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GI > Lower GI pathology > Flashcards

Lower GI pathology Flashcards

1
Q

The following abdominal x-ray shows _

A

The following abdominal x-ray shows air-fluid levels suggesting bowel obstruction
* The obstruction point appears to be in the descending colon, possibly sigmoid colon

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2
Q

A “bowel obstruction” typically refers to a
(mechanical/non-mechanical) blockage of the bowels

A

A “bowel obstruction” typically refers to a
mechanical blockage of the bowels

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3
Q

A non-mechanical obstruction of the bowels is called _

A

A non-mechanical obstruction of the bowels is called ileus

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4
Q

Ileus is a non-mechanical bowel obstruction due to _

A

Ileus is a non-mechanical bowel obstruction due to lack of movement or peristalsis of the bowel
* Presents like a bowel obstruction
* Common after surgery

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5
Q

Bowel obstruction is more common in the (small/large) bowel

A

Bowel obstruction is more common in the small bowel
* Roughly 80% of B.O
* The small bowel has a smaller lumen so it is easier to obstruct

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6
Q

The most common overall cause of small bowel obstructions in adults is _

A

The most common overall cause of small bowel obstructions in adults is adhesions
* Other causes: hernias, malignancy, stricture, volvulus

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7
Q

Incarcerated hernias are also common causes of bowel obstructions, most commonly in the (small/large) bowel

A

Incarcerated hernias are also common causes of bowel obstructions, most commonly in the small bowel

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8
Q

Volvulus is a more common cause of a bowel obstruction in the (small/large) bowel

A

Volvulus is a more common cause of a bowel obstruction in the large bowel

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9
Q

The most common site of volvulus in adults is the _

A

The most common site of volvulus in adults is the sigmoid colon
* The sigmoid colon becomes “droopy” and loops around itself

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10
Q

The most common cause of bowel obstruction in children is _

A

The most common cause of bowel obstruction in children is intussusception
* Usually in children < 3 years old

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11
Q

_ can predispose children to intussusception

A

Meckel’s diverticulum can predispose children to intussusception

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12
Q

Aside from intussusception, _ and _ are two common causes of bowel obstruction in children

A

Aside from intussusception, volvulus and foreign body ingestions are two common causes of bowel obstruction in children
* Crohn’s disease with strictures is also possible
* Adhesions and malignancy are uncommon in kids

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13
Q

Volvulus in children is more often due to _

A

Volvulus in children is more often due to congenital malrotation

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14
Q

Clinical signs of bowel obstruction:

A

Clinical signs of bowel obstruction:
* Colicky abdominal pain
* Abdominal distension
* Nausea
* Vomiting
* Lack of stool output
* Lack of flatus

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15
Q

On physical exam, bowel obstructions may present with distended abdomen, _ on percussion, and _ bowel sounds

A

On physical exam, bowel obstructions may present with distended abdomen, tympany on percussion, and high pitched bowel sounds

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16
Q

Initial management of bowel obstruction includes _

A

Initial management of bowel obstruction includes:
1. NPO in case of surgery
2. NG tube for suction to decompress the bowel
3. IV fluids to maintain intravascular hydration

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17
Q

Further evaluation of a bowel obstruction following NG tube decompression involves:

A

Further evaluation of a bowel obstruction following NG tube decompression involves:
1. CT imaging
2. Surgical consultation

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18
Q

(True/False) GI motility drugs/ laxatives may be utilized in the case of an acute mechanical bowel obstruction

A

False; GI motility drugs/ laxatives may be utilized in the case of an acute mechanical bowel obstruction

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19
Q

Individuals with a history of _ have a risk for adhesions and bowel obstructions

A

Individuals with a history of prior abdominal surgery have a risk for adhesions and bowel obstructions
* Adhesions are fibrous bands outside the bowel that cause the bowel to be tethered

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20
Q

Bowel torsion or twisting is called _

A

Bowel torsion or twisting is called volvulus

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21
Q

Adults tend to have _ volvulus; children tend to have _ volvulus

A

Adults tend to have sigmoid volvulus; children tend to have cecal volvulus

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22
Q

Coffee bean sign on abominal xray is pathopneumonic for _

A

Coffee bean sign on abominal xray is pathopneumonic for sigmoid volvulus

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23
Q

Scarring inside the bowel is called a _
Scarring outside the bowel is called _

A

Scarring inside the bowel is called a stricture
Scarring outside the bowel is called adhesion

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24
Q

Colon cancer is the _ most common cancer in the US

A

Colon cancer is the third most common cancer in the US
* It is the second deadliest cancer in the US

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25
Q

Risk factors of colon cancer:

A

Risk factors of colon cancer:
* Hereditary
* Male
* Type 2 diabetes
* IBD
* Smoking
* Alcohol
* Obesity
* Abdominal radiation

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26
Q

Positive factors that improve colon cancer risk:

A

Positive factors that improve colon cancer risk:
* Aspirin/ NSAID use
* Menopausal hormone therapy
* Statin use
* Physical activity
* Whole grains, dietary fiber
* Fish, nuts, calcium

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27
Q

There are two pathways for the pathogenesis of colon cancer, _ and _

A

There are two pathways for the pathogenesis of colon cancer:
1. Conventional adenoma-carcinoma pathway
2. Microsatellite instability pathway

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28
Q

70-90% of colon cancers develop via the _ pathway

A

70-90% of colon cancers develop via the adenoma-carcinoma pathway (polyps)

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29
Q

It is easier to screen for colon cancer that develops via the (adenoma- carcinoma pathway/ microsatellite instability pathway)

A

It is easier to screen for colon cancer that develops via the adenoma-carcinoma
* This is the slower growing form (10-20 years)

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30
Q

The colon cancers that develop via microsatellite instability pathway are harder to screen because they develop in _ years

A

The colon cancers that develop via microsatellite instability pathway are harder to screen because they develop in 1-5 years

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31
Q

The following shows an adenoma with _ histology

A

The following shows an adenoma with villous histology

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32
Q

The following shows an adenoma with _ histology

A

The following shows an adenoma with tubular histology

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33
Q

The following shows an adenoma with _ histology

A

The following shows an adenoma with tubulovillous histology

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34
Q

Low- grade dysplasia (adenoma) is characterized by _ and _

A

Low- grade dysplasia (adenoma) is characterized by loss of mucin and increased mitotic figures

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35
Q
A
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36
Q

Characterize by the stage of carcinoma

A

Early adenoma –> late/ high-grade adenoma –> carcinoma

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37
Q

The first line testing option for colon cancer is either direct visualization of the colon via _ or stool based test via _

A

The first line testing option for colon cancer is either direct visualization of the colon via colonoscopy or stool based test via fecal immunohistochemistry

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38
Q

FIT stands for _ and “cologuard” is a _ test

A

FIT stands for fecal immunohistochemistry and “cologuard” is a stool DNA test

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39
Q

If FIT or cologuard comes back abnormal, _ is still needed

A

If FIT or cologuard comes back abnormal, colonoscopy is still needed

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40
Q

Why is colonoscopy beneficial over FIT?

A

Colonoscopy offers…
* Higher sensitivity
* Diagnostic and therapeutic (polyp removal)
* Less frequent

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41
Q

FIT testing is done every _ years, colonoscopy is done every _ years

A

FIT testing is done every 1-3 years, colonoscopy is done every 5-10 years
* Colorectal cancer screening starts at age 45

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42
Q

Lynch syndrome has _ inheritance pattern

A

Lynch syndrome is autosomal dominant

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43
Q

(Lynch syndrome/ familial adenomatous polyposis) has a dramatic phenotype

A

Familial adenomatous polyposis has a dramatic phenotype

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44
Q

FAP is inherited in _ pattern

A

FAP is autosomal dominant

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45
Q

FAP involves the _ gene and _ signaling pathway

A

FAP involves the APC gene and Wnt signaling pathway
* We get too much wnt signaling

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46
Q

Lynch syndrome is also called _

A

Lynch syndrome is also called hereditary nonpolyposis CRC

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47
Q

Lynch syndrome increases the risk of the following (3) cancers:

A

Lynch syndrome increases the risk of:
1. Colorectal
2. Endometrial
3. Ovarian

Also associated with pancreaticobiliary, gastric, small bowel, GU, skin, brain

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48
Q
A

Colorectal cancer on colonoscopy

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49
Q
A

FAP, gross specimen

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50
Q
A

FAP

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51
Q

(True/ False) Lynch syndrome is also called hereditary non-polyposis colorectal cancer because it does not involve polyps

A

False; Lynch syndrome can have few polyps but it does not involve polyposis

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52
Q

The mutations in lynch syndrome are in _ genes

A

The mutations in lynch syndrome are in mismatch repair genes
* MLH1, MSH2, MSH6, PMS2

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53
Q

Patients with (lynch syndrome/ FAP) tend to present at a very young age with cancer

A

Patients with FAP tend to present at a very young age with cancer (20s, 30s)
* Patients with lynch syndrome are typically middle aged or older

54
Q

Patients with (FAP/ Lynch syndrome) have 100% lifetime risk of cancer

A

Patients with FAP have 100% lifetime risk of cancer

55
Q

Patients who present with hundreds of polyps in the colon may have _

A

Patients who present with hundreds of polyps in the colon may have FAP

56
Q

FAP associated cancers include (3):

A

FAP associated cancers include:
1. Gastric
2. Duodenal
3. Thyroid

57
Q

Expected physical exam findings for peritonitis include:

A

Peritonitis:
* Rigidity
* Rebound tenderness
* Pain with movement
* Pain with “stretching” of the peritoneal cavity

58
Q

Primary peritonitis is _

A

Primary peritonitis is direct infection of the peritoneum
* This is typically a bacterial infection
* Called spontaneous bacterial peritonitis SBP

59
Q

Primary peritonitis is typically seen in patients with _

A

Primary peritonitis is typically seen in patients with cirrhosis

60
Q

We treat primary peritonitis with _

A

We treat primary peritonitis with antibiotics
* Recall that this is a direct infection of the peritoneum

61
Q

Secondary peritonitis is due to _

A

Secondary peritonitis is due to severly inflamed or infected abdominal organ that comes in contact with peritoneum

62
Q

Causes of secondary peritonitis include:

A

Causes of secondary peritonitis include:
* Appendicitis
* Cholecystitis
* Severe/perforated diverticulitis
* Bowel perforation
* Ovarian torsion or abscess
* Perforated peptic ulcer

63
Q

Hematemesis suggests (upper/lower) GI bleed

A

Hematemesis suggests upper GI bleed

64
Q

Coffee ground emesis suggests (upper/lower) GI bleed

A

Coffee ground emesis suggests upper GI bleed

65
Q

Bright red blood per rectum suggests (upper/lower) GI bleed

A

Bright red blood per rectum suggests lower GI bleed

66
Q

Melena suggests (upper/lower) GI bleed

A

Melena suggests upper GI bleed

67
Q

Hematochezia suggests (upper/lower) GI bleed

A

Hematochezia can suggest either upper or lower GI bleed

68
Q

Upper vs lower GI bleeding is delineated by _ landmark

A

Upper vs. lower GI bleeding is delineated by ligament of Treitz

69
Q

The ligament of Treitz offers support at the end of the _ and beginning of the _

A

The ligament of Treitz offers support at the end of the duodenum and beginning of the jejunum

70
Q

Causes of upper GI bleeding:

A
71
Q

Causes of lower GI bleeding:

A
72
Q

Small bowel (“mid bowel”) bleeding may present with _ colors

A

Small bowel (“mid bowel”) bleeding may present with maroon, black, or bright red stool

73
Q

Anal fissures are small cuts/breaks in the _

A

Anal fissures are small cuts/breaks in the anorectal mucosa (anoderm)
* Like a paper cut in the anus

74
Q

Anal fissures will cause _ type of bleeding

A

Anal fissures will cause bright red bleeding on the outside of the stool

75
Q

Anal fissures can be caused by _

A

Anal fissures can be caused by trauma/stretching of anal mucosa
* Ex: hard stool

76
Q

Deep anal fissures can cause _ spasm

A

Deep anal fissures can cause anal sphincter spasm

77
Q

First line treatment for anal fissures includes treating the underlying cause with _ , or soothing measures like _

A

First line treatment for anal fissures includes treating the underlying cause with fiber, water, laxatives (constipation) , or soothing measures like sitz baths, topical analgesic

78
Q

We can use a smooth muscle relaxant like _ or _ to reduce anal sphincter spasms

A

We can use a smooth muscle relaxant like nifedipine or nitroglycerin to reduce anal sphincter spasms

79
Q

Refractory cases of anal fissures may require _

A

Refractory cases of anal fissures may require botox

80
Q

What are hemorrhoids?

A

Hemorrhoids are normal vascular structures in the anal canal

81
Q

Hemorrhoids arise from a channel of _ that drains into the superior and inferior _ veins

A

Hemorrhoids arise from a channel of arteriovenous connective tissue that drains into the superior and inferior hemorrhoidal (rectal) veins

82
Q

Hemorrhoids are only considered pathologic when they become _

A

Hemorrhoids are only considered pathologic when they become enlarged, cause pain, or bleed
* Possibly caused by straining or constipation

83
Q

(External/ Internal) hemorrhoids are more likely to bleed

A

Internal hemorrhoids are more likely to bleed

84
Q

(External/Internal) hemorrhoids are more likely to cause pain

A

External hemorrhoids are more likely to cause pain

85
Q

External hemorrhoids have _ innervation

A

External hemorrhoids have somatic afferent innervation (why they are painful)

86
Q

Internal hemorrhoids are less likely to cause pain because they are innervated by _

A

Internal hemorrhoids are less likely to cause pain because they are innervated by pelvic splanchnic afferent (visceral) nerves

87
Q

What does it mean that irritable bowel syndrome is a functional disorder?

A

There is no organic cause of IBS nor is it related to any structural abnormalities
* Instead it is a functional disorder liely related to gut-brain axis disorder

88
Q

Irritable bowel syndrome is associated with an increase in _ leading to osmosis into the gut lumen

A

Irritable bowel syndrome is associated with an increase in short chain carbohydrates (lactose, sucrose) leading to osmosis into the gut lumen

89
Q

How do short chain carbohydrates lead to the gas and cramping associated with IBS?

A
  1. Short chain carbohydrates get metabolized by gut bacteria –> gas
  2. An increase in luminal water expands the GIT, causes abdominal pain and intestinal smooth muscle spasms
90
Q

IBS is associated with an increase in visceral hypersensitivity; this is why abdominal pain is often relieved _ when?

A

IBS is associated with an increase in visceral hypersensitivity; this is why abdominal pain is often relieved following bowel movements

91
Q

IBS often presents with:

A

IBS often presents with:
* Abdominal pain
* Consipation, diarrhea
* Changes in stool consistency and frequency

92
Q

IBS is diagnosed using the _ criteria

A

IBS is diagnosed using the Rome IV criteria

93
Q

What is the Rome IV criteria for IBS?

A
  1. Recurrent abdominal pain (at least once per week for 3 months)

And at least 2 of the following:
a. Symptoms related to defecation
b. Change in stool frequency
c. Change in stool form/ appearance

94
Q

Create a ddx for RUQ pain

A
95
Q

Create a ddx for LUQ pain

A
96
Q

Create a ddx for RLQ pain

A
97
Q

Create a ddx for LLQ pain

A
98
Q

IBS-D is _

A

IBS-D is diarrhea predominant
* This means that the bowel pattern is diarrhea 25% of the time

99
Q

IBS-C is _

A

IBS-C is constipation predominant
* This means that the bowel pattern is constipation 25% of the time

100
Q

IBS-M is _

A

IBS-M is mixed diarrhea and constipation
* Alternating periods

101
Q

The first line treatment for IBS with abdominal pain is _

A

The first line treatment for IBS with abdominal pain is an anti-spasmodic like hyoscyamine or dicyclomine
* These have anti-cholinergic effects

102
Q

How do we manage IBS?

A
103
Q

IBS directed therapies (overview)

A
104
Q

_ is a congenital failure of neural crest cell migration to the myenteric and submucosal plexus in the rectum

A

Hirshsprung disease is a congenital failure of neural crest cell migration to the myenteric and submucosal plexus in the rectum

105
Q

A baby with hirschsprung disease may present with:

A

A baby with hirschsprung disease may present with:
* Abdominal distention
* Failure to pass meconium within 48 hours
* Constipation
* Bilious vomiting

106
Q

Hirschsprung disease causes defective relaxation and peristalsis of the rectum and distal sigmoid colon leading to _

A

Hirschsprung disease causes defective relaxation and peristalsis of the rectum and distal sigmoid colon leading to proximal megacolon

107
Q

Hirschsprung disease can present with _ sign on digital rectal exam

A

Hirschsprung disease can present with squirt sign on digital rectal exam
* Explosive expulsion of feces with empty rectal vault

108
Q

Hirschsprung disease is diagnosed via absence of _ cells on _ biopsy

A

Hirschsprung disease is diagnosed via absence of ganglion cells on rectal suction biopsy

109
Q

Hirschsprung disease is associated with _ syndrome and _ mutations

A

Hirschsprung disease is associated with down syndrome and RET mutations

110
Q

Necrotizing enterocolitis is a condition in which the bowel becomes _

A

Necrotizing enterocolitis is a condition in which the bowel becomes gangrenous, we see inflammation and ischemic necrosis of ileum and colon

111
Q

Necrotizing entercolitis is associated with _ infants

A

Necrotizing entercolitis is associated with premature, low-birth-weight, formula-fed infants
* Babies with immature immune systems and get overgrowth of bacteria from formula

112
Q

Acute mesenteric ischemia is _

A

Acute mesenteric ischemia is critical blockage of arterial blood flow to the intestines –> necrosis

113
Q

The most common cause of mesenteric ischemia is an embolic occlusion of the _ artery

A

The most common cause of mesenteric ischemia is an embolic occlusion of the superior mesenteric artery
* Supplies the small intestine
* Caused by valvular disease, atrial fibrillation

114
Q

Signs of acute mesenteric ischemia:

A

Signs of acute mesenteric ischemia:
* Pain out of proportion to physical exam
* Red currant jelly stools
* Decreased bowel sounds

Can progress to transmural infarction, perforation, shock

115
Q

Atherosclerosis of the celiac artery, SMA, or IMA may lead to _

A

Atherosclerosis of the celiac artery, SMA, or IMA may lead to chronic mesenteric ischemia

116
Q

Chronic mesenteric ischemia is associated with _ type pain

A

Chronic mesenteric ischemia is associated with postprandial epigastric pain
* Need increased blood flow after consuming a meal –> pain

117
Q

Colonic ischemia most often occurs in _ areas

A

Colonic ischemia most often occurs in watershed areas

118
Q

_ and _ are two watershed areas of the colon that are more likely to experience ischemia

A

Splenic flexure and rectosigmoid junction are two watershed areas of the colon that are more likely to experience ischemia

119
Q

Colonic ischemia may be diagnosed by cramping abdominal pain, hematochezia, and _ sign on abdominal xray

A

Colonic ischemia may be diagnosed by cramping abdominal pain, hematochezia, and thumbprint sign on abdominal xray

120
Q

Normal colonic mucosa is lined by _ epithelium and is rich in _ cells

A

Normal colonic mucosa is lined by simple columnar epithelium and is rich in goblet cells

121
Q

Increase number of cells is _

A

Increase number of cells is hyperplasia

122
Q

Change in the physiologic cell type is called _

A

Change in the physiologic cell type is called metaplasia

123
Q

Disordered cell growth is called _

A

Disordered cell growth is called dysplasia

124
Q

(Sessile/ pedunculated) polyps are more likely to be malignant or have malignant potential

A

Sessile polyps are more likely to be malignant or have malignant potential
* Villous = sessile

125
Q

A serrated polyp can often progress to colon cancer via the _ pathway

A

A serrated polyp can often progress to colon cancer via the microsatellite instability pathway

126
Q

Adenoma-Carcinoma sequence (3):

A

Adenoma-Carcinoma sequence (3):
1. Loss of APC
2. Mutation of KRAS
3. Loss of TP53

127
Q
A

Apple core constriction = colorectal cancer

128
Q

The most common location for colon cancer is in the _

A

The most common location for colon cancer is in the rectosigmoid
* Causes reduced stool caliber

129
Q

_ is a GI pathogen that may increase the risk of colon cancer

A

Streptococcus bovis is a GI pathogen that may increase the risk of colon cancer

130
Q

The most common location of colon cancer metastasis is the _

A

The most common location of colon cancer metastasis is the liver

131
Q

Lynch syndrome involves a mutation in DNA mismatch repair genes which leads to _ pathway of colorectal cancer

A

Lynch syndrome involves a mutation in DNA mismatch repair genes which leads to microsatellite instability

GI (13 decks)

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