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52 Cards in this Set
- Front
- Back
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What is Meckel's Diverticulum?
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SI diverticulum which is the remnant of the omphalomesenteric duct (from umbilical cord to SI)
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What is Hirchsprung's Disease?
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Meissner's and Auerbach's aganglionosis
i.e. lack of motility |
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What's up with Angiodysplasia?
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arterioles-->venules with no caps in between.
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Malabsorption Syndromes and examples
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DEFECTIVE DIGESTION: pancreatic/biliary insufficiency
MUCOSAL CELL ABNORMALITIES: REDUCED SI SURFACE AREA celiac's, crohn's, short gut LYMPHATIC OBSTRUCTION lymphoma INFECTION parasites, tropical sprue |
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Bowel Obstruction
2 types and examples |
MECHANICAL
hernias, tumors, gallstones, intussusception, volvulus PSEUDO-OBSTRUCTION Paralytic Ileus (post-op) Bowel infarction Myopathies, Neuropathies |
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What is Intussusception?
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Telescoping of intestines
Can become ischemic/necrotic |
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Most common site of diverticulum?
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colon
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Complications with divericulosis?
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Obstructed diverticulus-->infection
Bleeding Fistula (to bladder, vagina, etc) |
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What does Meckel's mimic?
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It can mimic appendicitis
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Most common site of acute diverticulitis?
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sigmoid colon
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During which seasons is appendicitis most common?
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spring and summer (maybe due to allergies)
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Appendicitis
Possible causes of obstruction |
Fecolith
Lymphoid Hyperplasia Foreign Body (worms) Cecal Tumor |
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Causes of Parasitic Dysentery
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Giardia Lamblia
Cryptosporidiosis (preschoolers) Entamoeba Histolytica Nematodes and Cestodes |
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Whipple Disease
What the crap is it? |
multiorgan bacterial disease
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Whipple Disease
affects? |
GI, CNS, cardiothoracic system, joints, LN's
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Whipple Disease
Caused by? |
Fastidious gram positive actinomycete: Tropheryma whippelii
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Whipple Disease
Kicker to culturing it? |
NEEDS FIBROBLASTS!
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Whipple Disease
HLA type? |
HLA-B27 in 30% of cases
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Whipple Disease
presents with? |
malabsorption, diarrhea, CNS, CT, arthritis
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Whipple Disease
Kicker to pathogenesis? |
Macrophages can't destory the organism, so there will be lots of macrophages present.
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CELIAC DISEASE
Associated with? |
dermatitis herpetiformis
small bowel lymphomas |
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CELIAC DISEASE
genetics? |
HLA-DQ2 and DQ8
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Chronic Relapsing IBD's
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Ulcerative Colitis
Crohn's |
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Genetics between UC and Crohn's?
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Familial concordance in Crohn's
Common HLA halotypes in both UC "personality" (type A) |
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ULCERATIVE COLITIS
region of GI tract? |
Rectum to proximal small bowel
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ULCERATIVE COLITIS
Pathology |
Acute and Recurrent IBD
Mucosal Disease-->ulcerations and pseudopolyps |
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ULCERATIVE COLITIS
Risk of progression |
90% of patients with chronic unrelenting inflammation, inducing glandular dysplasia with potential progression to adenocarcinoma
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ULCERATIVE COLITIS
Clinical Course |
Epidsodic Attacks of bloody mucoid diarrhea. Precipitated by stress. Can become emergencies. Can have associated arthritis, skin lesions, uveitis, primary sclerosing cholangitis (PSC)
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CROHN'S DISEASE
Pathology |
Chronic Recurrent IBD
Can be from lips to anus with frequent "skip lesions." TRANSMURAL (i.e. though the mucosa and into the wall) Often with mucosal linear ulceration (cobblestone) |
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CROHN's Disease
Complications |
Granulomas
Fissures Adhesions with fistulas Unrelenting inflammation-->fibrosis |
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CROHN'S
demographics |
Western World
2nd-3rd generation or 6th-7th Females Whites Jews |
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CROHN'S
Clinical Presentation |
Fever, Diarrhea, Abd Pain
precipitated by stress PROGRESSIVE: multiple ORs, fistula, anal disease MALABSORPTION: b12, albumin, bile salts SYSTEMIC: Iritis, Uveitis, Sacroiliitis, Pericholangitis, PSC |
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CROHN'S
Rx |
Remicade aka Infliximab
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Types of Non-Neoplastic Polyps
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HYPERPLASTIC (serrated): small, smooth in older pts w/ delayed shedding of benign cells
JUVENILE: under 5yo HAMARTOMA: mix of tissue elements |
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Types of neoplastic polyps
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ADENOMAS
Tubular, Villous, Tubulovillous SUBTYPES OF SERRATED POLYPS |
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Epidemiology of Adenomatous Polyps
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20-30% before age 40
40-50% after age 60 |
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Two genetic pathways to colonic adenocarcinoma
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1. Adematous Polyposis Coli (APC) gene mutations
2. DNA methylation of key mismatch repair genes |
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Polyposis Syndromes
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1. Familial Polyposis: tons of polyps, entire GI tract, 100% progress to carcinoma
2. Peutz-Jeghers Syndrome: hamartomas, melanosis of skin/oral mucosa |
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Hereditary Nonpolyposis Colon Cancer
Etiology |
DNA mismatch repair defect
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Hereditary Nonpolyposis Colon Cancer
Associated with cancer of: |
Intestines, endometrium, ovaries, urothelium
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Hereditary Nonpolyposis Colon Cancer
Risk associated with MMR defect |
80% lifetime risk
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Hereditary Nonpolyposis Colon Cancer
Location of colon cancer |
more proximal
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Colonic Adenocarcinoma
Etiology and Pathogenesis |
Older Pts
Bad Diets Longstanding UC (>10yrs) Polyposis Syndromes DCC Gene |
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Colonic Adenocarcinoma
1. Location 2. Differentiation 3. Spread |
1. Shift to right colon (25%)
2. Signet Rings 3. Through the wall, to LN's, to the Liver |
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Colonic Adenocarcinoma
Rx |
Surgery!
Chemo/Rad too |
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Colonic Adenocarcinoma
Poor Prognosticators |
very young or very old
males large, myoinvasive, locally invasive Obstruction Perf Vascular Invasion LN involvement Perineural Invasion |
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Kicker Risk factor of SCC of anus
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Butt Sex and HPV (serotype 16)
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Kicker type of Appendix neoplasm
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Mucocele; mucinous cystadenoma (filled with mucous) or mucinous cystadenocarcinoma
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what is peritonitis?
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peritoneal lining inflammation
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Peritonitis:
etiology |
bacterial (primary or secondary to rupture of abscess)
chemical (bile, gastric or pancreatic acid, meconium) |
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Peritoneal Neoplasms
1. Kicker cause |
1. 80% of mesothelioma's of peritoneal is from asbestos
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Peritoneal Neoplasms
2. other kicker type |
2. Pseudomyxomatous peritonei: grape-like tumors
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