Flashcards in Bowel Path IV Deck (53):
1
lymphoid polyp
non-neoplastic
2
adenoma
adenomatous polyp
neoplastic
3
most common adenoma
tubular adenoma - small and pedunculated
4
greater than 4cm diameter polyp
40% chance contain foci of cancer
5
epithelial dysplasia
in adenoma
is pre-malignant
6
tubular adenoma
neoplastic
pedunculated
velvety surface
have small round tubular glands
7
villous adenomas
larger and sessile - covered in villi
8
sessile serrated adenomas
like hyperplastic polyp
-but more common in right colon
9
hyperplastic polyp vs. sessile serrated adenoma
serrated architecture throughout in a sessile serrated adenoma
-also in right colon
only on surface of hyperplastic polyp
10
malignant risk
larger polyp
more epithelial dysplasia
villous > tubular
11
APC/WNT pathway
typical adenocarcinoma of colon
both familial and sporadic colon cancer
12
FAP
100% patients get colon cancer if don't do anything hundreds to thousands of polyps
13
microsatellite instability
mutation of MSH2 or MLH1 gene result in loss of enzymes in repair of damaged DNA - accumulation of microsatellite repeats
-mutation in TGF-beta receptor
-BAX genes
-BRAF gene
seen with HNPCC
-MLH1 and MSH2
14
familial adenomatous polyposis
auto dominant
-500-2500 colon polyps
colon cancer in 100% by age 30
most have APC gene defect, some MYH
15
HNPCC
lynch syndrome
hereditary non-polyposis colorectal cancer
auto dom
colon ca at young age
right sided and mucinous
microsatellite instability due to mismatch repair gene defect
16
CHRPE
congeintal hyperplasia of retinal pigmented epithelium
newborn with FAP
1st indication of mutation
17
colon carcinoma
common
clinical sx - mild abdominal discomfort, fatigue, weight loss, anemia
elevated CEA
with strep bovis
majority left sided
diet, smoking, alcohol, adenoma hx, black, older age
18
iron deficiency anemia in older man or postmenopausal woman
GI cancer - unless proven otherwise
19
path of colon carcinoma
requires multiple hits
two pathways:
-classic -APC/beta catenin - majority
-microsatellite instability - DNA mismatch repair defect
20
microsatellite instability
DNA mismatch repair defect
in colon carcinoma
21
majority of colorectal neoplasias
sporadic 97%
familial 3%
22
napkin ring lesion
colorectal carcinoma
typically left sided
aka apple core lesion
23
regional lymph nodes of colon
in pericolonic fat
24
VEGF
induces vessels to tumor
25
hard node
cancer
26
colon carcinoma mets
lymph node, lung, liver
27
dukes criteria
for level of invasion of colorectal carcinoma
28
T-IS
in situ
29
T1
no muscularis
30
T3
to serosa
31
T4
to adjacent organ
32
T2
to muscularis
33
staging of colorectal carcinoma
T - tumor
N - nodes
M - mets
34
stage 1 and 2
no nodes, no mets
35
stage 3
nodes, no mets
36
stage 4
nodes and mets
37
screening for colorectal cancer
after age 50yo - colonoscopy every 10 years is gold standard
38
carcinoid tumor of small bowel
neuroendocrine origin
mostly distal in ileum
malignant
39
adenomas and adenocarcinomas of small bowel
mostly in duodenum - proximal
40
carcinoid tumor
well differentiated neuroendocrine carcinoma
foregut - rarely met
midgut - often met and aggresive
hindgut - incidental finding
secrete - serotonin**
41
severe episodic skin flushing, diarrhea, cramping, asthma, tricuspid valve insufficiency
carcinoid tumor
42
serotonin secretion
carcinoid tumor
43
salt and pepper pattern of tumor
carcinoid tumor
cytoplasmic dense neurosecretory granules
44
vermiform appendix
in cecum - lymphoid rich
no known function
blind end tube attached to cecum
45
acute appendicitis
peri-umbilical pain - localizes to RLQ - mcburney
N/V
abdominal tenderness, rebound
mild fever
leukocytosis
exploratory laparoscopy outweighs risk of appendix perforation
46
fecalith
hard stool in appendix
-can cause inflammation and appendicitis
47
tumors of appendix
mostly carcinoid
48
mucocele and pseudomyxoma pertonei
tumor of appendix secreting mucin to abdominal cavity
jelly belly
49
jelly belly
mucin in abdominal cavity
-with tumor of appendix
mucocele and pseudomyxoma peritonei
50
peritonitis
bile leak, pancreatic enzymes, foreign material, endometriosis, ruptured dermoid cyst, perforation
51
bacterial peritonitis
may be fatal or heal with adhesions
e. coli, pneumococcus
52
mesothelioma
malignant tumor of peritoneal cavity
with asbestos exposure
53