Jeef First Aid Gi Part 8

Front 1

195. What is Malignant risk of Adenomatous polyps of colon associated with?

Back 1

a. Malignant risk is associate with:
1. ↑ size
2. Villous histology
3. ↑epithelial dysplasia
4. The more Villous the polyp, the more likely it is to be malignant!!!!!! “Villous = Villainous”!

Front 2

196. Hyperplastic colonic polyps?

Back 2

a. Most common non-neoplastic polyp in colon.
b. >50% found in rectosigmoid colon.

Front 3

197. Juvenile colonic polyps?

Back 3

a. Mostly sporadic lesions in children <5.
b. 80% in rectum.
c. If single, no malignant potential!.

Front 4

198. Juvenile polyposis syndrome?

Back 4

a. Multiple juvenile polyps in GI tract.
b. ↑ risk of adenocarcinoma.

Front 5

199. Peutz-Jeghers syndrome inheritance type?

Back 5

a. Autosomal-dominant.
b. Single polyps are not malignant

Front 6

200. Peutz-Jeghers sx?

Back 6

a. Multiple non-malignant hamartomas throughout GI tract
b. Hyperpigmented mouth, lips, hands, genitalia.
c. Associated w/ ↑ risk of colorectal cancer and other visceral malignancies.

Front 7

201. Colorectal cancer (CRC) epidemiology?

Back 7

a. 3rd most common cancer and 3rd most deadly
b. Most pts >50.
c. 25% have family hx

Front 8

202. Genetic conditions associated w/Colorectal cancer?

Back 8

1. Familial adenomatous polyposis (FAP)
2. Gardner’s syndrome
3. Turcot’s syndrome
4. Hereditary nonpolyposis colorectal cancer

Front 9

203. Familial adenomatous polyposis (FAP)?

Back 9

a. Autosomal dominant mutation of APC gene on chromosome 5q.
b. 2-hit hypothesis.
c. 100% progress to CRC!
d. Thousands of polyps; pancolonic.
e. Always involves rectum.

Front 10

204. Familial adenomatous polyposis + osseous and soft tissue tumours, retinal hyperplasia?

Back 10

a. Gardner’s syndrome.

Front 11

205. FAP + malignant CNS tumour?

Back 11

a. Turcot’s syndrome.
b. “TURcot =TURban”.

Front 12

206. Hereditary nonpolyposis colorectal cancer (HNPCC/Lynch syndrome)?

Back 12

a. Autosomal dominant mutations of DNA mismatch repair genes.
b. 80% progress to CRC.
c. Proximal colon is always involved!

Front 13

207. Additional risk factors for colorectal cancer?

Back 13

a. IBD
b. Streptococcus bovis bacteremia.
c. Tobacco use
d. Large villous adenomas
e. Juvenile polyposis syndrome.
f. Peutz-Jeghers syndrome.

Front 14

208. Presentation of colorectal cancer?

Back 14

a. Distal colon- Obstruction, colicky pain, hematochezia (maroon coloured) so not melena which is high up and digested and not bright red (lower down).
b. Proximal colon- Dull pain, iron deficiency anaemia, fatigue.

Front 15

209. Diagnosis of CRC?

Back 15

a. Iron deficiency anaemia in older males.
b. Screen pts >50 yrs w/stool occult blood test and colonoscopy.
c. “apple core” lesion seen on barium enema radiograph.

Front 16

210. Tumour marker for colorectal cancer?

Back 16

a. CEA!

Front 17

211. Molecular pathogenesis of Colorectal Cancer:
a. 2 molecular pathways that lead to CRC?

Back 17

1. Microsatellite instability pathway (15%)
2. APC/β-catenin (chromosomal instability) pathway (85%).

Front 18

212. Microsatellite instability pathway of CRC?

Back 18

a. DNA mismatch repair gene mutations ->sporadic and HNPCC syndrome.
b. Mutations accumulate, but no defined morphologic correlates

Front 19

213. APC/β-catenin (chromosomal instability) pathway (85%)?

Back 19

a. Normal colon->(Loss of APC gene)>Colon at risk> (K-RAS mutation)>Adenoma> (loss of p53)> Carcinoma.

Front 20

214. Carcinoid tumour?

Back 20

a. Tumour of neuro-endocrine cells.
b. Constitute 50% of small bowel tumours.
c. Often produce 5-HT, which can lead to carcinoid syndrome
d. If confined to GI system, no carcinoid syndrome is observed, since liver metabolizes 5-HT.
e. If tumour or mets (usually to liver) exist outside GI, carcinoid is observed.

Front 21

215. Carcinoid syndrome characteristic features (4)?

Back 21

1. Wheezing
2. Right-sided heart murmurs
3. Diarrhoea
4. Flushing

Front 22

216. Most common sites of Carcinoid tumours?

Back 22

a. Most common sites are the appendix, ileum, and rectum.

Front 23

217. Where are carcinoid tumours most commonly malignant?

Back 23

a. Small intestine.

Front 24

218. Carcinoid tumour key feature seen on electron microscope.?

Back 24

a. “Dense core bodies” seen on EM.

Front 25

219. Liver cirrhosis?

Back 25

a. Diffuse fibrosis of liver, destroys normal architecture.
b. Nodular regeneration
c. Micronodular/macronodular

Front 26

220. Micronodular liver cirrhosis?

Back 26

a. Nodules <3 mm.
b. Uniform size.
c. Due to metabolic insult (eg. Alcohol, hemochromatosis, Wilson’s disease).

Front 27

221. Macronodular liver cirrhosis?

Back 27

a. Nodules >3 mm, varied size.
b. Usually due to significant liver injury leading to hepatic necrosis (e.g, postinfectious or drug-induced hepatitis).

Front 28

222. What type of cirrhosis has increased risk of hepatocellular carcinoma- micro or macronodular?

Back 28

a. Macronodular!!! Makes sense since its post-infectious.

Front 29

223. What can relieve portal hypertension?

Back 29

a. Shunt between portal and systemic circulation.

Front 30

224. Effects of liver cell failure?

Back 30

a. Coma
b. Scleral icterus
c. Fetor hepaticus (breath smells like a freshly opened corpse)
d. Spider nevi
e. Gynecomastia/testicular atrophy.
f. Liver “Flap” = asterixis (course hand tremor).
g. Bleeding tendency (decreased PT and clotting factors).
h. Anaemia
i. Ankle oedema.