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Flashcards in Bowel Path III Deck (54):
1

tropical sprue

developing countries

bacterial overgrwoth of cyclospora, e coli, hemophilis

physical and neuro deficits

tx with broad antibiotics usually unsuccessful

2

autoimmune enteropathy

x-linked disorder

persistant diarrhea
-young children

IPEX- foxp3 mutation - defective CD4

3

foxp3 mutation

IPEX - defective CD4

with autoimmune enteropathy

4

lactase deficiency

congeintal - rare - auto recessive

acquired - with infection

histo bx is unremarkable

osmotic diarrhea**

avoid milk products - may resolve over time

aka disaccharidase deficiency

5

abetalipoproteinemia

rare auto recessive
-presents at infancy

-failure to thrive, diarrhea, steatorrhea

-MTP mutation

failure of transepithelial transport of lipids

see lipid vacuolization of epithelium**

6

lack of apolipoprotein B48 and B100

abetalipoproteinemia - cannot transport lipids across epithelium

malabsorption of fat soluble vits

7

acanthocytosis

abnormal star shaped RBCs

burr cells

in abetalipoproteinemia

8

abetalipoproteimia

degeneration of retina - Vit A

neuropathies - vit E

genetic test - necessary for diagnosis

9

chronic relapsing abdominal pain, bloating, changes in bowel habits

IBS - syndrome

clinical diagnosis**

10

IBS

clinical diagnosis
-20-40yo F

clinical criteria:
-abdomen pain 3 days per month over 3 months
-improvement with defecation
-change in stool frequency or form

avoid surgery**

11

IBD

crohn and ulcerative colitis

altered mucosal immunity

12

ulcerative colitis

limited to colon and rectum and only to mucosa/submucosa

13

crohn disease

transmural - and any part of GI tract

14

noncaseating granuloma in mouth

crohn until proven otherwise

15

IBD path

abnormal T cell response
-CD4 T cells - Th17

16

pANCA

in ulcerative colitis

17

ASCA

in crohn disease

18

crohn disease

white, jews, females

smoking - risk fx

20-30yo
60-70yo

19

unaffected skip areas, transmural mucosa, noncaseating granulomas, fistula formation

crohn disease

20

creeping fat

crohn disease
-serosal extension of mesenteric fat

21

cobblestone

crohn disease

22

common site of crohn

terminal ileum, ileocecal valve, cecum

has skip lesions

early lesion - aphthous ulcer

23

crohn histo

crypt abscess - with PMNs

mucosal damage

ulceration

transmural

fissure formation

noncaseating granulomas

24

crohn clinical

episodic

mild diarrhea, fever, abdomen pain, weight loss

chronic life long course

fistula - bad

clubbing of fingertips

risk for GI ca - 5-6x

erythema nodosum - shins
-inflammation of fat cells under skin

25

ulcerative colitis

inflammation of colon - mucosa and submucosa

continuous spread proximal from rectum

primary sclerosing cholangitis

26

UC epidemiology

white, female, 20-25yo, smoking may relieve symptoms**

27

UC clinical

relapsing - bloody mucoid diarrhea

-cramping, abdominal pain

at least 1 relapse in 10 years

risk for adenocarcinoma of colon

tx - colectomy

28

UC pathology

continuous - no skip areas
entire colon - pancolitis

ulcerations - pseudopolyps
-chronic

toxic megacolon

29

UC morph

rectum
-goes proximal
-pancolitis
-broad-based ulcers
-regenerating mucosa - pseudopolyps

-normal serosa

no granulomas

30

microscopic colitis

collagenous - old women
lymphocytic - older male and female (assocaited with celiac)

chronic watery diarrhea - 3-20x/day

benign - usually resolves

31

diverticular disease

diverticulosis - and if inflamed - diverticulitis

focal weakness in wall - high pressure - form outpouchings

tx - high fiver diet

32

false diverticula

acquired - most common sigmoid colon

33

bleeding of diverticuli

often stops on own

34

second most common killer in US

tumors of colon

majority old age - 50+ yo

35

small elevation of mucosa

sessile

36

growth with a stalk

pedunculated

core with vessels and lymphatics

easily removed

37

most common neoplastic polyp

adenoma
-potential to progress to cancer

38

hamartomatous polyp

almost always pednuculated

juvenile and peutz-jeghers
-non-neoplastic

39

adenoma

majority sessile

40

non-neoplastic polyps

inflammatory
hyperplastic
hamartomatous
lymphoid

41

inflammatory polyp

non-neoplastic
-chronic IBD - often UC

part of solitary rectal ulcer syndrome

42

solitary rectal ulcer syndrome

inflammatory lesion
-rectal bleeding, mucous discharge, inflammation lesion of anterior rectal wall

impaired relaxation of anorectal sphincter - abrasion and ulceration

mucosal prolapse can occur

fibromuscular hyperplasia

43

hyperplastic polyp

non-neoplastic

sessile

most common polyp

majority 50yo

44

strain with stooling

push against anterior rectum/anus - mucosa prolapse that becomes inflamed

solitary rectal ulcer syndrome - inflammatory polyp

anterior**

45

serrated, saw tooth glands in polyp

hyperplastic polyp

non-neoplastic

no malignant potential

must distinguish from serrated adenoma**

46

peutz jeghers syndrome

hamartomatous polyp

age 10-15

mutation in STK11 - AMP kinase related pathway

risk of colonic adenocarcinoma

47

juvenile polyposis

hamartomatous polyp

less than age 5 SMAD4, BMPR1A TGF-beta signaling mutations

risk of gastric small intestinal, colonic, and pancreatic carcinoma

association with congenital malformations

48

familial adenomatous polyposis mutation

APC

49

hamartomatous polyps of stomach, small intestine, colorectum that are like juvenile polyps with cystic crypt dilatation and lamina propria edema and inflammation

cronkhite-canada syndrome

nonhereditary - individuals over 50yo get it

often die**

50

juvenile polyp

retention polyp
-young <5yo
-pedunculated
-rectum
-bleeding occurs

-sporadic solitary majority
-auto dom - many polyps - this group has risk of cancer

dilated glands and cysts in lamina propria

cystically dilated crypts

SMAD4, BMPR1A TGF-beta signaling pathway

51

peutz jeghers polyp

rare auto dom - 10-15yo

pigmented mucocutaneous macules

increased risk of multiple malignancies

pedunculated GI polyps

splayed smooth m in polyp

52

pigmented lesions on lips

petuz jeghers syndrome

53

loss of STK11 kinase tumor suppressor gene

AMP-kinase related

peutz jeghers syndrome

54

glandular polyp with smooth muscle

peutz jeghers syndrome