Ch 10.3-10.8 GI Pathology

Question 1

Tracheoesophageal fistula is a __ defect resulting in a connection btwn the __ and __. Most common variant consists of proximal/distal __ with the proximal/distal __ arising from the trachea. Present with these 4 symptoms.

Answer 1

congenital; esophagus; trachea; proximal esophageal atresia; distal esophagus; 1) vomiting (food can’t go to stomach); 2) polyhydramnios (can’t swallow amniotic fluid); 3) abdominal distension (air goes in to stomach); 4) aspiration (stomach contents go in to trachea)

Question 2

Esophageal web is a thin __ of __, most often in the upper/lower esophagus. Presents with __ for poorly chewed food. Increased risk for esophageal __. Seen in __ syndrome.

Answer 2

protrusion; esophageal mucosa; upper; dysphagia (it’s like an obstruction); squamous cell carcinoma; Plummer-Vinson

Question 3

Plummer Vinson syndrome is characterized by these 3 symptoms.

Answer 3

1) iron deficiency anemia; 2) esophageal web; 3) beefy-red tongue due to atrophic glossitis (atrophy of mucosa reveals red bv’s)

Question 4

Zenker diverticulum is a ___ of __ through a congenital/acquired defect in the __ (true/false diverticulum). It arises above/below the __ at the junction of the __ and __. Presents with these 3 symptoms.

Answer 4

outpouching; pharyngeal mucosa; acquired; muscular wall (instead of through the lumen like in esophageal web); false; above; esophageal sphincter; esophagus; pharynx; 1) dysphagia; 2) obstruction; 3) halitosis

Question 5

Mallory-Weiss syndrome is a __ of __ at the __ junction. Caused by severe __, usually due to __ or __. Presents with painless/painful __. Risk of __ syndrome.

Answer 5

longitudinal laceration; mucosa; GE; vomiting; alcoholism; bulimia; painful; hematemesis; Boerhaave syndrome (“boer” through the esophagus)

Question 6

Boerhaave syndrome is a __ of the esophagus leading to __ in the __ and __.

Answer 6

rupture; air; mediastinum; subcutaneous emphysema (air bubble beneath the skin - can hear crackling noise when press them) “boer” through the esophagus

Question 7

Esophageal varices are ___ in the upper/lower esophagus. Arise secondary to __. Most esophageal blood drains via the __ into the __. Proximal/distal esophageal vein normally drains into the __ via the __ vein.

Answer 7

dilated submucosal veins; lower; portal hypertension; azygos vein; SVC; distal; portal vein; left gastric vein

Question 8

In portal hypertension, the __ vein backs up into the __ vein resulting in dilation (esophageal varices). Asymptomatic/symptomatic, and risk of __ exists. Presents with painless/painful __.

Answer 8

left gastric; esophageal vein; asymptomatic; rupture; painless hematemesis (these pts also have coagulopathy since liver isn’t functioning properly)

Question 9

What is the most common cause of death in patients with cirrhosis?

Answer 9

esophageal varices rupture

Question 10

Achalasia is disordered __ with inability to __ the __. It is due to damaged __ cells in the ___. Name 5 clinical features

Answer 10

esophageal motility; relax; lower esophageal sphincter; ganglion; myenteric plexus; 1) dysphagia for solids/liquids; 2) putrid breath; 3) high LES pressure on esophageal manometry; 4) ‘bird beak’ sign on barium swallow study (pictured); 5) inc risk for SqCC

Question 11

___ is due to damaged ganglion cells in the myenteric plexus. Ganglion cells of the myenteric plexus are located btwn the __ and __ layers of the __ of the esophagus and are important for regulating __ and relaxing __. Damage to ganglion cells can be __ or 2ndary to a known insult (e.g.__)

Answer 11

achalasia; inner circular; outer longitudinal; muscularis propria; bowel motility; LES (lower esoph sphincter); idiopathic; Trypanosoma cruzi infxn in Chagas disease

Question 12

GERD is __ of __ from the __ due increased/reduced LES tone. Name 6 risk factors

Answer 12

reflux of acid; stomach; reduced; 1) alcohol; 2) tobacco; 3) obesity; 4) fat-rich diet; 5) caffeine; 6) hiatal hernia (cardia of stomach herniates in to esophagus)

Question 13

Name 4 clinical features of gastroesophageal reflux disease

Answer 13

1) heartburn (mimics cardiac chest pain); 2) asthma (adult-onset) and cough; 3) damage to enamel of teeth; 4) ulceration w/stricture and Barrett esophagus are late complications (ulcerations is knock out of mucosa, leading to fibrosis to heal, and ultimate narrowing of lumen)

Question 14

Barrett esophagus is __ of the upper/lower esophageal __ from __ epithelium to __ epithlieum with __. Seen in __% of pts with GERD. It is a response of upper/lower esophageal stem cells to __. May progress to __ and __.

Answer 14

metaplasia; lower; mucosa; non-keratinizing squamous; non-ciliated columnar; goblet cells; 10%; lower; acidic stress; dysplasia; adenocarcinoma

Question 15

Esophageal carcinoma can be sub classified as __ or __. __ is the most common type of esophageal carcinoma in the West. __ is the most common type worldwide.

Answer 15

adenocarcinoma; squamous cell carcinoma; adenocarcinoma; squamous cell carcinoma

Question 16

Adenocarcinoma of the esophagus is a benign/malignant proliferation of __. It arises from __, and usually involves the upper/middle/lower third of the esophagus.

Answer 16

malignant; glands; preexisting Barrett esophagus; lower

Question 17

Squamous cell carcinoma is a benign/malignant proliferation of __ cells. Usually arises in upper/middle/lower third of the esophagus. Major risk factors are related to __. Name 5 and most common

Answer 17

malignant; squamous; upper or middle; irritation; 1) alcohol and tobacco (MCC); 2) very hot tea; 3) achalasia; 4) esophageal web (Plummer Vinson syndrome); 5) esophageal injury (e.g. lye ingestion). 3/4 due to rotting food irritating mucosa

Question 18

Esopahgeal carcinoma presents early/late (good/poor prognosis). Name 4 symptoms. Squamous cell carcinoma may additionally present with __ (__ involvement) and __ (__involvement)

Answer 18

late; poor; 1) progressive dysphagia (solids to liquids); 2) weight loss; 3) pain; 4) hematemesis; hoarse voice; recurrent laryngeal nerve involvement; cough; tracheal

Question 19

In esophageal carcinoma location of lymph node spread depends on level of the esophagus that is involved. 1) Upper 1/3; 2) Middle 1/3; 3) Lower 1/3

Answer 19

1) cervical nodes 2) mediastinal or tracheobronchial nodes 3) celiac and gastric nodes

Question 20

Name 9 pathologies of the esophagus

Answer 20

1) tracheoesophageal fistula; 2) esophageal web; 3) zenker diverticulum; 4) mallory-weiss syndrome; 5) esophageal varices; 6) achalasia; 7) GERD; 8) barrett esophagus; 9) esophageal carcinoma

Question 21

Which esophageal disorder is caused by Chagas disease? portal hypertension? part of Plummer Vinson syndrome? Risk of developing Boerhaave syndrome? A congenital defect?

Answer 21

achalasia; varices; Plummer Vinson: esophageal web; mallory-weiss; congenital: tracheoesophageal fistula

Question 22

Gastroschisis is a __ malformation of the __ leading to exposure of __.

Answer 22

congenital; anterior abdominal wall; abdominal contents

Question 23

Omphalocele is a persistent __ of __ into __. Due to failure of __ to return to the __ during development. Contents are covered by __ and __ of the __.

Answer 23

herniation; bowel; umbilical cord; herniated intestines; body cavity; peritoneum; amnion; umbilical cord

Question 24

Pyloric stenosis is congenital/acquired __ of ___. More common in females/males. Classically presents __ after __ with these 3 symptoms. Treatment is ___.

Answer 24

congenital; hypertrophy; pyloric smooth muscle; males; 2 wks; birth; 1) projectile non-bilious vomiting; 2) visible peristalsis; 3) olive-like mass in the abdomen; myotomy

Question 25

Acute gastritis is __ damage to the stomach __. Due to imbalance btwn __ and __. Name 3 normal defenses and what produces it.

Answer 25

acidic; mucosa; mucosal defenses and acidic environment; 1) mucin layer produced by foveolar cells; 2) bicarbonate secretion by surface epithelium; 3) normal blood supply (provides nutrients and picks up leaked acid)

Question 26

Name 6 risk factors for acute gastritis

Answer 26

1) severe burn (Curling ulcer); 2) NSAIDs (decreased PGE2); 3) heavy alcohol consumption; 4) chemotherapy; 5) increased intracranial pressure (Cushing ulcer); 6) shock

Question 27

In acute gastritis, acid damage results in these 3 things.

Answer 27

1) superficial inflammation; 2) erosion (loss of superficial epithelium); 3) ulcer (loss of mucosal layer)

Question 28

A curling ulcer in acute gastritis is caused by ___, leading to __ which decreases the ___. A cushing ulcer is caused by increased __, which increases ___ leading to increased acid production.

Answer 28

severe burn; hypovolemia; decreased blood supply; intracranial pressure; stimulation of the vagus nerve

Question 29

In the stomach, prostaglandins (PGE2 specifically) decreases __, stimulates cells to ___, and increases __. Using an NSAID can therefore cause __.

Answer 29

acid production; produce bicarb and mucus; blood flow to mucosal barrier; acute gastritis

Question 30

Shock can cause acute gastritis, seen as a single/multiple __ ulcers in ICU patients due to decreased __.

Answer 30

multiple stress; blood flow

Question 31

Name three parietal cell receptors that increase acid production

Answer 31

ACh, gastrin, histamine

Question 32

Chronic gastritis is chronic __ of stomach __. Divided into 2 types based on etiology: __ and __. Where are they located in the stomach? Which is most common

Answer 32

inflammation; mucosa; chronic autoimmune gastritis (body and fundus); chronic H pylori gastritis (antrum); H pylori is most common cause of gastritis (90%)

Question 33

Chronic autoimmune gastritis is due to __ destruction of __ cells, which are located in the stomach __ and __. Associated with __ against __ cells and/or __. Useful for dx but pathogenesis is mediated by __ (type _ hypersens).

Answer 33

autoimmune; gastric parietal cells; body; fundus; antibodies; parietal cells; intrinsic factor; T cells; type IV

Question 34

Name 4 clinical features of chronic autoimmune gastritis

Answer 34

1) atrophy of mucosa w/intestinal metaplasia (see goblet cells in stomach in picture); 2) achlorhydria w/inc gastrin levels and antral G-cell hyperplasia; 3) megaloblastic (pernicious) anemia due to lack of IF; 4) increased risk for gastric adenocarcinoma (intestinal type)

Question 35

G-cells are found in the __ of the stomach and make __. Parietal cells are found in the __ and __ of the stomach and secrete __ and produce __.

Answer 35

antrum; gastrin; body; fundus; acid; intrinsic factor

Question 36

Chronic H pylori gastritis is due to _-induced __ and __. H pylori __ and __ along with __ weaken __. __ is the most common site.

Answer 36

H pylori; acute and chronic inflammation; ureases; proteases; inflammation; mucosal defenses (h pylori doesn’t invade stomach, it makes things that weaken mucosal defenses); antrum

Question 37

Chronic H pylori gastritis presents with __. It increases risk for these 3 diseases.

Answer 37

epigastric abdominal pain; 1) ulceration (peptic ulcer disease); 2) gastric adenocarcinoma (intestinal type); 3) MALT lymphoma (marginal zone)

Question 38

Treatment of chronic H pylori gastritis involves __. Resolves __ and reverses __. Negative __ test and lack of __ confirm eradication of H pylori

Answer 38

triple therapy (clarithromycin, amoxicillin, PPIs); gastritis/ulcer; intestinal metaplasia; urea breath; stool antigen

Question 39

Peptic ulcer disease is solitary/multiple ulcer(s) involving the __ (90%) or __ (10%). Differential diagnosis of ulcers include __.

Answer 39

solitary ulcer; proximal duodenum; distal stomach; carcinoma

Question 40

Duodenal ulcer (PUD) is almost always due to __ (gt 95%). Rarely, may be due to __. Presents with __ that improves/worsens with meals.

Answer 40

H pylori; Zollinger Ellison syndrome (due to a gastrinoma); epigastric pain; improves (duodenum inc secretion of stuff that protects it from stomach acid during meals)

Question 41

Duodenal ulcers are diagnosed with __, which shows ulcer with __ of __. Usually they arise in __ duodenum. When present in __ duodenum, __ may lead to bleeding from the __ or may lead to __.

Answer 41

endoscopic biopsy; hypertrophy; Brunner glands (mucus secreting glands in duodenum); anterior; posterior; rupture; gastroduodenal artery; acute pancreatitis

Question 42

Gastric ulcer is usually due to __ (75%). Other causes include __ and __. Presents with __ that improves/worsens with meals. Ulcer is usually located on the __ of the __. __ carries risk of bleeding from __.

Answer 42

H pylori; NSAIDs; bile reflux; epigastric pain; worsens (stomach inc acid production during meals); lesser curvature; antrum; rupture; left gastric artery (runs along lesser curvature)

Question 43

Duodenal ulcers are almost always/never malignant (duodenal carcinoma is extremely common/rare).

Answer 43

never; rare

Question 44

Gastric ulcers can be caused by gastric carcinoma (__ subtype). Benign peptic ulcers are usually small/large (size __), sharply demarcated/irregular, surrounded by heaped up margins/radiating folds of mucosa

Answer 44

intestinal; small; lt 3cm; sharply demarcated (“punched out”); radiating folds of mucosa (normal mucosa around it)

Question 45

Malignant gastric ulcers are __ and __ with __ margins. __ is required for definitive diagnosis.

Answer 45

large; irregular; heaped up; biopsy

Question 46

Gastric carcinoma is a benign/malignant proliferation of __ (__). Sub classified into __ and __ types. Which one is more common? Which one is associated with H pylori?

Answer 46

malignant; surface epithelial cells; adenocarcinoma; intestinal and diffuse; intestinal is more common and is assoc with H pylori

Question 47

Intestina type gastric carcinoma presents as a small/large, __ __ with __ margins. Most commonly involves the __ of the __ (similar to gastric __). Name 3 risk factors

Answer 47

large, irregular ulcer; heaped up; lesser curvature; antrum; ulcers; 1) intestinal metaplasia (due to H pylori and autoimmune gastritis); 2) nitrosamines in smoked foods (Japan); 3) blood type A

Question 48

Diffuse type gastric carcinoma is characterized by __ that diffusely __ the __. __ results in thickening of stomach wall (__).

Answer 48

signet ring cells; infiltrate; gastric wall; desmoplasia (reactive response of the stroma to invading tumor); linitis plastica; (Not associated with H pylori, intestinal metaplasia, or nitrosamines)

Question 49

Gastric carcinoma presents early/late with these 4 symptoms. Rarely presents with __ or __ sign.

Answer 49

late; 1) weight loss; 2) abdominal pain; 3) anemia; 4) early satiety; acanthosis nigricans (thickening and darkening of skin in axillary region); Leser Trelat sign (seborrheic keratoses on skin)

Question 50

Gastric carcinomas spread to lymph nodes can involve the __ node (__ node). Distant metastasis most commonly involve the __. Name two other sites and which type they are associated with

Answer 50

left supraclaviclar node; Virchow; liver; 1) periumbilical region (Sister Mary Joseph nodule) seen with intestinal type; 2) bilateral ovaries (Krukenberg tumor) seen with diffuse type (signet cells - mucus producing)

Question 51

What is virchow node, sister mary joseph nodule, and a krukenberg tumor?

Answer 51

Virchow = left supraclavicular node w/gastric carcinoma; SMJN: periumbilical region metastates w/intestinal type; Kruk: bilateral ovary metastases with diffuse type

Question 52

Acanthosis nigricans is ___ in the __ region. Lester Trelat sign is __ popping up all over the __. Both are a sign of __.

Answer 52

thickening and darkening of skin; axillary; seborrheic keratoses; skin; gastric carcinoma

Question 53

Name 3 congenital pathologies of the stomach

Answer 53

1) gastroschisis; 2) omphalocele; 3) pyloric stenosis

Question 54

Name 4 non-congenital pathologies of the stomach

Answer 54

1) acute gastritis; 2) chronic gastritis; 3) peptic ulcer disease; 4) gastric carcinoma

Question 55

Which form of chronic gastritis is found in the antrum? Body and fundus?

Answer 55

H pylori; autoimmune

Question 56

Duodenal atresia is __ failure of duodenum to __. Associated with __. Name 3 clinical features.

Answer 56

congenital; canalize; Down syndrome; 1) polyhdramnios (baby can’t digest amniotic fluid); 2) distension of stomach and blind loop of duodenum (double bubble sign); 3) bilious vomiting (bile able to come in to duodenum)

Question 57

Meckel diverticulum is a __ of __ layers of the __ (true/false diverticulum). Arises due to ___. Associated with the __.

Answer 57

outpouching; all 3; bowel wall; true; failure of the vitelline duct to involute. Rule of 2’s

Question 58

Name the 3 rule of 2’s associated with Meckel diverticulum

Answer 58

1) seen in 2% of the population; 2) 2 inches long and located in the small bowel w/in 2 ft of the ileocecal valve; 3) can present during first 2 yrs of life

Question 59

Meckel diverticulum can present within the first 2 years of life with these 4 symptoms, however most cases are __.

Answer 59

1) bleeding (due to heterotypic gastric mucosa - which makes acid and causes bleeding); 2) volvulus; 3) intussusception; 4) obstruction (mimics appendicitis); asymptomatic

Question 60

In gestation, mid gut receives nutrients from __ via the __, which forms in the __ week, then involutes in the __ week. Persistence leads to __. Complete failure of involution can cause passing of __ at birth via the __

Answer 60

yolk sac; vitelline duct; 4th; 7th wk; Meckel diverticulum; meconium; umbilicus (with Meckel, may feel stool in the umbilicus)

Question 61

Volvulus is the __ of __ along its __. Results in __ and __ of the __ with __. Most common locations are __ (elderly) and __ (young adults)

Answer 61

twisting; bowel; mesentery; obstruction; disruption; blood supply; infarction; sigmoid colon; cecum

Question 62

Intussusception is __ of the __ segment of bowel forward/backward into the __ segment. __ segment is pulled forward/backward by __, resulting in obstruction and disruption of __ with __.

Answer 62

telescoping; proximal; forward; distal; telescoped; forward; peristalsis; blood supply; infarction

Question 63

Intussusception is associated with a leading edge (___). In children the MCC is __ (e.g. due to __). Usually arises in the __, leading to intussusception into the __. In adults, the most common cause is __.

Answer 63

focus of traction; lymphoid hyperplasia; rotavirus; terminal ileum; cecum; tumor

Question 64

Small bowel is highly susceptible to __ due to the large amounts of absorption that is required of it. Small bowel infarction can be __ or __

Answer 64

ischemic injury; transmural; mucosal

Question 65

Transmural infarction of the small bowel occurs with __ of the __ or __ of the __. Mucosal infarction occurs with __. Name 3 clinical features of small bowel infarction.

Answer 65

thrombosis/embolism; superior mesenteric artery; thrombosis; mesenteric vein; marked hypotension; 1) abdominal pain; 2) bloody diarrhea; 3) decreased bowel sounds

Question 66

Lactose intolerance is deceased __ of the __ enzyme found in the __ of __. __ normally breaks down lactose into __ and __. Presents with __ and __ upon consumption of milk products. Undigested lactose is __.

Answer 66

function; lactase; brush border; enterocytes; lactase; glucose and galactose; abdominal distension; diarrhea; osmotically active

Question 67

Lactose intolerance may be __ (rare, __ PoI) or __ (often develops in late __). Temporary deficiency is seen after __ (lactase is highly susceptible to injury)

Answer 67

congenital; autosomal recessive; acquired; childhood; small bowel infection

Question 68

Celiac disease is __-mediated damage of __ due to __ exposure. Associated with HLA-__ and __.

Answer 68

immune; small bowel villi; gluten; DQ2 and DQ8

Question 69

Gluten is present in __ and __. Its most pathogenic component is __, which once absorbed is __ by __. The resultant __ is presented by APCs via __. __ cells mediate tissue damage.

Answer 69

wheat and grains; gliadin; deamidated; tissue transglutaminase (tTG); deamidated gliadin; MHC class II; helper T

Question 70

In children, celiac disease presents with these 3 symptoms. In adults with these 2 symptoms. Small __-like __ may arise on the skin (___), due to __ at the tips of __. Resolves with __.

Answer 70

1) abdominal distension; 2) diarrhea; 3) failure to thrive; 1) chronic diarrhea; 2) bloating; herpes; vesicles; dermatitis herpetiformis; IgA deposition; dermal papillae; gluten free diet

Question 71

In celiac disease, lab findings include Ig_ antibodies against __, __, or __. Ig_ antibodies are also present and are useful for dx in pts with __ deficiency.

Answer 71

IgA; endomysium (sheath around each muscle fiber - no damage occurs to them); tTG (tissue transglutaminase); gliadin; IgG; IgA

Question 72

In celiac disease, duodenal bx reveals __, __ and __. Damage is most prominent in __, and the __ and __ are less involved.

Answer 72

flattening of villi; hyperplasia of crypts; increased intraepithelial lymphocytes; duodenum; jejunum and ileum

Question 73

Celiac disease symptoms resolve with __. __ and __ are late complications that present as __ despite good __. (Normal villi on this side of card)

Answer 73

gluten-free diet; small bowel carcinoma; T-cell lymphoma (rare - EATL = enteropathy associated t cell lymphoma); refractory disease; dietary control

Question 74

Tropical sprue is damage to __ due to __ resulting in __. Similar to celiac disease except it occurs in __ regions, it arises after __ and responds to __, and damage is most prominent in __ and __ (__ or __ may ensue)

Answer 74

small bowel villi; unknown organism; malabsorption; tropical (e.g. Caribbean); infectious diarrhea; antibiotics; jejunum and ileum; 2ndary vit B12 or folate deficiency (duodenum less commonly involved)

Question 75

Whipple disease is systemic/local __ damage characterized by __ loaded with __. Partially destroyed __ are present in __ (positive for __).

Answer 75

systemic; tissue; macrophages; Tropheryma whippelii; organisms; macrophage lysosomes; PAS

Question 76

Whipple disease classically involves the __. Macrophages compress __. __ cannot be transferred from __ to __, resulting in __ and __. Name 4 other common sites of involvement

Answer 76

small bowel lamina propria; lacteals; chylomicrons; enterocytes; lymphatics; fat malabsorption; steatorrhea; 1) synovium of joints (arthritis); 2) cardiac valves; 3) LNs; 4) CNS

(T whippelii organisms highlighted by PAS stain)

Question 77

Abetalipoproteinemia is a __(PoI) deficiency of __ and __. Clinical features include __, due to defective __ formation (requires __). Also absent __ and __ (which requires __)

Answer 77

autosomal recessive; apolipoprotein B-48 and B-100; malabsorption; chylomicron; B-48; VLDL and LDL: B-100

Question 78

Carcinoid tumor is a benign/malignant proliferation of __. High/low grade. Tumor cells contain __ that are positive for __. Can arise anywhere along the __. __ is most common site. It grows as a __.

Answer 78

malignant; neuroendocrine cells; low-grade; neurosecretory granules; chromogranin; gut; small bowel (or appendix per Dr. Castro); submucosal polyp-like nodule

Question 79

Carcinoid tumors often secrete __, which is released into the __ and metabolized by the liver __ into __, which is excreted in the __. Metastasis to the liver allows __ to bypass __. It is released into the __ and leaks into __ via __, resulting in __ and __.

Answer 79

serotonin; portal circulation; monoamine oxidase (MAO); 5-HIAA; urine; serotonin; liver metabolism; hepatic vein; systemic circulation; hepato-systemic shunts; carcinoid syndrome; carcinoid heart disease

Question 80

Carcinoid syndrome is characterized by these 3 symptoms. Symptoms can be triggered by __ or __, which stimulate __ release from the tumor.

Answer 80

bronchospasm (wheezing), diarrhea, and flushing of skin; alcohol; emotional stress; serotonin

Question 81

Carcinoid heart disease is characterized by right/left-sided __ (increased __) leading to __ and __. Right/left sided __ lesions are not seen dude to presence of __ in the __.

Answer 81

right; valvular fibrosis; collagen; tricuspid regurgitation; pulmonary valve stenosis; left; valvular; MOA (metabolizes serotonin); lung

Question 82

What is the most common congenital anomaly of the GI tract? Which small bowel pathology is associated w/Down syndrome? Which is associated with HLA-DQ2/DQ8? Which is associated w/rotavirus causing lymphoid hyperplasia? Antibodies against endomysium, tTG, or gliadin?

Answer 82

Meckel diverticulum; duodenal atresia; celiac disease; intussception in children (lymphoid hyperplasia can also lead to acute appendicitis in children); celiac (IgA antibodies)

Question 83

Acute appendicitis is acute __ of the appendix. It is related to to __ of the appendix by __ (children) or a __ (adults). Name 4 symptoms

Answer 83

inflammation; obstruction; lymphoid hyperplasia; fecalith (poop); 1) periumbilical pain; 2) fever; 3) nausea; 4) pain eventually localizes to RLQ (McBurney point)

Question 84

Appendicitis can rupture resulting in __ that presents with __ and __. __ is a common complication of acute appendicitis.

Answer 84

peritonitis; guarding; rebound tenderness; periappendiceal abscess

Question 85

Inflammatory bowel disease is __, __ inflammation of bowel. Possibly due to abnormal __ to __. Classically presents in young/old women/men (age __) as __ bouts of __ and __. More prevalent in these 2 groups.

Answer 85

chronic; relapsing; immune response; enteric flora; young women (teens to 30s); recurrent; bloody diarrhea; abdominal pain; in the West, particularly Caucasians and Eastern European Jews

Question 86

IBD is a diagnosis of __. Symptoms mimic other causes of bowel inflammation (e.g. __). Sub classified as __ or __

Answer 86

exclusion; infection; ulcerative colitis; Crohn disease

Question 87

Ulcerative colitis wall involvement includes __ and __. It begins in the __ and can extend proximally up to the __. Involvement is __. The remainder of the GI tract is affected/unaffected.

Answer 87

mucosal and submucosal ulcers; rectum; cecum; continuous; unaffected

Question 88

Symptoms of ulcerative colitis include __ pain (__) with __. On bx, there are crypt __ with __. The gross appearance shows __ with loss of __ (__sign on imaging).

Answer 88

LLQ; rectum; bloody diarrhea; abscesses; neutrophils; pseudopolyps; haustra; lead pipe

Question 89

Complications of ulcerative colitis include __ and __ (risk is based on extent of __ involvement and __ of disease; generally not a concern until __ of the disease). __ protects against UC.

Answer 89

toxic megacolon (massive dilation of colon w/risk of rupture); carcinoma; colonic; duration; gt 10 yrs; smoking

Question 90

Crohn disease wall involvement includes __ inflammation with __. It occurs anywhere from __ to __ with __ lesions. The __ is the MC site, and the __ is the least common.

Answer 90

full-thickness; knife-like fissures; mouth to anus; skip (not continuous); terminal ileum; rectum

Question 91

Crohn disease presents with __ pain (__) with __. On bx there are __ aggregates with __ (40% of cases). Grossly, there is __ mucosa, __, and __ (__ sign on imaging). __ increases the risk for Crohn disease.

Answer 91

RLQ; ileum; non-bloody diarrhea; lymphoid; *granulomas; cobblestone; creeping fat; strictures (myofibroblasts contracting during healing); string; smoking

Question 92

Complications of Crohn disease include these 4

Answer 92

1) malabsorption w/nutritional deficiency; 2) calcium oxalate nephrolithiasis; 3) fistula formation; 4) carcinoma (if colonic disease is present)

Question 93

Both ulcerative colitis and crohn disease share similar extra intestinal manifestations. Name 6.

Answer 93

1) arthritis (peripheral joints, ankylosing spondylitis, sacroiliitis, migratory polyarthritis); 2) uveitis; 3) erythema nodosum; 4) pyoderma gangrenosum; 5) primary sclerosing cholangitis; 6) p-ANCA

Question 94

UC vs CD: which has bloody diarrhea? cobblestone mucosa? complications include calcium oxalate nephrolithiasis? LLQ pain? Begins in rectum? Occurs anywhere in GI tract?

Answer 94

UC; CD; stones: CD; UC; UC; CD

Question 95

UC vs CD: which has formation of granulomas? crypt abscesses? complications include toxic megacolon? carcinoma? smoking is protective? lead pipe sign? string sign? pseudopolyps?

Answer 95

CD; UC; UC; both; UC; UC; CD; UC

Question 96

Hirschsprung disease is defective __ and __ of __ and __. Associated with __. It is due to a congenital/acquired failure of __ cells (__-derived) to __ into the __ and __.

Answer 96

relaxation; peristalsis; rectum; distal sigmoid colon; Down syndrome; congenital; ganglion; neural crest; descend; myenteric and submucosal plexus

Question 97

Myenteric (__) plexus is located btwn the __ and __ layers of the __ and regulates __. The submucosal (__) plexus is located in the __ and regulates __.

Answer 97

auerbach; inner circular; outer longitudinal; muscularis propria; motility; meissner; submucosa; blood flow, secretions, and absorption

Question 98

Clinical features of Hirschsprung disease are based on __. Name 3

Answer 98

obstruction; 1) failure to pass meconium; 2) empty rectal vault on digital rectal exam; 3) massive dilatation (megacolon) of bowel proximal to obstruction w/risk for rupture

Question 99

In Hirschsprung disease, __ bx reveals lack of __. Treatment involves __ of the involved bowel. __ cells are present in the bowel proximal/distal to the disease segment

Answer 99

rectal suction (need to do suction to get submucosa since mucosa doesn’t have ganglion cells); ganglion cells; resection; ganglion; proximal

Question 100

Colonic diverticula are __ of __ and __ though the __ (true/false diverticulum). It is related to __, and therefore associated with __, __, and __. Commonly seen in __.

Answer 100

outpouchings; mucosa; submucosa; muscularis propria; false; wall stress; constipation; straining; low fiber diet; older adults (risk increases with age)

Question 101

Colonic diverticular are usually __. Complications include these 3. They typically arise where the __ traverse the __ (weak point in colonic wall). __ is the most common location

Answer 101

asymptomatic; 1) rectal bleeding (hematochezia); 2) diverticulitis; 3) fistula; vasa recta; muscularis propria; sigmoid colon

Question 102

Diverticulitis is due to __. Presents with __-like symptoms in the __. A fistula can occur from colonic diverticula when inflamed diverticula __ and __ to a local structure. Colovesicular fistula presents with __ (or __) in urine.

Answer 102

obstructing fecal material; appendicitis; LLQ; rupture; attach; air; stool

Question 103

Angiodysplasia is a congenital/acquired malformation of __ and __ __. Usually arises in the __ and __ due to high __. Rupture classically presents as __ in an older adult.

Answer 103

acquired; mucosal; submucosal; capillary beds; cecum; right colon; wall tension; hematochezia (right sided stress w/hematochezia is angiodysplasia)

Question 104

Hereditary hemorrhagic telangiectasia is a ___(PoI) disorder resulting in __, especially in the __ and __. __ presents as bleeding

Answer 104

autosomal dominant; thin-walled blood vessels; mouth; GI tract; rupture

Question 105

Ischemic colitis is __ damage to the __, usually at the __ (since it is a __ of the __). __ of __ is the MCC. Presents with __ and __. Infarction results in __ and __.

Answer 105

ischemic; colon; splenic flexure; watershed area; superior mesenteric artery (SMA); atherosclerosis; SMA; postprandial pain; weight loss; pain; bloody diarrhea

Question 106

Irritable bowel syndrome is relapsing __ pain with these 3 symptoms that improves with __. Classically seen in __. Related to disturbed __. __ is seen on bx. Increased __ may improve symptoms.

Answer 106

abdominal; 1) bloating; 2) flatulence; 3) change in bowel habits (diarrhea or constipation); defecation; middle-aged females; intestinal motility; no identifiable pathologic changes; dietary fiber

Question 107

Colonic polyps are __ of colonic __. MC types are __ and __ polyps (which is the most common btwn them). Screening for polyps is performed by __ and __. They are usually __, but can __.

Answer 107

raised protrusions; mucosa; hyperplastic (most common type of polyp); adenomatous (2nd MC type); colonoscopy; fecal occult blood testing; clinically silent; bleed

Question 108

Hyperplastic colonic polyps are due to __. Classically show a __ appearance on microscopy. Usually arise in the __ colon (__). They are benign/malignant.

Answer 108

hyperplasia of glands; serrated; left; rectosigmoid; benign (with no malignant potential!)

Question 109

Adenomatous polyps are due to __ of __. They are benign/malignant, but __ and may progress to __ via the __. Goal is to remove adenomatous polyps before progression to carcinoma.

Answer 109

neoplastic proliferation; glands; benign; premalignant; adenocarcinoma; adenoma-carcinoma sequence

Question 110

Adenoma-carcinoma sequence describes the molecular __ from normal __ to __ to __. __ mutations (__ or __) increase risk for formation of polyp. __ mutation leads to formation of polyp. __ mutation and increased expression of __ allow for progression to carcinoma. __ impedes progression from adenoma to carcinoma.

Answer 110

progression; colonic mucosa; adenomatous polyp; carcinoma; APC (adenomatous polyposis coli gene - tumor suppressor gene); sporadic; germline; K-ras; p53; COX; aspirin

Question 111

Name the gene mutations required in the adenoma-carcinoma sequence and what they lead to.

Answer 111

1) APC mutation - increases risk for formation of polyp (tumor suppressor gene so need to knockout both copies); 2) K-ras mutation leads to formation of polyp; 3) p53 mutation and increased COX expression allows for progression to carcinoma

Question 112

On colonoscopy, hyperplastic and adenomatous polyps look __, so __ polyps are removed and examined microscopically. Greatest risk for progression from adenoma to carcinoma is related to these 3 things.

Answer 112

identical; all; 1) size gt 2 cm; 2) sessile growth (grow right from mucosa without a pedunculated trunk); 3) villous histology (have long villous projections, not tubular)

Question 113

Familial adenomatous polyposis (FAP) is a __ (PoI) disorder characterized by __ to __ (#) of __. Due to inherited __ mutation (chromosome __), which increases propensity to develop __ throughout the __ and __. __ and __ are removed __. Otherwise almost all pts develop __ by __ yrs of age.

Answer 113

autosomal dominant; 100s-1000s; adenomatous colonic polyps; APC; 5; adenomatous polyps; colon; rectum; colon; rectum; prophylactically; carcinoma; 40

Question 114

Name 2 syndromes of which familial adenomatous polyposis is a part of, and what else they have.

Answer 114

Gardner syndrome (FAP, fibromatosis, osteomas) and Turcot syndrome (FAP, CNS tumors - medulloblastoma and glial tumors)

Question 115

Gardner syndrome contains these 3 things. __ is a non-neoplastic proliferation of __, which arises in the __ (__) and locally destroys tissue. __ is a benign tumor of __ that usually arises in the __.

Answer 115

1) FAP; 2) fibromatosis; 3) osteomas; fibromatosis; fibroblasts; retroperitoneum; desmoid; osteoma; bone; skull

Question 116

Juvenile polyp is a sporadic/acquired __ (malignant/benign) polyp that arises in __ (__ yr of age). Usually present as a solitary/multiple __ polyp that __ and __.

Answer 116

sporadic; hamartomous (tumor comprised of normal tissue but disorganized); children; LT 5 yrs; solitary; rectal; prolapses; bleeds

Question 117

Juvenile polyposis is characterized by solitary/multiple juvenile __ in the __ and __. Large numbers of juvenile polyps increase the risk of __.

Answer 117

multiple; polyps; stomach; colon; progression to carcinoma (only large numbers increase the risk)

Question 118

Peutz-Jeghers syndrome has these 2 symptoms. It is a __ (PoI) disorder. Increased risk for these 3 types of cancer.

Answer 118

1) hamartomatous (benign) polyps throughout GI tract; 2) mucocutaneous hyperpigmentation (freckle-like spots) on lips, oral mucosa, and genital skin; autosomal dominant; colorectal, breast, and gynecologic

Question 119

Colorectal carcinoma arises from colonic or rectal __. It is the 1/2/3/4 most common site of cancer and 1/2/3/4 most common cause of cancer-related death. Peak incidence is __ years of age. Most commonly arises from __. A 2nd impt molecular pathway is __.

Answer 119

mucosa; 3rd; 3rd; 60-70; adenoma-carcinoma sequence (APC - Kras - p53 and inc COX); microsatellite instability

Question 120

Microsatellites are __ sequences of __. Integrity (__) is maintained during __. Instability indicates defective __ (e.g. __). ___ is due to inherited mutations in __ enzymes.

Answer 120

repeating; non-coding DNA; stability; cell division; DNA copy mechanisms; DNA mismatch repair enzymes; hereditary nonpolyposis colorectal carcinoma (HNPCC); DNA mismatch repair

Question 121

Hereditary nonpolyposis colorectal carcinoma (HNPCC) is due to inherited mutations in __. Pts have an increased risk for these 3 cancers. Colorectal carcinoma arises __ (from/not from adenomatous polyps) at a late/early age. Usually right/left sided.

Answer 121

DNA mismatch repair enzyme; colorectal, ovarian, endometrial; de novo; not from; early (relatively early); right sided

Question 122

Screening for colorectal carcinoma occurs via __ and __. Begins at __ age. Goal is to remove __ before carcinoma develops and to detect cancer early before clinical symptoms arise. Colonic carcinoma is associated with an increased risk for __.

Answer 122

colonoscopy; fecal occult blood testing; 50; adenomatous polyps; Streptococcus bovis endocarditis

Question 123

Carcinoma can develop __ along entire length of colon. Left-sided carcinoma usually grows as a __ lesion, and presents with these 3 symptoms. Right sided carcinoma usually grows as a __ lesion. Presents with these 2 symptoms.

Answer 123

anywhere; napkin ring; 1) decreased stool caliber; 2) LLQ pain; 3) blood-streaked stool; raised; 1) iron deficiency anemia (occult bleeding); 2) vague pain

Question 124

An older adult with iron deficiency anemia has __ until proven otherwise.

Answer 124

colorectal carcinoma

Question 125

Adenoma-carcinoma sequence usually presents with __-sided carcinoma. MSI pathway usually presents with __-sided carcinoma. Name two other pathways to colorectal cancer.

Answer 125

left; right; 1) ulcerative colitis; 2) Peutz-Jeghers

Question 126

Staging colorectal carcinoma. T is __ of invasion. Tumors limited to mucosa generally do not spread due to lack of __ in the mucosa. N is spread to __. and M is distant spread, and most commonly involves the __. __ is a serum tumor marker useful for __ and __ and not __.

Answer 126

depth; lymphatics; regional lymph nodes; liver; CEA; assessing tx response; detecting recurrence; screening