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Robbins Pathology GI (Chptr 16,17,18,19) > Chapter 17-Small Intestine And Colon > Flashcards

Chapter 17-Small Intestine And Colon Flashcards

1
Q

What is the most common cause of intestinal obstruction worldwide

A

Hernias

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2
Q

What are the common causes in the formation of adhesions

A

Surgical
Infection
Peritoneal inflammation
Endometriosis

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3
Q

What is the most common cause of herniations in the US

A

Adhesions

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4
Q

What is the most common cause of obstruction in patients under the age of 2

A

Intussusception

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5
Q

What are the two steps in the intestinal response to ischemic injury

A

1) Hypoxic injury due to vascular compromise

2) Reperfusion injury during restoration of blood

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6
Q

What are the watershed areas of the colon that are susceptible to ischemia

A

1) Splenic flexure (SMA and IMA)

2) Sigmoid Colon and rectum (IMA, pudundal, and iliac)

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7
Q

Which portion of the colon is prone to ischemic event, and which is more resistant

A

Surface epithelium is prone, while the crypts are more resistant

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8
Q

Transmural infarction is due to what

A

Acute arterial obstruction

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9
Q

What type of necrosis is seen in the ischemic events of the colon

A

Coagulative necrosis

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10
Q

When does ischemic disease of the colon commonly happen

A

After 70 years of age and in women

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11
Q

How does acute colonic ischemia typically present

A

Sudden onset of cramping, lower left abdominal pain, desire to dedicate and passage of blood or bloody diarrhea

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12
Q

Which portion of the colon is more severe with regards to an ischemic event

A

Right sided (mortality is doubled)

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13
Q

Which prognostic indicators prove to have a worse result with acute ischemia of the colon

A

-COPD and symptoms lasting 2 weeks

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14
Q

Why is the right side of the colon correlated with a worse prognosis

A

SMA supplies it, so its the first presentation of severe disease, such as the occlusion of the SMA

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15
Q

During radiation enterocolitis, what are the common clinical findings

A
  • Radiation fibroblasts in the stroma
  • anorexia
  • Abdominal cramps
  • Malabsorption diarrhea
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16
Q

What is the most common acquired GI emergency of neonates and what is the cause/presentation

A

Necrotizing enterocolitis aka transmural necrosis

  • During low birth weight or prematurity
  • Presents when oral feeding is initiated
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17
Q

When does Angio dysplasia present

A

After 60 years old

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18
Q

What is the cause of the angiodysplasia and where does it commonly occur

A

-Malformed submucosal blood vessels, and occurs in the right colon or cecum

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19
Q

What is a very important cause of malabsorption and diarrhea

A

Intestinal graft versus host disease after allogenic hematopoietic stem cell transplantation

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20
Q

What is the process of intraluminal digestion

A

Proteins, carbs, and fats are broken down into absorbable forms

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21
Q

What is the process of terminal digestion

A

Hydrolysis of carbs and peptides by disaccharidases and peptidases in the brush border

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22
Q

What is the process of transepithelial transport

A

Nutrients, fluid, and electrolytes are transported across and processed in the small intestine epithelium

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23
Q

What are the qualifications for secretory diarrhea

A

isotonic stool persisting during fasting

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24
Q

What are the qualifications for osmotic diarrhea

A

Excessive osmotic forces exerted by nonabsorpable luminal solutes

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25
Q

What are the qualifications for malabsorptive diarrhea

A

Failure of absorption, relieved with fasting

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26
Q

What are the qualifications of exudative diarrhea

A

Inflammatory disease in which purulent, bloody stool is continued during fasting

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27
Q

What does the lack of CTFR in CF lead to with regards to the pancreas

A

Dehydration leads to formation of pancreatic intraductual concretions

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28
Q

What is the process that celiac disease causes damage

A

-lymphocytes expressing NKG2D and MICA attack epithelium and allow gliadin through, which are attacked by CD4 T cells

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29
Q

What are the MHC compounds that are present with damage due to celiac disease

A

HLA-DQ2 and HLA-DQ8

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30
Q

Which portion of the Gi tract is normally diagnositic for Celiac

A

Second portion of duodenum

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31
Q

What are the histological findings for celiac disease

A

-Increased CD8, crypto hyperplasia, vilous atrophy

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32
Q

When do most cases of Celiac Disease present

A

30-60

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33
Q

Which gender is more common for celiac disease in adults

A

Women

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34
Q

What are extraintestinal complications associated with celiac disease

A
  • Arthritis and joint pain
  • aphthous stomatitis
  • iron deficiency anemia
  • delayed puberty
  • Short stature
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35
Q

What are characteristic extraintestinal findings indicative of celiacs disease

A

Itchy, blistering skin lesion, dermatitis herpetiformis

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36
Q

A gluten free diet may reduce the risk of which conditions in those with celiac disease

A
  • anemia
  • female infertility
  • osteoporosis
  • cancer
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37
Q

What condition are those with celiac disease at a higher risk for

A

Aggressive malignancy in the form of enteropathy-associated T cell lymphoma

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38
Q

In some areas such as Australia, , Africa, Gambia, South America and Asia, what is a common cause of failure of oral vaccines

A

Environmental enteropathies such as tropical spruce.

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39
Q

In patients with IPEX, which autoantibodies are commonly present

A

Enterocytes, goblet cells, parietal cells, and islet cells

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40
Q

What is the heritability of lactase deficiency

A

Autosomal recessive

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41
Q

Abetalipoproteinemia is caused by a mutation in which gene

A

Microsomes triglyceride transfer protein (MTP)

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42
Q

What is the role of the MTP protein

A

-Transfers lipids to specialized domains o the aoplipoprotein B polypeptide within the Rough ER

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43
Q

What is the result of lack of MTP

A

Accumulation of intracellular lipids

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44
Q

What stain can be used to recognize Abetalipoproteinemia

A

Oil Red-O, especially after a fatty meal

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45
Q

What are the clinal presentations of Abetalipoproteinemia

A

Failure to thrive, diarrhea, and steatorrhea

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46
Q

What does the presence of a Anthonthocytic red cells characterize as

A

Aka burr cells in abetalipoproteinemia

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47
Q

Pediatric infectious diarrhea is commonly caused by which group of infectious agents

A

Enteric viruses

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48
Q

What is the location of cholera during an infection

A

Noninvasive and remains intralumenal

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49
Q

IN the case of cholera infection, what is the role of hemagglutinin

A

A metalloproteinase, for bacterial detachment and shedding in stool

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50
Q

IN the case of cholera infection, what part of the toxin is the effector and what does it bind to

A

Beta subunit binds to GM ganglioside to get endocytosed, but the A subunit activates the GCPR

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51
Q

What is the most common bacterial enteric pathogen in developed countries

A

C. Jejuni

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52
Q

What is a autoimmune complication with C. Jejuni and which MHC complex is it due to

A

Reactive arthritis, especially the HLA-B27

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53
Q

What are some common histological finding with campylobacter

A

Neutrophil infiltrates within the superficial mucosa, cryptitis, and crypt abscesses, but the architecture is preserved

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54
Q

What is the presentation of C jejuni in the clinical setting

A

Watery diarrhea, followed by a flu like prodrome as the primary symptom

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55
Q

What is the recommendation of antibiotic treatment for C jejuni

A

Not recommended

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56
Q

What are the physical features of shigellosis

A

Gram negative, non capsulated, non motile, facultative anaerobes

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57
Q

Which patients are likely to acquire shigellosis

A

Children in daycares, migrant workers, travelers, urging homes

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58
Q

What is the pathogenesis of Shigella

A

Taken up by M cells, proliferate intracellular, engulfed by macrophages and induce apoptosis.

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59
Q

Which toxin is secreted by shigella

A

Stx, part of the type 3 secretion system

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60
Q

Which portion of the GI tract is most affected by shigella

A

Left colon

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61
Q

Infection with which organism is commonly causes progression of water diarrhea into dysentery

A

Shigella

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62
Q

What are complications commonly seen with shigella and what is the HLA associated with

A

HLA-B27

  • Sterile reactive arthritis
  • Urethritis
  • Conjunctivits
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63
Q

Which condition can occur following Shigella infection, and which other infection does it mimic

A

Mimics EHEC by the presence of hemolytic uremic syndrome

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64
Q

Which medication is contraindicated in Shella infection

A

Antidiarrheals

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65
Q

When is salmonella commonly seen

A

Younger children and older adults during the summer and fall

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66
Q

Chances of salmonella infection are increased in patients with which conditions

A

Decreased amounts of gastric acid

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67
Q

What is the recommendation of antibiotics in salmonella

A

Not recommended

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68
Q

What is the clinical features of salmonella

A

Fever (resolves in 2 days), but diarrhea for a week

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69
Q

Which patients have an increased risk of severe illness and complication as a result of salmonella

A
  • Malignancies
  • Immunosuppresion
  • Alcoholics
  • CV disease
  • Sickle celled
  • Hemplytic anemia
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70
Q

What is the location of colonization of typhus

A

Gallbladder

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71
Q

What is S typhi able to do thats different and what is the result systemically

A

-Disseminates via lymphatic fluid and blood, resulting in reactive hyperplasia of phagocytes

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72
Q

What is the result in the Peyer patches in a typhus infection

A

Enlargement in the terminal illeum in the form of elevated plateaus, along with the draining mesenteric LN

73
Q

Morphologically, what is the damage seen in the GI tract

A

Oval ulcers, along the axis of the ileum with the risk of perforation

74
Q

What are the findings in the spleen during a typhoid infection

A

Enlarged, soft, and uniformaly pale red pulp, obliterated follicular markings, and phagocytic hyperplasia

75
Q

What are the findings in the liver during an typhoid infection

A

Typhoid nodules in the form of small, randomly scattered necrosis where hepatocytes are replaced by macrophages

76
Q

What is the clinal course of infection with typhoid fever

A
  • Anorexia, abdominal pain, bloating, nausea, vomiting, bloody diarrhea followed by a short asymptomatic phase
  • Followed by bacteremi and fever with flu like symptoms
77
Q

What can be seen on a physical exam during typhoid fever

A

Rose spots on the chest and abdomen

78
Q

Patients with sickle celled diseases are prone to what complication with typhoid fever

A

Osteomyelitis

79
Q

Increased levels of what in the blood stream are at greater risk for death and sepsis following infection with yersinia

A

Iron

80
Q

Which preconditions increase the risk of death and sepsis with infection of yersinia

A

Anemia or hemochromatosis

81
Q

What are the histological findings with yersinia

A

Regional LN and peyer patch hyperplasia, with bowel wall thickening

82
Q

Which condition can yersinia infection mimic

A

Appendicitis

83
Q

Which conditions are commonly seen during infection with yersinia

A

Pharyngitis
Arthralgia
Erythema nodosum

84
Q

What is the principal cause of travelers diarrhea with regards to E. Coli

A

ETEC

85
Q

What are the common symptoms with ETEC

A

Noninflammatory diarrhea, dehydration, and shock

86
Q

Which patients are susceptible to ETEC

A

Children under 2

87
Q

What are the proteins associated with virulence in EPEC

A

-Tir and espE gene

88
Q

What is the recommendation for antibiotics during infection with EHEC

A

Not recommended.

89
Q

What bacteria causes pseudomembranous colitis, and what is the common feature that allows the infection

A

C. Difficile and usually following antibiotic treatment

90
Q

What is the pathogensis of C. difficile

A

Toxins activate Rho, leading to disruption of the epithelial cytoskeleton, tight junctions, and apoptosis

91
Q

What are the risk factors for C. Difficile

A

Advanced age, hospitalization, antibiotic use

92
Q

How will a patient with C. difficile present

A

Fever, leukocytosis, abdominal pain, cramps, watery diarrhea, cramps, and dehydration, leading to hypoproteinuremia

93
Q

What is the histological finding in C. difficile

A

Volcano appearing as neutrophils leave the crypt

94
Q

What is the method of detection of C. difficile

A

Toxin being present

95
Q

What are the clinical findings of Whipple disease

A

Malabsorption, lymphadenopathy, arthritis of unknown causes

96
Q

How common is Whipple disease

A

Rare

97
Q

What are the diagnostic findings in Whipple disease

A

Foamy macrophages and large number of argyrphilic rods in the LN.

98
Q

What is the cause of Whipple disease

A

Tropheryma whippelii

99
Q

What is the stain use to diagnosis Whipple disease

A

PAS with diastase resistant granules

100
Q

What stain should be used to confirm Whipple disease

A

Acid fast to rule out mycobacteria

101
Q

What are the morpholigical findings in the case of Norovirus

A

Small intestine will have mild villi shortening, epithelial vacuolization, loss of brisk border, crypt hype trophy, and lamina propia lymphocytes infiltrating

102
Q

Which patients are at increased risk of mortality due to norovirus

A

Immunosuppresed kidney transplant patients or graft versus host

103
Q

What is the pathogensis of Rotavirus

A

Destroys the mature enterocytes of the small intestine, resulting in the villus surface to be repopulated by immature secretory cells

104
Q

What is the toxin used by rotavirus

A

Nonstructural protein 4 (NSP4)

105
Q

Which patients are commonly affected by adenovirus

A

Pediatrics and immunosuppressed

106
Q

What type of parasite is ascaris lumbricoides

A

Nematode

107
Q

What are the complications form ascaris lumbricoides

A

Obstruction of the intestine of biliary system

108
Q

IN the cause of strongyloides, what is the pathogensis

A

Hatches in the intestine and then penetrates the mucosa.

109
Q

Which complication arises from strongyloides

A

Autoinfection

110
Q

What are the complications that arise from necator duodenale and ancylostoma duodenale

A

Superficial erosions, focal hemorrhages, inflammatory infiltrates, and iron deficiency anemia

111
Q

What type of parasite is enterobius vermicularis

A

Pinworms

112
Q

What is the pathogensis of enterobius vermicularis

A

Rarely serious complications, but deposit their eggs around the anus at night

113
Q

What kinda of parasite is trichuris trichiura

A

Whipworms

114
Q

What are the complications from trichuris trichiura

A

Very rarely, it can cause bloody diarrhea during heavy infections

115
Q

What does schistosomiasis prefer to reside

A

Mesenteric veins

116
Q

The intestinal cestodes can cause what complications

A

Normally do not cause them, but can cause diarrhea, nausea, and megaloblastic anemia (D. Latum)

117
Q

What countries are common to see Entamoeba histolytica

A

India, Mexico, Columbia

118
Q

What are of the GI tract does entamoabe histolytica commonly affect

A

Cecum, ascending colon

119
Q

What is the characteristic of the histological finding of infection of entamoeba histolytica

A

Creates a flask shaped ulcer with a narrow neck and broad base

120
Q

What are the complications with infection of entamoeba histolytica

A

Penetration of the splanchnic vessels which allow for embolization to the liver, forming abscesses

121
Q

What are the characteristic finding of the liver abscesses in entamoeba histolytica

A

Scant inflammation at the margains, with shaggy fibrin lining

122
Q

What is the most common parasite pathogen in humans

A

Giardia lamblia

123
Q

What is the result of the infection with cryptosporidium

A

Sodium malabsorption
Chloride secretion
Nonblooddy, watery diarrhea

124
Q

What is the irritable bowel syndrome (IBS) characterized by

A

Chronic, relapsing abdominal pain, bloating, and changes in bowel habits

125
Q

What are some of the genome associations that have been liked to IBS

A

Serotonin reuptake transporters, cannabinol receptors, TNF related mediated

126
Q

What has been effective for treatment for irritable bowel syndrome

A

5-HT3 receptor antagonists

127
Q

What is the common patient group for irritable bowel syndrome

A

Females 20-40

128
Q

What is the prognosis of irritable bowel syndrome (IBS) related to

A

Symptom duration, with longer duration linked to reduced likihood of improvement

129
Q

What are the two conditions classified under IBD

A

Ulcerative colitis and Crohn disease

130
Q

Which of the IBD conditions are transmural

A

Crohn disease

131
Q

What is the age group the the IBD conditions will present

A

White Females in the Teens and early 20s

132
Q

What is a genetic component strongly related to Crohns

A

NOD2 (nucleotide oligomerization binding domain 2)

133
Q

In crohn disease, which cells are activated

A

CD4 as part of Th1

134
Q

The barrier dysfunction associated with Crohns is due to which mutation

A

NOD2

135
Q

What are the genes associated with ulcerative colitis

A

ECM1 (metalloproteinase 9

136
Q

Which gene is associated with ulcerative colitis and maturity onset diabetes of the young

A

HNFA

137
Q

Antibodies against what are present in Crohn’s disease what complications follow

A

-Against bacterial protein flagellum, seen in patients with NOD2, stricture formation, perforation, and small bowel

138
Q

What is the morphological finding of Crohn’s disease

A

Cobblestone appearance that is depressed below the level of normal mucosa
-Creeping fat

139
Q

What is a histological finding that is a hallmark of Crohn’s disease

A

Noncasseating granulomas

140
Q

What are activities that can retrigger the events of crohns

A

Smoking, physical or emotional stress

141
Q

What is the prevalence of fibrosis strictures in crohns and what is the clinical course of action

A

Very common in the terminal ileum and dealt by surgical resection

142
Q

What is the treatment of Crohn’s disease

A

Anti TNF

143
Q

What are the extraintestinal manifestations of crohns

A

-Uveitis
-Migratory polyarthriits
-sacroilitis
-ankylosis spondylitis
Erythema nodosum
-Clubbing of fingers

144
Q

What two conditions commonly show with crohns or ulcerative colitis, but is more common in UC

A
  • Pericholoangitis

- PSC

145
Q

What does the long term outlook for patients with ulcerative cholitis depend on

A

Severity of active disease and disease duration

146
Q

What is UC of the entire colon termed as

A

Pancolitis

147
Q

In the cases of ulcerative colitis that develops toxic megacolon, what is the main concern

A

Perforation

148
Q

What are the clinical presentations of ulcerative colitis

A

Relapsing disorder with attacks of bloody diarrhea with stringy, mucous material, lower abdominal pain, and cramps that are relieved by defications

149
Q

The presence of perinuclear anti-neutrophil cytoplasmic antibodies are present in which condition

A

75% of Ulcerative colitis

150
Q

Antibodies against saccaromyces cerevisiae are present in which condition

A

Crohns

151
Q

What three factors with regards to IBD lead to increased chances of neoplasms

A
  • Increased risk after 8 to 10 years
  • Increased risk if pancolitis is present
  • increased risk with more acute inflammation attacks
152
Q

What is the feature of diversion colitis

A
  • Mucosal erythema and friability

- numerous mucosal lymphoid follicles

153
Q

What is diversion colitis

A

Inflammation of diverted segments of colon as a result of surgical resection due to another disease

154
Q

What is treatment for diversion colitis

A

Enemas containing short chained fatty acids, which are a source for colonic epithelium

155
Q

What are the characteristics of collagenous colitis

A

Increased collagen layer, lymphocytes and inflammation infiltrates in older women

156
Q

What conditions are associated with lymphocytic colitis

A

-Celiac disease and autoimmune diseases:
Graves
RA
Autoimmune gastritis

157
Q

What portions of the GI tract are commonly involved in graft versus host disease

A

Small bowel and colon

158
Q

What is the most common histological finding of graft verses host in the GI

A

Epithelial apoptosis of crypt cells

159
Q

What is the age group that commonly has diverticula disease

A

Older that 60 (extremely rare under 30)

160
Q

What are the characteristics of diverticula disease

A

Not true diverticula as they do invest in all three layers

161
Q

What is the cause of colonic diverticula

A

Elevated intraluminal pressure in the sigmoid colon causes pushing through focal discontinuities that nerves, vasa recta, and sheaths penetrate the inner circular muscle

162
Q

Which portion of the colon is most common for false diverticulum

A

Sigmoid colon

163
Q

What are the clinical presentations of diverticula disease

A

Intermittent cramping, continous lower abdominal discomfort, constipation, distention, alternating diarrhea and constipation
***Never being able to fully completely empty the rectum

164
Q

What is required for the diagnosis of acute pancreatitis

A

Neutrophilic infiltration of the muscularis propria

165
Q

How can an appendicitis be in the left upper quadrant

A

Malrotated colon

166
Q

What are the complications with appendicitis

A

Pyelophlebitis
Portal vein thrombosis
Liver abscess
Bacteremia

167
Q

Why is the appendix sometimes taken out even if healthy

A

Better than than the alternative of an appendix perforation

168
Q

What is the most common tumor of the appendix

A

Well differentiated Neuroendocrine (carcinoid) tumor

169
Q

What are the characteristics of the appendix

A

Always benign and in the distal tip

170
Q

What is the condition of pseudomyxoma peritoneum

A

Mucocele forms in the appendix, leading to the abdomen filling with tenacious, semisolid mucin

171
Q

What is the process of sterile peritonitis

A

Leakage of bile or pancreatic enzymes into the peritoneal cavity

172
Q

What is the complication seen with perforation or rupture of the biliary system

A

Irritating peritonitis, complicated by bacterial superinfections

173
Q

What is occurring with an acute hemorrhagic pancreatitis

A

Leakage of pancreatic enzymes and fat necrosis

174
Q

What is a ruptured Desmond cysts leakage of chemical

A

Release of keratins and resulting granulomatous reaction

175
Q

Spontaneous bacterial peritonitis develops in which patients

A

Cirrhosis, ascities, and children with nephrotic syndome

176
Q

Sclerosing retroperitonitis aka Ormond disease is caused by what

A

Ig4

177
Q

What is the most common tumor of the peritoneal lining

A

Desmoplastic small round cell

178
Q

What are the tumors of the peritoneal lining characterized by with regards to translocations and gene

A

t(11;22)(p13;q12)

Fusion of EWS and WT1

Robbins Pathology GI (Chptr 16,17,18,19) (32 decks)

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