2 Disease of lower GI: path - [3] deveraj Flashcards Preview

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Flashcards in 2 Disease of lower GI: path - [3] deveraj Deck (20)
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1
Q

pathogenesis of Celiac disease (gluten sensitive enteropathy)

A

Gluten digested by luminel + brush border enzymes →
exposure to α-gliadin peptide results in autoAb formation →
inflammation (↑ T lymph) →
villous atrophy →
tissue damage →
loss of mucosal and brush border surface area →
malabsorption, diarrhea

2
Q

classical presentation of celiacs

A
bulky fatty diarrhea
flatulence
weight loss
anemia
nutritional deficiencies
growth failure in children
3
Q

3 characteristic findings in tissue biopsy for Celiacs

Endoscopy findings?

A
  1. villous blunting
  2. increased intraepithelial lymphocytes
  3. lymphoplasmacytosis of the lamina propria
scalloped appearance
(*note: IgA ab to TTG and anti-endomysial ab)
4
Q

celiacs disease is associated with the blistering skin disease _____

A

dermatitis herpetiformis

5
Q

Pathogenesis of Whipple disease

A

caused by gram (+) bacilli Tropheryma whippelii
- bacilli absorbed by lamina propria macrophages →
organism-laden mac. accumulate in sm Int lamina propria + mesenteric lymph nodes → lymphatic obstruction →
malabsorptive diarrhea

“foamy macrophages”

6
Q

clinical features of whipple disease

A

triad of:
diarrhea, weight loss, malabsorption

typically in middle ages or elderly white males

7
Q

Giardia lamblia

  • what
  • dx
  • sx
  • tx
A

protozoan parasite
waterborne + Cl resistant

dx: trophozites or cysts (cute purple smiley guy)
sx: bloating, flatulence, foul smelling fatty diarrhea
tx: metronidazole

8
Q

Infectious enterocolITIS

- bacterial infections

A

typically create an acute self-limited colitis

pts usually present several weeks after onset of sx, so tisue biopsy rarely shows classic acute infectious findings

  • campylobacter
  • shigellosis
  • salmonellosis
  • E. coli
9
Q

Campylobacter spp

  • Gram ___
  • usually found ____
  • Presentation
A

gram NEGATIVE major cause of diarrhea worldwide
a leading cause of bacterial foodborne illness in US
- found in contaminated meat (poultry), water, and unpasteurized dairy
Prod. WATERY diarrhea +/- blood

Infectious enterocolITIS

10
Q

Salmonella

  • Gram ___
  • usually found ____
  • Presentation
  • Characteristic pathology most commonly seen in:
A
gram NEGATIVE 
food and water
- food poisoning + travelers diarrhea
- typhoid mary
Prod diarrhea @ 2nd week of infxn initially watery then bloody
ileum, colon, appendix, Peyer's patches

Infectious enterocolITIS

11
Q
Enterohemorrhagic E. Coli
pathology
sx
endoscopy
area of colon affected
A

[O157:H7] “jack in the box”
non invasive, toxin producing, contaminated hamburgers
bloody diarrhea, severe cramps, mild or no fever, renal failure maybe

12
Q

Pseudomembranous colitis

  • commonly caused by
  • susceptibility factor?
  • sx?
  • type of diarrhea?
A
C. diff
colitis often occurs after course of antibiotic therapy
"antibiotic associated colitis"
- 3rd gen cephalosporins
common in hospitalized pts

sx: fever, leukocytosis, abdominal pain, cramps, watery diarrhea

13
Q

which virus is the most common cause of severe childhood diarrhea and diarrheal mortality worldwide?
- path?

A

rotavirus
- children 6-24 mo vulnerable

infects and destroys mature enterocytes →
villus surface repopulated by immature secretory cells →
loss of absorptive fxn →
net secretion of water and electrolytes →
osmotic diarrhea →
DEHYDRATION

2 vaccines now available

14
Q

Indiv at risk for ischemic colitis

A

older indiv w/ co-existing cardiac or vascular disease
young pts: long distance runners, women on oral con.
mech. obstruction: hernias, volvulus

  • splenic flexure + rectosigmoid area at risk (watershed)
15
Q

presentation of ischemic colitis

A
acute transmural infarction → severe abdominal pain
tenderness
n/v
bloody diarrhea
PERISTALSIS SOUNDS DISAPPEAR
rigid abdomen
shock/sepsis
16
Q

what makes up the pseudomembrane in PC?

A

adherent layer of inflammatory cells and mucinous debris at sites of colonic mucosal injury

surface epithelium denuded, mucopurulent exudates

17
Q

Two histological patterns associated with microscopic colitis

A
  1. collagenous colitis
    - thickened subepithelial collagen layer
    - too many lymphocytes in LP
  2. lymphocytic colitis
    - increased intraepithelial lymphocyte
    - too many lymphocytes in LP
18
Q

Does crohns or UC present worse distally by rectum and present with pseudopolyps and has thinner walls

A

UC

19
Q

Primary sclerosing cholangitis (PSC) is heavily associated with ____

A

UC

20
Q

fecalith pathopneumonic for ______

A

appendicitis

- inflammatory response