Back 25

Mucosa: villis atrophy and crypt hyperplasia; PMN and eosinophil infiltration of the Lamina Propria

Front 26

Why might hemorrhaging be a possible extra-intestinal manifestation of Celiac’s Disease?

Back 26

A malabsorption induced Vit K deficiency due to villi atrophy interrupts the coagulation cascade so that factors II, VII, IX and X, as well as Protein S, Protein C are dysfunctional.

Front 27

Define Polyp

Back 27

A polyp is a tumorous mass that protrudes into the gut lumen.

Front 28

What are the four classifications of polyps found in the large bowel?

Back 28

Hyperplastic
Hamartomatous
Pseudopolyps (inflammatory)
Neoplastic

Front 29

What is the size of an adenoma polyp that poses the significant risk of developing into a carcinoma?

Back 29

Polyps >2cm has a 46% chance of developing into a carcinoma.

Front 30

Name the 3 types of colonic adenoma, their relative frequency, and risk of developing into a carninoma.

Back 30

Tubular adenoma: f 75%; r 5%
Tubulovillousadenoma: f 10%; r 22%
Villous adenoma: f 15%; r 46%

Front 31

Adenomas can acquire mutations which makes them, malignant, how long does this usually take?

Back 31

5 years

Front 32

A 48 year old patient with a history of constipation and straining brings in a piece of toilet paper with a blood smear on it what are you going to do?

Back 32

Although hemorrhoids are the most probable cause of rectal bleeding, especially with the patient’s history, colon cancer presents at 50 (peak 60-79) and should be ruled out as a potential bleeding source.

Front 33

The first script written as a CC-3 was for Clindamycin to treat a UTI of an elderly woman living in a long-term care facility. Your smug, after getting 90% in HDI you know you choose the correct anti-biotic, however she develops persistent diarrhea, you immediately think the worst and order a colonoscopy, what are the most probable findings?

Back 33

Cream colored exudates firmly adhered to the mucosal surface : PMC pseudomembranous colitis mediated by C. difficile exotoxins causing epithelial cell disaggregation.