Bowel Path III

Question 1

tropical sprue

Answer 1

developing countries

bacterial overgrwoth of cyclospora, e coli, hemophilis

physical and neuro deficits

tx with broad antibiotics usually unsuccessful

Question 2

autoimmune enteropathy

Answer 2

x-linked disorder

persistant diarrhea
-young children

IPEX- foxp3 mutation - defective CD4

Question 3

foxp3 mutation

Answer 3

IPEX - defective CD4

with autoimmune enteropathy

Question 4

lactase deficiency

Answer 4

congeintal - rare - auto recessive

acquired - with infection

histo bx is unremarkable

osmotic diarrhea**

avoid milk products - may resolve over time

aka disaccharidase deficiency

Question 5

abetalipoproteinemia

Answer 5

rare auto recessive
-presents at infancy

• failure to thrive, diarrhea, steatorrhea
• MTP mutation

failure of transepithelial transport of lipids

see lipid vacuolization of epithelium**

Question 6

lack of apolipoprotein B48 and B100

Answer 6

abetalipoproteinemia - cannot transport lipids across epithelium

malabsorption of fat soluble vits

Question 7

acanthocytosis

Answer 7

abnormal star shaped RBCs

burr cells

in abetalipoproteinemia

Question 8

abetalipoproteimia

Answer 8

degeneration of retina - Vit A

neuropathies - vit E

genetic test - necessary for diagnosis

Question 9

chronic relapsing abdominal pain, bloating, changes in bowel habits

Answer 9

IBS - syndrome

clinical diagnosis**

Question 10

IBS

Answer 10

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**

Question 11

IBD

Answer 11

crohn and ulcerative colitis

altered mucosal immunity

Question 12

ulcerative colitis

Answer 12

limited to colon and rectum and only to mucosa/submucosa

Question 13

crohn disease

Answer 13

transmural - and any part of GI tract

Question 14

noncaseating granuloma in mouth

Answer 14

crohn until proven otherwise

Question 15

IBD path

Answer 15

abnormal T cell response

-CD4 T cells - Th17

Question 16

pANCA

Answer 16

in ulcerative colitis

Question 17

ASCA

Answer 17

in crohn disease

Question 18

crohn disease

Answer 18

white, jews, females

smoking - risk fx

20-30yo
60-70yo

Question 19

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

Answer 19

crohn disease

Question 20

creeping fat

Answer 20

crohn disease

-serosal extension of mesenteric fat

Question 21

cobblestone

Answer 21

crohn disease

Question 22

common site of crohn

Answer 22

terminal ileum, ileocecal valve, cecum

has skip lesions

early lesion - aphthous ulcer

Question 23

crohn histo

Answer 23

crypt abscess - with PMNs

mucosal damage

ulceration

transmural

fissure formation

noncaseating granulomas

Question 24

crohn clinical

Answer 24

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

Question 25

ulcerative colitis

Answer 25

inflammation of colon - mucosa and submucosa continuous spread proximal from rectum primary sclerosing cholangitis

Question 26

UC epidemiology

Answer 26

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

Question 27

UC clinical

Answer 27

relapsing - bloody mucoid diarrhea -cramping, abdominal pain at least 1 relapse in 10 years risk for adenocarcinoma of colon tx - colectomy

Question 28

UC pathology

Answer 28

continuous - no skip areas entire colon - pancolitis ulcerations - pseudopolyps -chronic toxic megacolon

Question 29

UC morph

Answer 29

rectum - goes proximal - pancolitis - broad-based ulcers - regenerating mucosa - pseudopolyps -normal serosa no granulomas

Question 30

microscopic colitis

Answer 30

collagenous - old women lymphocytic - older male and female (assocaited with celiac) chronic watery diarrhea - 3-20x/day benign - usually resolves

Question 31

diverticular disease

Answer 31

diverticulosis - and if inflamed - diverticulitis focal weakness in wall - high pressure - form outpouchings tx - high fiver diet

Question 32

false diverticula

Answer 32

acquired - most common sigmoid colon

Question 33

bleeding of diverticuli

Answer 33

often stops on own

Question 34

second most common killer in US

Answer 34

tumors of colon majority old age - 50+ yo

Question 35

small elevation of mucosa

Answer 35

sessile

Question 36

growth with a stalk

Answer 36

pedunculated core with vessels and lymphatics easily removed

Question 37

most common neoplastic polyp

Answer 37

adenoma | -potential to progress to cancer

Question 38

hamartomatous polyp

Answer 38

almost always pednuculated juvenile and peutz-jeghers -non-neoplastic

Question 39

adenoma

Answer 39

majority sessile

Question 40

non-neoplastic polyps

Answer 40

inflammatory hyperplastic hamartomatous lymphoid

Question 41

inflammatory polyp

Answer 41

non-neoplastic -chronic IBD - often UC part of solitary rectal ulcer syndrome

Question 42

solitary rectal ulcer syndrome

Answer 42

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

Question 43

hyperplastic polyp

Answer 43

non-neoplastic sessile most common polyp majority 50yo

Question 44

strain with stooling

Answer 44

push against anterior rectum/anus - mucosa prolapse that becomes inflamed solitary rectal ulcer syndrome - inflammatory polyp anterior**

Question 45

serrated, saw tooth glands in polyp

Answer 45

hyperplastic polyp non-neoplastic no malignant potential must distinguish from serrated adenoma**

Question 46

peutz jeghers syndrome

Answer 46

hamartomatous polyp age 10-15 mutation in STK11 - AMP kinase related pathway risk of colonic adenocarcinoma

Question 47

juvenile polyposis

Answer 47

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

Question 48

familial adenomatous polyposis mutation

Answer 48

APC

Question 49

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

Answer 49

cronkhite-canada syndrome nonhereditary - individuals over 50yo get it often die**

Question 50

juvenile polyp

Answer 50

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

Question 51

peutz jeghers polyp

Answer 51

rare auto dom - 10-15yo pigmented mucocutaneous macules increased risk of multiple malignancies pedunculated GI polyps splayed smooth m in polyp

Question 52

pigmented lesions on lips

Answer 52

petuz jeghers syndrome

Question 53

loss of STK11 kinase tumor suppressor gene

Answer 53

AMP-kinase related peutz jeghers syndrome

Question 54

glandular polyp with smooth muscle

Answer 54

peutz jeghers syndrome