Pathology Of Intestines

Front 1

Presence of what differentiates dueodenum from jejunum?

Back 1

Brunner glands - secrete mucus and bicarb

Front 2

Ileum has more of what type of tissue than other parts of the small intestine

Back 2

lymphoid tissue - Peyer's patch

Front 3

Which part of the duodenum is retroperotineal?

Back 3

duodenum

Front 4

most common form of congenital intestinal atresia

Back 4

imperforate anus

Front 5

meckel diverticulum

what is it?
why can it be a problem?

Back 5

failure of involution of vitelline duct near ilealcecal valve

50% are heterotopic gastic or pancreatic tissue - secretion of enzymes or acid that the intestinal mucosa cannot handle -> bleeding or perforation

Front 6

Hirschprung disease

Back 6

most common cause of congenital intestinal obstruction:

congenital aganglionic megacolon - part of the colon is paralyzed due to lack of dev of the ganglionic cells -> obstruction

Front 7

Hirschprung disease complications

Back 7

rupture -> peritonitis
enterocolitis -> sepsis

Front 8

meissner's plexus

Back 8

plexus within the submucosa of the intestine

parasympathetics

Front 9

auerbach's plexus

Back 9

myenteric plexus

plexus between the circular and longitudinal muscles in muscularis externa - controls motor

parasympathetics and sympathetics

Front 10

Causes of obsturction

Back 10

Hernia of intestine through peritoneum

adhesions - secondary to surgery, infection due to fibrosis -> closed loops -> internal herniation

intussusception - telecoping of intestine into immediate distal segment

volvulus - twisting of segment of intestine about its attachment

Front 11

obstruction occurs more in the small intestine or colon?

Back 11

small intestine

Front 12

hernia, adhesions, intussusception, volvulus complications

Back 12

obstruction
infarction

Front 13

most common hernia

Back 13

inguinal

Front 14

incarceration of bowel

Back 14

permanent entrapment

Front 15

strangulation of bowel

Back 15

vascular compromise -> infarction

red infarction

Front 16

pseudo-obstruction

Back 16

clinical syndrome due to bowel inability to propel contents - lack of peristalsis

NO MECHANICAL OBSTRUCTION

most common: paralytic ileus due to abdominal surgery or truama or peritonitis

Front 17

Hallmark of malabsorption

Back 17

steatorrhea

Front 18

malabsorption

Back 18

defective absorption of nutrients and water

can be due to improper:
digestion
transport through epithelium
transport through lymph

Front 19

Most common causes of malabsorption in the U.S.

Back 19

pancreatic insufficiency:
chronic pancreatitis (adults)
cystic fibrosis (children)

celiac disease

crohn disease (inflammatory bowel disease) - reduces functional surface area for absorption

Front 20

celiac disease

what kind of disease?
sensitivity to what?

Back 20

autoimmune disease - T cell mediated and autoantibodies

sensitive to gliadin (protein in gluten)

Front 21

Celiac Disease histology

Back 21

diffuse enteritis
intraepithelial lymphocytosis
villous atrophy
crypt hyperplasia

mucosa is normal in thickness

Front 22

What skin rash is associated with celiac disease

Back 22

dermatitis herptiformis - abnormal deposition of IgA

Front 23

Whipple disease

Back 23

due to Tropheryma whippeli

macrophages cannot kill them so become distended -> villi expansion and obstruction of lymphatics

lymphatics obstruction -> lipid deposition

clinical: lipid malabsorption

Front 24

diarrhea vs dysentery

Back 24

diarrhea is increased in stool mass, frequency, and/or fluidity

dysentery is low volume, painful, BLOODY diarrhea

Front 25

viral gastroenteritis causes

Back 25

rotavirus, adenovirus, norovirus

Front 26

bacterial enterocolitis - bacteria that invade

morphology

Back 26

salmonella

yersinia

campylobacter - most common in develop countries

shigellosis - bacillary dysentery

usually see cryptitis with neutrophils and ulceration in the GI tract

Front 27

bacterial enterocolitis - toxin producer

Back 27

cholera

c. diff - pseudomembranous colitis

Front 28

pseudomembranous colitis

Back 28

associated with use of broad-spectrum antibiotics that alter normal intestinal flora - allowing C. diff to grow

see fibrinopurulent necrotic debris and mucus = pseudomembrane (not a true membrane which is made of cells and tissue)

dmg to epithelium

Front 29

bacterial overgrowth syndrome

Back 29

chronic diarrhea with malabsorption

see with gastric hypoacidity, immunologic deficiency, dysmotility

Front 30

intestinal tuberculosis

Back 30

caseating granulomata with overlying ulcers

from food or swallowed sputum

Front 31

intestinal fungi

Back 31

only with immunosupression or suppression of normal flora by antibiotics

Front 32

parasitic enterocolitis

Back 32

nematodes - ascaris

cestodes - tapeworms

amebiasis - entamoeba histolytica

giardiasis - giardia lamblia

Front 33

amebiasis

histology?
where does it attack

Back 33

invades tissue of colon

histology: flask shaped ulcer

Front 34

giardiasis

histology?
where does it attack

Back 34

toxin mediate destruction of small intestine

histology "leaves blowing in wind" pattern

Front 35

Tumors more common in small intestine or colorectum?

Back 35

colorectum

Front 36

benign tumors of small intestine (3)

Back 36

adenoma most common - often periampullary causing jaundice

harmartoma (peutz-Jeghers polyp)

mesenchymal tumors

Front 37

metastases to small intestine

Back 37

direct seeding from colon

lung

female genital tract

melanoma

Front 38

2 main types of primary malignancy in small intestine

Back 38

adenocarcinoma - like the colon - often cause obstruction

neuroendocrine (carcinoid) - tumor - most frequent - primary intestinal lymphoma or mesenchymal tumor

Front 39

most prognostic factor of neuroendocrine tumor

Back 39

site:

appendix is the most common but the least agressive

ileum is 2nd most common and most aggressive (any small intestine or colon - agressive)

Front 40

neuroendocrine tumors morphology

Back 40

undiffereniated cells that are neuroendocrine committed

start at base of crypt and move to submucosa

uniform cells, round nuclei with neurosecretory granules

Front 41

primary intestinal lymphoma location

Back 41

alimentary canal most common location of extranodal lymphoma

stomach>intestines

Front 42

patients with this disease have increased likely hood of primary intestinal Tcell lymphoma

Back 42

celiac disease or other immunodeficiency

Front 43

primary intestinal lymphoma morphology

Back 43

exaggerated mucosal folds due to expanded villi due to lymphocytic infiltrate

Front 44

Cell types of primary intestinal lymphoma is usually Bcell or Tcell?

Back 44

Bcell 95%

Front 45

Bcell MALT lymphoma

Back 45

most common type of primary intestinal lymphoma

assocated with H pylori

subtype of marginal zone lymphoma

Front 46

immunoproliferative small intestinal disease (IPSID)

Back 46

mediterranean lymphoma - frequent in middle east

associated with Campylobacter jejuni

subtype of marginal zone lymphoma (same as B cell MALT)

Front 47

large B-cell lymphoma

Back 47

transforms from Bcell MALT or IPSID

Front 48

intestinal T cell lymphoma

Back 48

associated with celiac disease

proximal small intestine

poor prognosis

Front 49

mesenchymal tumors of intestine

Back 49

lipoma - most common - submucosal - often near ileocecal valve

GIST

smooth muscle, kaposi sarcoma