Bowel Path IV

Question 1

lymphoid polyp

Answer 1

non-neoplastic

Question 2

adenoma

Answer 2

adenomatous polyp

neoplastic

Question 3

most common adenoma

Answer 3

tubular adenoma - small and pedunculated

Question 4

greater than 4cm diameter polyp

Answer 4

40% chance contain foci of cancer

Question 5

epithelial dysplasia

Answer 5

in adenoma

is pre-malignant

Question 6

tubular adenoma

Answer 6

neoplastic

pedunculated

velvety surface

have small round tubular glands

Question 7

villous adenomas

Answer 7

larger and sessile - covered in villi

Question 8

sessile serrated adenomas

Answer 8

like hyperplastic polyp

-but more common in right colon

Question 9

hyperplastic polyp vs. sessile serrated adenoma

Answer 9

serrated architecture throughout in a sessile serrated adenoma
-also in right colon

only on surface of hyperplastic polyp

Question 10

malignant risk

Answer 10

larger polyp
more epithelial dysplasia
villous > tubular

Question 11

APC/WNT pathway

Answer 11

typical adenocarcinoma of colon

both familial and sporadic colon cancer

Question 12

FAP

Answer 12

100% patients get colon cancer if don’t do anything hundreds to thousands of polyps

Question 13

microsatellite instability

Answer 13

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

Question 14

familial adenomatous polyposis

Answer 14

auto dominant
-500-2500 colon polyps

colon cancer in 100% by age 30

most have APC gene defect, some MYH

Question 15

HNPCC

Answer 15

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

Question 16

CHRPE

Answer 16

congeintal hyperplasia of retinal pigmented epithelium

newborn with FAP

1st indication of mutation

Question 17

colon carcinoma

Answer 17

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

Question 18

iron deficiency anemia in older man or postmenopausal woman

Answer 18

GI cancer - unless proven otherwise

Question 19

path of colon carcinoma

Answer 19

requires multiple hits

two pathways:

• classic -APC/beta catenin - majority
• microsatellite instability - DNA mismatch repair defect

Question 20

microsatellite instability

Answer 20

DNA mismatch repair defect

in colon carcinoma

Question 21

majority of colorectal neoplasias

Answer 21

sporadic 97%

familial 3%

Question 22

napkin ring lesion

Answer 22

colorectal carcinoma

typically left sided

aka apple core lesion

Question 23

regional lymph nodes of colon

Answer 23

in pericolonic fat

Question 24

VEGF

Answer 24

induces vessels to tumor

Question 25

hard node

Answer 25

cancer

Question 26

colon carcinoma mets

Answer 26

lymph node, lung, liver

Question 27

dukes criteria

Answer 27

for level of invasion of colorectal carcinoma

Question 28

T-IS

Answer 28

in situ

Question 29

T1

Answer 29

no muscularis

Question 30

T3

Answer 30

to serosa

Question 31

T4

Answer 31

to adjacent organ

Question 32

T2

Answer 32

to muscularis

Question 33

staging of colorectal carcinoma

Answer 33

T - tumor N - nodes M - mets

Question 34

stage 1 and 2

Answer 34

no nodes, no mets

Question 35

stage 3

Answer 35

nodes, no mets

Question 36

stage 4

Answer 36

nodes and mets

Question 37

screening for colorectal cancer

Answer 37

after age 50yo - colonoscopy every 10 years is gold standard

Question 38

carcinoid tumor of small bowel

Answer 38

neuroendocrine origin mostly distal in ileum malignant

Question 39

adenomas and adenocarcinomas of small bowel

Answer 39

mostly in duodenum - proximal

Question 40

carcinoid tumor

Answer 40

well differentiated neuroendocrine carcinoma foregut - rarely met midgut - often met and aggresive hindgut - incidental finding secrete - serotonin**

Question 41

severe episodic skin flushing, diarrhea, cramping, asthma, tricuspid valve insufficiency

Answer 41

carcinoid tumor

Question 42

serotonin secretion

Answer 42

carcinoid tumor

Question 43

salt and pepper pattern of tumor

Answer 43

carcinoid tumor cytoplasmic dense neurosecretory granules

Question 44

vermiform appendix

Answer 44

in cecum - lymphoid rich no known function blind end tube attached to cecum

Question 45

acute appendicitis

Answer 45

peri-umbilical pain - localizes to RLQ - mcburney N/V abdominal tenderness, rebound mild fever leukocytosis exploratory laparoscopy outweighs risk of appendix perforation

Question 46

fecalith

Answer 46

hard stool in appendix | -can cause inflammation and appendicitis

Question 47

tumors of appendix

Answer 47

mostly carcinoid

Question 48

mucocele and pseudomyxoma pertonei

Answer 48

tumor of appendix secreting mucin to abdominal cavity jelly belly

Question 49

jelly belly

Answer 49

mucin in abdominal cavity -with tumor of appendix mucocele and pseudomyxoma peritonei

Question 50

peritonitis

Answer 50

bile leak, pancreatic enzymes, foreign material, endometriosis, ruptured dermoid cyst, perforation

Question 51

bacterial peritonitis

Answer 51

may be fatal or heal with adhesions e. coli, pneumococcus

Question 52

mesothelioma

Answer 52

malignant tumor of peritoneal cavity with asbestos exposure

Question 53

tumors in peritoneal cavity

Answer 53

majority secondary to mets - ovary, pancreas, GI