EXAM #1: SMALL BOWEL PATHOLOGY Flashcards Preview

Gastrointestinal System > EXAM #1: SMALL BOWEL PATHOLOGY > Flashcards

Flashcards in EXAM #1: SMALL BOWEL PATHOLOGY Deck (43):
1

What is the definition of IBD?

Inflammatory Bowel Disease

2

What two diseases comprise IBD?

Crohn's Disease
Ulcerative Colitis

3

What is the postulated etiology of IBD?

Abnormal immune response to gut flora

4

What lymophocyte is implicated as the "prime culprit" in IBD?

T-cells; there is an impairment of T-cell downregulation

5

What antibody is helpful in diagnosis of UC?

ANCA

6

What antibody is helpful in diagnosing Chron's Disease?

ASCA

7

In addition to T-cell dysregulation, what pathogenic feature is associated with CD?

Chronic Delayed Hypersensitivity

8

In addition to T-cell dysregulation, what pathogenic feature is associated with UC?

Excessive Th2 stimulation

9

What part of the GI tract is involved in Chron's Disease? What is least common?

Any region from "mouth to anus," but most commonly the terminal ileum

(Rectum is least common)

10

What are the hallmark symptoms of Chron's Disease?

- Intermittent diarrhea (non-bloody)
- Right lower quadrant abdominal pain
- Fever

11

How many walls of the bowel are involved in Chron's Disease?

ALL-- i.e. this is "transmural" or full thickness inflammation of the bowel

12

What type of inflammation is associated with Chron's Disease?

Lymphoid aggregates with granulomas

13

Describe the gross appearance of Chron's Disease?

1) Skip lesions
2) Cobblestone mucosa (healing)
4) Rubber hose sign (fibrosis causing thickening of bowel wall)
5) Creeping fat (pulling in of mesenteric fat with fibrosis)

14

What is a string sign? What disease is this associated with?

In Chron's Disease, narrowing of the lumen due to fibrosis causes the appearance of a "string" on barium study

15

What are the major complications of Chron's Disease?

1) Malabsorption and nutritional deficiency
2) Calcium oxalate nephrolithiasis
3) Fistula formation
4) Carcinoma

16

What are the extraintesintal manifestations associated with Chron's Disease?

- Arthritis
- Erythema nodosum
- Uveitis

17

What types of arthritis are associated with Chron's Disease?

1) Peripheral joint
2) Ankylosing spondyliitis
3) Migratory polyarthritis

18

What is the relationship between smoking and Chron's Disease?

Smoking INCREASES risk for Chron's

19

Where is the inflammation localized in Ulceractive Colitis?

Mucosa/ Submucosa

20

How does Ulceractive Colitis differ from Chron's?

1) Extends in a cont. fashion i.e. NO SKIP LESIONS
2) NO granulomas
3) Thinning, not a thickening of the bowel
4) Involves all of the "tube"

21

What are the clinical features of Ulceractive Colitis?

1) Bloody mucoid diarrhea
2) Left lower quadrant abdominal pain relieved by defecation

22

What is pancolitis?

Involvement of the entire colon in Ulceractive Colitis

23

What is backwash ileitis?

Inflammation of the distal ileum in UC due to "backwash" of cecal contents

24

What are the major complications of Ulceractive Colitis?

1) Toxic megacolon
2) Perforation
3) Carcinoma

25

What are the class gross features of Ulcerative Colitis?

- Pseudopolyps
- Loss of haustra

26

What is a pseuodpolyp seen in Ulceractive Colitis?

Bumps on the surface of the bowel in UC--represents areas of healing

27

What radiologic sign is associated with UC?

Lead pipe sign on X-ray

****This represents the loss of haustra i.e. a smooth tube seen on X-ray****

28

What extraintestinal manifestation is associated with UC?

Primary sclerosing cholangitis (Disease/ blockage of the bile ducts due to fibrosis)

29

What are the two main factors that determine the progression of UC to carcinoma?

1) Extent of colonic involvement
2) Duration of disease (greater than 10 years= high risk)

30

What is the relationship between smoking and UC?

Smoking is PROTECTIVE against UC

31

What type of inflammation is seen in UC?

Crypt abscess formation i.e. neutrophilic infiltration colonic "crypts" i.e. glands

32

What is Ischemic Bowel Disease?

Ischemic damage the colon due to occlusion of the mesenteric vessels

33

Where is the bowel most likely to become ischemic?

Watershed areas:
1) Splenic flexure
2) Rectosigmoid

34

What vessels meet at the splenic flexure?

SMA and IMA

35

What vessels meet at the rectosigmoid flexure?

IMA
Hypogastric

36

What are the causes of Ischemia Bowel Disease?

1) Atherosclerosis/ thrombosis
2) Arterial embolism
3) Low flow states (CHF)
4) Venous thrombosis from hypercoaguability

37

What typically causes transmural infarction of the bowel?

Acute vascular obstruction

38

What typically causes mural and mucosal infarction?

Hypoperfusion

39

What artery is most commonly occluded in a transmural infarction?

SMA (typically due to atherosclerosis)

40

What is the clinical picture of a patient with a transmural infarction of the bowel?

1) Older adult
2) Acute abdomen
3) Rapid progression to shock

100% mortality if NOT treated early

41

What is the major complication of chronic bowel ischemia?

Stricture leading to obstruction

42

What is angiodysplasia?

Vascular dilation and malformation of submucosal or mucosal blood vessels in cecum and ascending colon

43

What is the predominant symptom associated with angiodysplasia?

Significant hematochezia (due to rupture)