Imported: Gi_Test 2: Tol_Pathology Of Colon And Anus

Front 1

what is hematochezia?

Melana ?

Back 1

Bright red blood in poo

Melana- Black blood in stool (blood has been digested, iron is oxidized)

Front 2

what is an anorectal malformation?

Back 2

Opening to the anus absent or structurally obstructed
Rectum may end in blind sac or connect to urethra, urinary bladder, vagina, scrotum

Front 3

What is Hirschsprungs disease? Associated genetics?

Back 3

Absence of parasympathetic neuronal cell bodies (ganglion cells) of the enteric ganglia

Neurons of the submucosal (Meissner’s) and myenteric (Auerbach’s) plexus
Failure of normal caudal migration of enteric neurons produces “aganglionic segment”

Familial and sporadic cases related to RET gene loss-of-function mutations

Front 4

a pt is unable to relax the anus and thus develops a congenital form of megacolon. What genetic problem would you likely see? What type of pt would you likely see this in?

**

Back 4

This is Hirschsprung's disease, in which you have absence of parasympathetic neuronal cell bodies in the enteric ganglia

so you would see a RET gene loss-of-function mutation

Seen in Down Syndrome (Trisomy 21)

Front 5

symptoms of Hirschsprungs Disease?

Back 5

Stenosis and constipation: newborns with failure to pass meconium and vomiting

Dilation of proximal (“upstream”) uninvolved segment of bowel (megacolon)

Front 6

Most common CONGENITAL cause of intestinal obstruction?

Most common functional GI tract disorder ?

Back 6

Hirschsprungs

IBS

Front 7

where do diverticuli occur within the wall of the bowel?

Back 7

btw the taenia coli (outer longitudinal layer of muscularis propria)

Front 8

although the majority are asymptomatic, some pts may present with flatulence or inflammation from retained fecal material with bacterial build-up. What does this describe?

Back 8

Diverticular Disease

Front 9

Sx’s and signs: abdominal pain, ∆ in bowel habits, dysuria, fever, blood per rectum; leukocytosis, palpable mass, + FOB

describes? (just read this card probably)

Back 9

A diverticuli

Abscess
Perforation → peritonitis and possibly sepsis

Fistulas between colon and adjacent structures(e.g., urinary bladder, segment of bowel, vagina, skin)

Front 10

pt presents with inflammation of the colon that has a "paper-like" plaque that presents after prolonged antibioitic therapy...what is the pathogenesis?

Back 10

Clostridium Difficile

(this is Pseudomembranous colitis due to prolonged ABX use)

Front 11

what is the key problem in IBD?

Back 11

INFLAMMATION

we don't really know why (infection, ischemia, drug rxn)

Front 12

Mouth to anus, skip lesions.....

*

Back 12

Chron's Disease

(Human Centipede)

Front 13

Ulcertive Colitis affects where?

*

Back 13

anus to colon

Front 14

is resection going to be helpful for a person with ulcerative colitis or Chron's disease?

Back 14

UC- only affects colon and anus, so you could surgically take them out

whereas in CD, it affects ass to mouth

Front 15

Cobblestoning and Creeping fat are going to be buzz words for what?

**

Back 15

Chron's Disease

Front 16

noncaseating granulomas with multinucleated giant cells is pathognomonic for what?

*

Back 16

Chron's Disease

note: Transmural inflammation (full-thickness

Front 17

Ulcerative Colitis vs. Chrons

Continuous lesions

Back 17

UC

(Chron's are spot lesions)

Front 18

Ulcerative Colitis vs. Chrons

full thickness affected

Back 18

Chrons

(UC is NOT full thickness, only mucosa and submucosa)

Front 19

radiographic lead pipe appearance?

*

Back 19

Ulcerative colitis

note: With prolonged inflammation, develop inflammatory pseudopolyps; crypt abscesses

Front 20

With prolonged inflammation, develop inflammatory pseudopolyps; crypt abscesses

what does this occur in? *

Back 20

Ulcerative colitis

Front 21

What is indeterminate colitis?

Back 21

Cannot distinguish btw CD and UC

Front 22

a polyp that is an abnormal proliferations/arrangements of normal tissue constituents is what kind of polyp?

Back 22

Hamartomatous

Front 23

what is polyposis syndrome?

Back 23

multiple hamartomatous polyps

Front 24

Mucocutaneous lesions sucha as tricholemmomas, oral mucosal papillomas, acral keratoses are associated with what?

Back 24

Cowden’s syndrome

Front 25

Mucosal pigmentation of the buccal mucosa and lips are associated with what?

Back 25

Peutz-Jeghers polyposis

Front 26

Peutz-Jeghers polyposis and Cowden's syndrome have increased risk of what?

Back 26

Malignancy (the polyps themselves do not give rise to the neoplasm)

Peutz-Jeghers polyposis: gastric, small bowel, colorectal, pancreas, breast, lung, ovary

Cowden's syndrome: thyroid, breast), but not likely in colorectal polyps (these are considered benign)

Front 27

doing an ophthalmologic exam on a child you see dark spots on the retina, what might you think

Back 27

Familial adenomatous polyposis (FAP)

Front 28

upon scope and biopsy you find a pt with hyperplastic polyps. What should you do next?

Back 28

nothing!

they don't normally enlarge, they are asymptomatic, and have minimal malignant potential

you don't even need to watch them more closely

Front 29

what type of adenoma is more likely to become an invasive carcinoma?

Back 29

Villous (as opposed to Tubular)

Front 30

genetics associated with Familial adenomatous Polyposis (FAP)

***

Back 30

inactivation of adenomatous polyposis coli (APC) tumor suppressor gene

Front 31

what are Gardner's syndrome and Turcot's syndrome?

Back 31

Gardner’s syndrome (AD) polyposis with osteomas and desmoid tumors

Turcot’s syndrome (AR) polyposis with CNS tumors

Front 32

how do you get from adenoma polyp to Colorectal carcinoma

**

Back 32

in general you just get a sequence of gene changes

APC → RAS → p53

Front 33

What are the mismatch repair genes that malfunction in Hereditary Nonpolyposis Colon Cancer (HNPCC)?

*

Back 33

MLH1

MSH2

Front 34

what sided Colorectal cancer is associated with the following?

Change in bowel habits occur earlier, can have dark blood

Back 34

Left-sided

this is because the bowel diameter is smaller

Front 35

what sided Colorectal cancer is associated with the following?

iron deficiency anemia

Back 35

Right-sided CRC


DUE TO MORE SUBSTANTIAL BLEEDING

Front 36

what sided Colorectal cancer is associated with the following?

Larger tumors

Back 36

Right-sided CRC

(larger diameter bowel)

Front 37

Colorectal cancer tends to spread to where?

Back 37

Liver most often

Front 38

3 most common anorectal neoplasms?

Back 38

Basaloid carcinoma
Adenocarcimona
squamous cell carcinoma

Front 39

why are mucoceles important when found in the appendix (2)

Back 39

Non-neoplastic, obstructed appendix (just fills with mucous)

Mucinous cystadenoma or cystadenocarcinoma

Front 40

what is a Pseudomyxoma peritonei

Back 40

Mucinous neoplasm erodes through the appendiceal wall and mucinous tumor implants throughout peritoneum – e.g., on ovaries

Confused with primary ovarian mucinous neoplasm

Front 41

receptor tyrosine kinase, plays crucial role in neural crest development

Loss of function mutation in Hirschsprung Dz

Back 41

RET gene

Front 42

Newborn patient presents with a chronically contracted muscularis causing constipation

Intestinal biopsy reveals:
Absence of submucosal enteric ganglion cells with compensatory hypertrophy of non-enteric parasympathetic nerve fibers that normally innervate the enteric ganglion cells

Back 42

Hirschsprung Dz

Front 43

What's happening in Panel B?

Back 43

Hirschsprung Dz

Biopsy shows a [hypertrophied] nerve in the mesenteric plexus (arrow) and an absence of ganglion cells

Front 44

**Pathogenesis:**
– Prolonged increased intraluminal pressure

• Lack of adequate fiber

• Most often affects sigmoid colon


**Symptoms**

– Asymptomatic in majority of cases (~ 80%)

– Flatulence

– Inflammation from retained fecal material (~ 10-20%)

Back 44

Diverticular Dz

Front 45

• Located between taenia coli (outer longitudinal layer of muscularis propria)

– At sites of penetrating nutrient blood vessels surrounded by collagen, less wall integrity

• Surrounding muscular wall is hypertrophied

Back 45

Diverticuli

Front 46

CD vs UC

Radiography: “string sign” from narrowed lumen

Back 46

Crohn's Dz

Front 47

CD vs UC

Back 47

1: Crohn's DZ

2: Ulcerative Colitis

Front 48

CD vs. UC

Extraintestinal Features:

-nephrolithiasis

Back 48

Crohn's Dz

Front 49

CD vs. UC

Extraintestinal Features:

-Primary sclerosing cholangitis (PSC)

Back 49

Ulcerative Colitis

Front 50

CD vs. UC

Clinical Presentation:

-RLQ colicky pain; BPR (blood per rectum); aphthous ulcers (mouth)

Back 50

Crohn's Dz

Front 51

CD vs. UC

Clinical Presentation:

- Left-sided abdominal pain, bloody diarrhea w/ mucus

Back 51

Ulcerative Colitis

Front 52

CD vs. UC

Laboratory:
- p-ANCA neg. & ASCA pos.

Back 52

Crohn's Dz

Front 53

CD vs. UC

Laboratory:
- p-ANCA pos. & ASCA neg.

Back 53

Ulcerative Colitis

Front 54

CD vs. UC

Which one is more likely to cause:

Epithelial dysplasia and adenocarcinoma

***

Back 54

UC

**Most likely to cause cancer!!**

Front 55

T/F

• All adenomas, by definition, exhibit at least lowgrade dysplasia and are neoplastic

***EXAM***

Back 55

True!!

Note:
-Adenomas are common and typically asymptomatic

-Prevalence increases with age

Front 56

What is the initial proliferative abnormality of the colonic mucosa that
leads to the accumulation of mucosal cells --> adenocarcinoma

Back 56

the extension of the mitotic zone in the crypts

Front 57

Internal/External Hemorrhoids

–superior plexus, above pectinate line

• Bleeding, “painless”

Back 57

Internal

Front 58

Internal/External Hemorrhoids:

– inferior plexus, below pectinate line

• Painful thrombosis

Back 58

External

Front 59

FAP vs HNPCC

Hundreds of adenomas, with malignant
transformation in 30’s or 40’s

Back 59

FAP

(There aren't tons of polyps present in HNPCC)

Front 60

What is seen in almost all cases of HNPCC but only ~ 15% of
sporadic cases?

Back 60

Micro Satellite Instability (MSI)

(If cancer arises with abscense of polyps; look for MLH1 and MSH2 gene mutations to Dx HNPCC!)