Fa: Gastrointestinal - Pathology - 4

Front 1

What diagnosis should you consider in an elderly male presenting with dysphagia, obstruction, and foul breath?

Back 1

Zenker Diverticulum

Front 2

What is the name of the pharyngoesophageal false diverticulum (only through mucosa and submucosa)?

Back 2

Zenker Diverticulum

Front 3

What is a Zenker Diverticulum? Location?

Back 3

- False diverticulum
- Pharyngoesophageal
- Herniation of mucosal tissue at Killian triangle between thyropharyngeal and cricopharyngeal parts of inferior pharyngeal constrictor

Front 4

What symptoms does a patient with a Zenker Diverticulum show? Who is most likely to get it?

Back 4

- Dysphagia
- Obstruction
- Foul breath from trapped food particles (halitosis)
- Most commonly in elderly males

Front 5

Which pathology is characterized by the five 2's: 2 inches long, 2 feet from the ileocecal valve, 2% of population, commonly presents in first 2 years of life, and may have 2 types of epithelia (gastric/pancreatic)?

Back 5

Meckel Diverticulum

Front 6

What is the term for the true diverticulum that forms because of the persistence of the vitelline duct?

Back 6

Meckel Diverticulum

Front 7

What is a Meckel Diverticulum? Cause?

Back 7

- True diverticulum
- Persistence of vitelline duct
- May contain ectopic acid-secreting gastric mucosa and/or pancreatic tissue

Front 8

What is the most common congenital anomaly of the GI tract?

Back 8

Meckel Diverticulum
- True diverticulum
- Persistence of vitelline duct
- May contain ectopic acid-secreting gastric mucosa and/or pancreatic tissue

Front 9

What should you suspect in a patient <2 years old with melena (dark sticky feces containing partly digested blood) and RLQ pain?

Back 9

Meckel Diverticulum

Front 10

What can Meckel Diverticulum cause?

Back 10

- Melena (dark sticky feces containing partially digested blood)
- RLQ pain
- Intussusception
- Volvulus
- Obstruction (near terminal ileum)

Front 11

What is the term for the cystic dilation of the vitelline duct?

Back 11

Omphalomesenteric Cyst

Front 12

How do you diagnose Meckel Diverticulum?

Back 12

Pertechnetate study - for uptake by ectopic gastric mucosa

Front 13

What is the mnemonic to remember the characteristics of the Meckel Diverticulum?

Back 13

Five 2's:
- 2 inches long
- 2 feet from ileocecal valve
- 2% of population (most common congenital anomaly of GI tract)
- Commonly presents in first 2 years
- May have 2 types of epithelia (gastric and/or pancreatic)

Front 14

Which pathology causes "currant jelly" stools?

Back 14

Intussusception

Front 15

What is the term for "telescoping" of 1 bowel segment into a distal segment? Most common location?

Back 15

Intussusception - commonly at ileocecal junction

Front 16

What are the consequences of Intussusception?

Back 16

- Compromised blood supply → intermittent abdominal pain
- Often with currant jelly stools

Front 17

Who is more likely to get Intussusception? Associated with?

Back 17

- Unusual in adults (associated with intraluminal mass or tumor that acts as lead point that is pulled into lumen)
- Majority of cases are in children (usually idiopathic, may be associated with recent enteric or respiratory viral infection)

Front 18

How severe is intussusception?

Back 18

Abdominal emergency in early childhood

Front 19

What is the term for the twisting of portions of the bowel around its mesentery?

Back 19

Volvulus

Front 20

What can Volvulus lead to?

Back 20

Obstruction and infarction

Front 21

Where can Volvulus occur? Who is more likely to get it?

Back 21

- Midgut volvulus: more common in infants and children
- Sigmoid volvulus: more common in elderly

Front 22

What diagnosis should you consider in a newborn (<48 hours) that has bilious emesis, abdominal distention, and a failure to pass meconium? Cause?

Back 22

Hirschsprung Disease (congenital megacolon)
- Lack of ganglion cells / enteric nervous plexuses (Auerbach and Meissner plexuses) in segment of intestine
- Due to failure of neural crest cell migration
- Associated with mutations in RET gene

Front 23

What genetic problem is Hirschsprung disease associated with?

Back 23

- Mutations in RET gene
- Risk ↑ with Down Syndrome

Front 24

What are the signs / symptoms of Hirschsprung disease?

Back 24

- Bilious emesis
- Abdominal distention
- Failure to pass meconium in first 48 hours = chronic constipation
- Dilated portion of colon proximal to aganglionic segment

Front 25

How do you diagnose Hirschsprung disease?

Back 25

Rectal suction biopsy - confirm the lack of ganglion cells / enteric nervous plexuses in segment of intestine

Front 26

How do you treat Hirschsprung disease?

Back 26

Resection of aganglionic portion of colon

Front 27

Which intestinal disorder is the most common cause of small bowel obstruction? Pathology?

Back 27

Intestinal Adhesion:
- Fibrous band of scar tissue
- Commonly after surgery
- Can have well-demarcated necrotic zones

Front 28

Which intestinal disorder causes tortuous dilation of vessels leading to hematochezia? Where is it found? How is diagnosis confirmed?

Back 28

Angiodysplasia
- Most often in cecum, terminal ileum, and ascending colon
- More common in older patients
- Confirmed by angiography

Front 29

Which intestinal disorder causes early bilious vomiting with a double bubble sign on x-ray? What is it associated with?

Back 29

Duodenal atresia
- Proximal stomach distention
- Failure of small bowel recanalization
- Associated with Down Syndrome

Front 30

Which intestinal disorder causes hypomotility? Signs? Causes?

Back 30

Ileus
- Hypomotility without obstruction → constipation and ↓ flatus
- Distended / tympanic abdomen with ↓ bowel sounds
- Associated with abdominal surgeries, opiates, hypokalemia, and sepsis

Front 31

Which intestinal disorder is associated with reduced intestinal blood flow? Location? Other?

Back 31

Ischemic Colitis
- Pain after eating → weight loss
- Commonly at splenic flexure (watershed zone) and distal colon
- Typically affects elderly

Front 32

Which intestinal disorder is associated with cystic fibrosis?

Back 32

Meconium Ileus
- Meconium plug obstructs intestine
- Prevents stool passage at birth

Front 33

Which intestinal disorder is more common in preemies? Why? Location?

Back 33

Necrotizing Enterocolitis
- Necrosis of intestinal mucosa and possible perforation
- More common in preemies because they have decreased immunity
- Colon is usually involved, but can involve entire GI tract

Front 34

What does an intestinal adhesion cause?

Back 34

- Fibrous band of scar tissue, commonly after surgery
- Most common cause of small bowel obstruction
- Can have well de-marcated necrotic zones

Front 35

What does angiodysplasia cause?

Back 35

- Tortuous dilation of vessels → hematochezia
- Most often found in cecum, terminal ileum, and ascending colon
- More common in older patients
- Confirmed by angiography

Front 36

What does duodenal atresia cause?

Back 36

- Causes early bilious vomiting with proximal stomach distention
- Double bubble sign on x-ray
- Due to failure of small bowel recanalization
- Associated with Down syndrome

Front 37

What does ileus cause?

Back 37

- Intestinal hypomotility without obstruction → constipation and ↓ flatus
- Distended / tympanic abdomen with ↓ bowel sounds
- Associated with abdominal surgeries, opiates, hypokalemia, and sepsis

Front 38

What does Ischemic Colitis cause?

Back 38

- Reduction in intestinal blood flow causes ischemia
- Pain after eating → weight loss
- Commonly occurs at splenic flexure and distal colon
- Typically affects elderly

Front 39

What does Meconium Ileus cause?

Back 39

- In cystic fibrosis, meconium plug obstructs intestine
- Prevents stool passage at birth

Front 40

What does Necrotizing Enterocolitis cause?

Back 40

- Necrosis of intestinal mucosa and possible perforation
- Colon is usually involved, but can involve entire GI tract
- In neonates, more common in preemies (↓ immunity)

Front 41

What is the term for masses that protrude into the gut lumen? Appearance?

Back 41

Colonic polyps - sawtooth appearance

Front 42

What are the types of colonic polyps?

Back 42

- Adenomatous
- Hyperplastic
- Juvenile
- Hamartomatous

Front 43

Are colonic polyps cancerous?

Back 43

90% are non-neoplastic

Front 44

Where are colonic polyps usually found?

Back 44

Rectosigmoid portion of colon

Front 45

What are the two histologic appearances of colonic polyps?

Back 45

- Tubular (left)
- Villous (right)

Front 46

Which type of colonic polyp is precancerous? What increases the malignant risk?

Back 46

Adenomatous Colonic Polyps
- ↑ Size
- Villous histology (more villous = more villainous)
- ↑ Epithelial dysplasia

Front 47

Which type of colonic polyp is a precursor or associated with increased risk of colorectal cancer?

Back 47

- Adenomatous = precursor to CRC
- Hamartomatous = increased risk of CRC

Front 48

What are the symptoms of adenomatous colonic polyps?

Back 48

- Often asymptomatic
- Lower GI bleed
- Partial obstruction
- Secretory diarrhea (villous adenomas)

Front 49

What is the most common non-neoplastic polyp in the colon? Location?

Back 49

Hyperplastic colonic polyps (>50% found in rectosigmoid colon)

Front 50

Which type of colonic polyp is seen in children <5 years old? Malignant potential? Location?

Back 50

Juvenile
- If single, no malignant potential
- Juvenile polyposis syndrome: multiple juvenile polyps in GI tract, ↑ risk of adenocarcinoma
- 80% in rectum

Front 51

Which type of colonic polyp is associated with increased risk of adenocarcinoma?

Back 51

Juvenile colonic polyp in Juvenile Polyposis Syndrome (multiple polyps)

Front 52

Which type of colonic polyp has an autosomal dominant inheritance pattern?

Back 52

Hamartomatous:
- Peutz-Jeghers Syndrome

Front 53

What are the signs/symptoms of Peutz-Jeghers Syndrome? How is it inherited?

Back 53

- Autosomal dominant syndrome
- Multiple non-malignant hamartomas throughout GI tract
- Hyperpigmented mouth, lips, hands, and genitalia
- Associated with ↑ risk of CRC and other visceral malignancies

Front 54

What are the characteristics of Adenomatous Colonic Polyps?

Back 54

- Adenomatous polyps are PRE-CANCEROUS
- Malignant risk associated with ↑ size, villous histology, and ↑ epithelial dysplasia
- Precursor to colorectal cancer (CRC)
- Polyp symptoms: asymptomatic, lower GI bleed, partial obstruction, or secretory diarrhea

Front 55

What are the characteristics of Hyperplastic Colonic Polyps?

Back 55

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

Front 56

What are the characteristics of Juvenile Colonic Polyps?

Back 56

- Mostly sporadic lesions in children <5 years old
- 80% in rectum
- If single, no malignant potential
- Juvenile Polyposis Syndrome: multiple juvenile polyps in GI tract, ↑ risk of adenocarcinoma

Front 57

What are the characteristics of Hamartomatous Colonic Polyps?

Back 57

Peutz Jeghers Syndrome
- Autosomal dominant
- Multiple non-malignant hamartomas throughout GI tract
- Hyperpigmented mouth, lips, hands, genitalia
- Associated with ↑ risk of CRC and other visceral malignancies

Front 58

What does this histology show?

Back 58

Tubular Adenoma
- Smaller, more rounded villi
- More likely to be benign colonic polyp

Front 59

What does this histology show?

Back 59

Villous Adenoma
- Long finger-like villi
- More likely to be malignant (villous = villainous)