Bowel Path IV Flashcards Preview

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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

tumors in peritoneal cavity

majority secondary to mets - ovary, pancreas, GI