Pathology of the General Intestinal Tract

Question 1

This GI pathology is caused by the twisting of a loop of the bowel around its mesenteric base of attachment.

Answer 1

Volvulus

Question 2

What is the most common cause of ischemic colitis?

Answer 2

Arterial obstruction

Question 3

Acute appendicitis is a surgical emergency with pain in the RLQ. At what point does pain often localize?

Answer 3

McBurney’s Point - 1/3 of the way from the ASIS to the umbilicus

Question 4

Diverticulosis pain generally arises in what quadrant?

Answer 4

LLQ - descending and sigmoid colon

Question 5

What are diverticula?

Answer 5

Small outpouchings or sacs in the GI wall through the lamina propria

Question 6

True/False. Patients with ischemic colitis may present with severe abdominal pain, but a normal abdominal exam.

Answer 6

True - this is called pain out of proportion to exam

Question 7

This pathology is due to malformed mucosal and submucosal blood vessels, most common in the sixth decade.

Answer 7

Angiodysplasia

Question 8

Tyeps of ischemic infarcts.

Answer 8

Mucosal and mural infarcts have a better prognosis than transmural that involves more layers.

Question 9

What is the most common clinical symptoms of angiodysplasia?

Answer 9

Hematochezia - undigested blood in stool

Question 10

Mesenteric venous thrombosis is classically a result of Virchow’s triad that causes ischemic colitis. What is Virchow’s triad?

Answer 10

Stagnant blood flow, hypercoagulability, vascular injury

Question 11

Where do direct hernias originate?

Answer 11

Direct hernias are acquired, originate medially to the inferior epigastric artery, and protrude through the inferior peritoneal ring

Question 12

This type of hernia can be manually reduced back into the abdominal cavity with a finger or by lying supine.

Answer 12

Reproducible hernia

Question 13

These two factors are responsible for hernia formation.

Answer 13

Weakness of the peritoneal wall and increased abdominal pressure

Question 14

What areas are most commonly affected by angiodysplasia?

Answer 14

Right colon and cecum

Question 15

How do the causes of intussusception in children and adults differ?

Answer 15

Most cases occur in children and are idiopathic. In adults, intussusception is often caused by an intraluminal mass.

Question 16

Watershed areas are the most susceptible to ischemic damage. Where are these areas?

Answer 16

Splenic flexure and rectosigmoid junction

Question 17

This type of hernia is difficult or impossible to retract due to the enlargement of the hernial sac by obstructed venous flow.

Answer 17

Incarcerated hernia

Question 18

What is the bloody supply for the distal transverse colon and descending colon?

Answer 18

Inferior mesenteric artery

Question 19

Blood may appear in the stool in cases of ischemic colitis. Why is this?

Answer 19

Surface epithelium dies due to poor blood flow and ischemia. The dead epithelium sloughs off and carries blood with it in the stool.

Question 20

Where do cecal volvulus arise?

Answer 20

RLQ - cause collapse of the ascending, transverse, and descending colon

Question 21

This condition is caused by a lack of blood flow to the bowel, that may be obstructive or non-obstructive.

Answer 21

Ischemic colitis

Question 22

This type of volvulus arises in the LLQ and is characterized by the coffee bean sign on imaging.

Answer 22

Sigmoid volvulus

Question 23

How do true and false diverticula differ?

Answer 23

True diverticula involve all layers. False diverticula only involves the mucosal and submucosal layers.

Question 24

What is the number one cause of small bowel obstructions?

Answer 24

Adhesions

Question 25

Intestinal obstructions may be caused by one of these GI pathologies.

Answer 25

Hernia, volvulus, adhesion, intussusception

Question 26

What are GI adhesions?

Answer 26

Fibrous bridges between bowel segments or the abdominal wall due to repeated inflammation that may cause obstruction

Question 27

What is reperfusion injury?

Answer 27

Causes the most damage during ischemic colitis when blood flow returns due to the release of inflammatory factors, free radicals, neutrophils, etc.

Question 28

Meckel’s diverticulum is the most common congenital abnormality of the GI tract. What is the cause?

Answer 28

Persistence of the vitelline duct

Question 29

What is the blood supply for the ascending and proximal transverse colon?

Answer 29

Superior mesenteric artery

Question 30

This is the most severe type of hernia, considered a surgical emergency due to ischemia and necrosis.

Answer 30

Strangulated hernia

Question 31

What are the two more common causes of a congenital hernia?

Answer 31

Failure of the inguinal ring to close or process vaginalis to obliterate

Question 32

Where do indirect hernias originate?

Answer 32

Indirect hernias are congenital, originate laterally to the inferior epigastric artery, and protrude through the deep inguinal ring

Question 33

What is the most common tumor of the appendix?

Answer 33

Carcinoids (neuroendocrine tumor/NET)

Question 34

These class of hernias are most common in men, on the right side of the body, and in premature babies.

Answer 34

Congenital hernias

Question 35

What is intussusception?

Answer 35

Telescoping of a portion of the bowel into the immediate distal portion

Question 36

What is the most common location of a volvulus?

Answer 36

Sigmoid colon