Large Intestine And Appendix Path

Front 1

a. What is Hirschsprung disease?

Back 1

i. Defective relaxation and peristalsis of rectum and distal sigmoid colon

Front 2

b. What are the clinical features of Hirschsprung disease?

Back 2

a. What is the most common cause of pseudomembranous colitis?

Front 3

a. What is the most common cause of pseudomembranous colitis?

Back 3

i. C. dif

Front 4

a. Where does Chron disease present? With what type of lesions?

Back 4

i. Anywhere from mouth to anus
ii. Skip lesions

Front 5

b. What are the symptoms of Chron disease?

Back 5

i. RLQ pain
ii. Non-blood diarrhea

Front 6

c. What type of inflammation is in Chron disease?

Back 6

i. Lymphoid aggregates with granulomas

Front 7

d. What is the gross appearance of Chron disease?

Back 7

i. Cobblestone mucosa
ii. Creeping fat
iii. Strictures

Front 8

e. What are the complications of Chron disease?

Back 8

i. Malabsorption with nutritional deficiency
ii. Carcinoma if colonic disease is present
iii. Fistula formation

Front 9

a. Where does UC present?

Back 9

i. Begins in rectum and can extend proximally up to cecum

Front 10

b. What are the symptoms of UC?

Back 10

i. LLQ pain
ii. Blood diarrhea

Front 11

c. What type of inflammation is in UC?

Back 11

i. Crypt abscesses with neutrophils

Front 12

d. What are the complications of UC?

Back 12

i. Toxic megacolon
ii. Carcinoma

Front 13

a. What is acute appendicitis caused by?

Back 13

i. Children→ Lymphoid hyperplasia
ii. Adults→ fecalith

Front 14

b. What are the symptoms of acute appendicitis?

Back 14

i. Periumbilical pain
ii. Fever
iii. Nausea
iv. RLQ pain

Front 15

a. What are colonic diverticula?

Back 15

i. Outpouchings of mucosa and submucosa through the lamina propria

Front 16

b. What causes colonic diverticula?

Back 16

i. Constipation
ii. Straining
iii. Low-fiber diet

Front 17

c. Where do colonic diverticula arise?

Back 17

i. Where vasa recta traverse the lamina propria

Front 18

d. What are the symptoms of colonic diverticula?

Back 18

i. Hematochezia
ii. Diverticulitis
iii. Fistula

Front 19

a. What are colonic polyps?

Back 19

i. Raised protrusions of colonic mucosa

Front 20

b. What are the two types of colonic polyps?

Back 20

i. Hyperplastic
ii. Adenomatous

Front 21

c. What are hyperplastic polyps? What is their malignant potential?

Back 21

i. Due to hyperplasia of glands
ii. Benign with no malignant potential

Front 22

d. Where do hyperplastic polyps arise?

Back 22

i. Left side-- colon

Front 23

e. What are adenomatous polyps? What is their malignant potential?

Back 23

i. Neoplastic proliferation of glands
ii. Benign but premalignant

Front 24

f. How do you screen for polyps?

Back 24

i. Colonoscopy
ii. Testing for fecal occult blood

Front 25

g. What are the greatest progression risk factors for colonic polyps?

Back 25

i. Size >2 cm
ii. Sessile growth
iii. Villous histology

Front 26

a. What is FAP?

Back 26

i. Autosomal dominant disorder characterized by 100s to 1000s of adenomatous polyps

Front 27

b. What causes FAP?

Back 27

i. Inherited APC mutation
ii. Increases propensity to develop adenomatous polyps throughout colon and rectum

Front 28

c. What is the tx for FAP?

Back 28

i. Prophylactic removal of colon and rectum

Front 29

d. How many polyps typically present in FAP? What is the minimum?

Back 29

i. 500-2500
ii. 100 is the minimum

Front 30

e. How can you prevent cancer in FAP?

Back 30

i. Early detection
ii. Prophylactic colectomy

Front 31

f. What is Gardner syndrome?

Back 31

i. FAP with fibromatosis and osteomas

Front 32

g. What is fibromatosis?

Back 32

i. Non-neoplastic proliferation of fibroblasts

Front 33

h. What is an osteoma?

Back 33

i. Benign tumor of bone

Front 34

i. For what other conditions does HNCC put you at risk?

Back 34

1. Colorectal cancer
2. Extraintestinal cancer-- endometrium

Front 35

ii. What is the typical presentation of HNCC?

Back 35

1. Right-sided tumors
2. More likely to be poorly differentiated
3. Present at a younger age

Front 36

iii. What is stage T1S cancer?

Back 36

1. Penetration into the mucosa

Front 37

iv. What is state T1 cancer?

Back 37

1. Penetrates full thickness of mucosa and muscularis mucosae into submucosa

Front 38

v. What is stage T2 cancer?

Back 38

1. Penetrates down to serosa

Front 39

vi. What is stage T3 cancer?

Back 39

1. Penetrates through serosa

Front 40

vii. What causes HNCC?

Back 40

1. Mutations in genes encoding proteins responsible for detections, excision, and repair of DNA replication errors

Front 41

viii. What genes are mutated in HNCC?

Back 41

1. MSH2
2. MLH1

Front 42

1. What is the most common GI malignancy?

Back 42

a. Adenocarcinoma

Front 43

2. What are the risk factors for colonic adenocarcinoma?

Back 43

a. Diets high in fat and refined carbohydrates
b. Diets low in vegetable fiber and antioxidants
c. Alterations in GI flora
d. FAP, HNCC

Front 44

3. What causes colonic adenocarcinoma?

Back 44

a. APC/beta-catenin pathway→ activation of genes that promote epithelial proliferation
b. Microsatellite instability results in increased proliferation and decreased apoptosis
c. Late K-RAS and P53 mutations promote growth and prevent apoptosis
d. SMAD mutations reduce TGF-beta signaling and promote cell cycle progression

Front 45

4. What will a colonic adenocarcinoma look like upon gross examination?

Back 45

a. May be polypoid and exophytic
b. Distal colon→ napkin ring mass encircling the bowel
c. May be ulcerated

Front 46

5. What will the microscopic appearance of colonic adenocarcinoma be?

Back 46

a. Tall columnar cells arranged in haphazard glands
b. Similar to adenomatous polyps

Front 47

6. What is a dx for iron deficiency anemia in a post-menopausal female or adult male without any eating disorder or malabsorption syndrome?

Back 47

a. Colon cancer until proven otherwise

Front 48

1. With what is squamous cell carcinoma of the anal canal associated?

Back 48

a. HPV
b. Condyloma accuminatum

Front 49

1. From where to carcinoid tumors arise?

Back 49

a. Neuroendocrine cells of the gut

Front 50

2. What is the most common tumor of the appendix?

Back 50

a. Carcinoid tumor
b. Most often near tip

Front 51

1. What are the sx of carcinoid syndrome?

Back 51

a. Cutaneous flushing
b. Bronchospasm
c. Increased bowel motility-- projectile diarrhea
d. Right-sided cardiac valve thickening

Front 52

4. How do you cure foregut carcinoids? What is their metastatic potential?

Back 52

a. Excision
b. Rarely metastasize

Front 53

1. What is the metastatic potential of midgut carcinoids?

Back 53

a. Multiple and aggressive

Front 54

6. What are the characteristics of hindgut carcinoids?

Back 54

a. Usually found incidentally
b. Very indolent
c. Excision is curative

Front 55

7. What is the gross morphology of a carcinoid?

Back 55

a. Tan-yellow polypoid lesions

Front 56

8. What is the microscopic morphology of a carcinoid?

Back 56

a. Nests and cords or islands and sheets of uniform, small, round to oval cells
b. Nuceli are oval