Path: Small And Lg Bowel D/os

Front 1

circumscribed pouch of a tubular ogan

Back 1

diverticulum

Front 2

true vs. false diverticulum

Back 2

True: pouch contains all layers (mucosa, submucosa, muscularis propria, adventitia)

false: pouch contains mucosa and submucosa that have herniated thru the muscularis propria

Front 3

Meckel's diverticulum: defn

Back 3

Failure of the vitelline duct to involute.

A True diverticulum in distal ileum.

Front 4

What is the rule of 2s for Meckels diverticulum?

Back 4

2% of population

2" long

Located in ileum 2 feet from ileocecal valve

usually presents at 2 years old

Front 5

Complications of Meckels diverticulum

Back 5

Bleeding, volvulus, intussusceptions or obstruction, generally during first two years of life.

Front 6

T/F approximately 50% of symptomatic Meckel's diverticula have ectopic gastric or pancreatic cells and can develop gastric ulcers in there

Back 6

T

Front 7

Hirschsprung’s Disease: defn

Back 7

disorder of the gut which is caused by the failure of the neural crest cells (enteric ganglion cells) to migrate completely during fetal development of the intestine.

aka enteric aganglionosis

Front 8

Diverticular Disease of the Colon
involves (true, false) diverticula.

Back 8

False

Front 9

Where are false diverticula most common?

Back 9

sigmoid colon

Front 10

Sx of false diverticula?

Back 10

cramping pain, bleeding, and perforation

Front 11

pathogenesis of false diverticula

Back 11

Low fiber diet makes the colon have to develop very high pressures to move food through. These high pressures cause outpouchings of areas that are naturally weaker because they're where blood vessels enter

Front 12

What is duodenal atresia?

Back 12

Failure of duodenum to develop

Front 13

What other disease is associated wtih duodenal atresia?

Back 13

Down syndrome

Front 14

What is the polyhydramnios in duodenal atresia from?

Back 14

Amniotic fluid that has been swallowed and can't go anywhere, causing distension of stomach and duodenum.

Gives rise to double bubble sign on xray

Front 15

Twisting of bowel around mesentery, leading to ishemia

Back 15

volvulus

Front 16

Telescoping of proximal bowel into a distal segment, with resulting infarction causing currant jelly stool

Back 16

intussusception

Front 17

What must be present for an intussusception to develop?

Back 17

Must have something for the bowel to "catch" on

Children: usually lymphoid hyperplasia

Adults: usually tumor

Front 18

What must be present for an intussusception to develop?

Back 18

Must have something for the bowel to "catch" on

Children: usually lymphoid hyperplasia

Adults: usually tumor

Front 19

T/F the small bowel is highly sensitive to ischemic injury

Back 19

T

Front 20

What HLAs is celiac disease associated with?

Back 20

DQ2 and DQ8

Front 21

What is the primary pathologic component of gluten?

Back 21

Gliadin

Front 22

caseating lymph nodes may be seen in what?

Back 22

tuberculosis of intestine

Front 23

What is mycobacterium avium intracellulare?

Back 23

atypical mycobacterial infection which can occur in the later stages of AIDS.

Front 24

What is the stain for acid-fast bacteria? How will acid-fast bacteria appear?

Back 24

Ziehl–Neelsen stain; Appear bright pink

Front 25

To diagnose amebic colitis, where will you look for the organisms?

Back 25

In histological section, look for the organism in the necrotic base.

Front 26

Sloughed mucosa and mucopurulent exudate form  a "____" in C. difficile infection.

Back 26

pseudomembrane

Front 27

What is the classic look of C. difficile pseudomembranous colitis on histological exam?

Back 27

see "exploding volcano" exudate coming out of surface

Front 28

What is microscopic colitis?

Back 28

Refers to colitis that isn't visible on gross specimen, but when biopsied, see inflammatory cells (increased intraepithelial lymphocytes).

Symptoms are watery diarrhea, but when they get colonoscopy, it looks normal.

Front 29

What is crypt hyperplastic villous atrophy?

Back 29

Seen in celiac disease. THe villi have atrophied, but the bowel is trying to proliferate, results in hyperplasia or crypts. The section of small bowel looks like colon.

Front 30

What is crypt hypoplastic villous atrophy?

Back 30

Seen in radiation enteritis. The bowel has lost ability to proliferate.

Front 31

Celiac disease is a ___ cell mediated chronic inflammatory reaction

Back 31

T

Front 32

Celiac disease is found almost exclusively in what ethnic group?

Back 32

Caucasians

Front 33

What cancer are Celiac patients susceptible to if the disease is refractory?

Back 33

T cell lymphoma (most lymphomas are Bcell).

Front 34

What is tropical sprue?

Back 34

damage to small bowel villi due to organism. Responds to antibiotics.

Front 35

Where are these primarily found in small intestine?
1) Celiac disease
2) Tropical sprue

Back 35

1) Duodenum
2) Jejunum, Ileum

Front 36

What is Whipple's disease?

Back 36

Systemic infection by gram positive bacillus Trophyerma whippelli.

Macrophages engulf the bacteria but they don't die. The bacterial-laden macrophages then obstruct intestinal lacteals causing impaired transport.

Front 37

Sx of Whipple's disease

Back 37

Steatorrhea due to obstruction of fat transport

Front 38

What stain is used to dx Whipple's disease?

Back 38

PAS - will see it within macrophages.

Front 39

What is abetalipoproteinemia?

Back 39

Defeciency in certain lipoproteins involved in making chylomicrons and VLDL.

Deficiency in fat soluble vitamins (A,D,E,K)

Front 40

Sx of abetalipoproteinemia

Back 40

Steatorrhea
Failure to thrive
Vitamin deficiency (esp vitamin E) and its sequelae

Front 41

What is the wall involvement in
A) Ulcerative colitis
B) Crohn's disease

Back 41

A) ulceration/inflammation limited to mucosa

B) full thickness inflammation with knife fissures

Front 42

What is the intestinal location in
A) Ulcerative colitis
B) Crohn's disease

Back 42

A) Starts in rectum and spreads proximally, always involving continuously (doesn't jump from section to section)

B) Anywhere from mouth-anus, but terminal ileum is most common site. Least common site is rectum.

Front 43

IBD of the rectum is most likely to be

Back 43

Ulcerative colitis

Front 44

Symptoms of
A) Ulcerative colitis
B) Crohn's disease

Back 44

A) LLQ pain, bloody diarrhea

B) RLQ pain, nonbloody diarrhea

Front 45

Histology of
A) Ulcerative colitis
B) Crohn's disease

Back 45

A) Crypt abscesses: see neutrophils in the crypts

B) See lymphs and GRANULOMAS

Front 46

Granulomas are associated with:
A) Ulcerative colitis
B) Crohn's disease

Back 46

B

Front 47

Gross appearance of
A) Ulcerative colitis
B) Crohn's disease

Back 47

A) Pseudopolpyps: bumps on colon and loss of haustra

B) Cobblestone mucosa, stricture, thickening, creeping fat

Front 48

What is the difference in wall thickness in
A) Ulcerative colitis
B) Crohn's disease

Back 48

A) Normal in thickness
B) Very thickened

Front 49

What is an aphthous ulcer?

Back 49

Canker sore. Can occur in intestine, common with Crohn's

Front 50

Fissures and fistulae are more common with
A) Ulcerative colitis
B) Crohn's disease

Back 50

B

Front 51

Any benign lesion that protrudes above surface of surrounding mucosa

Back 51

polyp

Front 52

Benign proliferation of smooth muscle

Back 52

rectal leiomyoma

Front 53

What is a hyperplastic polyp?

Back 53

Failure of sloughing. A non-dysplastic lesion. Not necessarily concerning for cancer but a preponderance of them increases risk.

Front 54

Sessile serrated adenoma: defn

Back 54

Dysplastic, precancerous lesion in colon.

Unlike traditional colonic adenomas (e.g. tubular adenoma, villous adenoma), they do not (typically) have nuclear changes (nuclear hyperchromatism, nuclear crowding, elliptical/cigar-shaped nuclei).

Front 55

What gene is frequently mutated in colon cancer, originally leading to a proliferative state, and leading to cancer with DNA hypomethylation?

Back 55

APC

Front 56

Pedunculated tubular adenoma: defn

Back 56

The type that leads to cancer.

Front 57

What is familial adenomatous polyposis?

Back 57

an inherited condition in which numerous polyps form mainly in the epithelium of the large intestine. While these polyps start out benign, malignant transformation into colon cancer occurs when not treated.

Front 58

Treatment of familial adenomatous polyposis

Back 58

Most individuals with the APC mutation will develop colon cancer by the age of 40. Therefore, prophylactic surgery is generally recommended before the age of 25.

Front 59

Exophytic: defn

Back 59

Growing outward.

Front 60

Annular: defn

Back 60

Growing inward, forming a stricture

Front 61

Exophytic carcinomas tend to be ___ sided while annular carcinomas tend to be ____ sided

Back 61

R; L

Front 62

Hereditary Nonpolyposis Colon Cancer Syndrome is characterized by mutations in ______ pathway.

Back 62

Mismatch repair.

Front 63

What is the carcinoid syndrome?

Back 63

Paroxysmal flushing - vasomotor disturbances

Diarrhea - hypersecretion/hypermotility

Wheezing - bronchoconstriction

Tricuspid/pulmonary stenosis - endocardial fibrosis

Front 64

What does it mean when the carcinoid syndrome appears?

Back 64

The tumor has already metastasized to the liver.

Front 65

What do carcinoid tumors stain positive for?

Back 65

Chromogranin

Front 66

_____ is excreted in urine in patients with carcinoid syndrome

Back 66

5-HIAA