Gastrointestinal Pathology_2 Flashcards Preview

► Med Notes > Gastrointestinal Pathology_2 > Flashcards

Flashcards in Gastrointestinal Pathology_2 Deck (211):
1

what is the morphology seen in necrotizing enterocolitis?

terminal ileum and ascending colon (gas in intestinal walls- radiology)

2

what are the clinical features of necrotizing enterocolitis?

mild GI disturbance or as a fulminant illness with intestinal gangrene, perforation, sepsis, shock

3

what is collagen EC?

when patches of band like collagen deposits under the surface epithelium, common in middle aged and older women

4

what is the gender prevalence of collagen EC?

W>M

5

what happens in lymphocytic EC?

intraepithelial infiltrate

6

what is the gender prevalence of lymphocytic EC?

M=F

7

what are the clinical features of both collagen and lymphocytic EC?

- endoscopy= normal • - radiology= unremarkable • - clinically= chronic watery diarrhea • - clinical course= benign in nature

8

what is another name for neutropenic colitis?

typhilitis

9

what happens in neutropenic colitis?

acute inflammatory destruction of the mucosa

10

what is an important cause of neutropenic colitis?

compromised blood flow

11

what is the site of neutropenic colitis?

cecal region

12

what is the pathogenesis of neutropenic colitis?

impaired mucosal immunity

13

how dangerous is Neutropenic colitis?

life threatening

14

what are the features of solitary rectal ulcer syndrome?

- inflammation of the rectum • - impaired relaxation and sharp angulation of the anterior rectal shelf • - inflammatory polyp

15

what is the characteristic triad associated with solitary rectal ulcer syndrome?

1. rectal bleeding • 2. mucus discharge from the anus • 3. superficial ulceration of the anterior rectal wall

16

what are the intestinal malabsorption syndromes?

celiac sprue • tropical sprue • Whipple disease • disaccharidase deficiency

17

malabsorption syndromes are characterized by what?

deficient absorption of fat, protein, carbohydrates, electrolytes, minerals, fat soluble vitamins, water • --> vitamin deficiency, tetani

18

malabsorption syndromes are caused by what?

- deficient digestion (biliary-pancreatic disease) • - deficient absorption (small intestinal disease)

19

what are the clinical findings in malabsorption syndromes?

weight loss • flatulence • diarrhea with bulky, frothy, greasy stools

20

what happens in prolonged cases of malabsorption?

anemia • petechiae • hemorrhages • dermatitis • bone aches • latent tetany • menstrual disturbance • impotence • infertility

21

what are the common causes of malabsorption?

celiac sprue • chronic pancreatitis • Crohn's • tropical sprue • Whipple's • bacterial overgrowth • disaccharidase deficiency • abetalipoproteinemia

22

what is the geographic distribution of tropical vs celiac sprue?

tropical= tropics and travelers • celiac= caucasian

23

what is the etiology of tropical vs celiac sprue?

1. tropical= ?infection (E coli, Hemophilus) • 2. celiac= diet: gluten--> gliadins

24

what is the site of involvement in tropical vs celiac sprue?

tropical= all levels of small intestine • celiac= proximal small intestine (duodenum, proximal jejunum)

25

what is the clinical presentation of tropical vs celiac sprue?

1. tropical= symptoms after acute diarrheal episode • 2. celiac= after gluten diet

26

what is the treatment for tropical vs celiac sprue?

tropical= antibiotic • celiac= gluten free diet

27

what is the ris of malignancy in tropical vs celiac sprue?

tropical= no risk • celiac= yes increased risk

28

how common is Whipple's disease?

rare systemic disease

29

what does Whipple's disease involve?

intestines • joints • CNS

30

Whipple's disease is caused by what?

Gram-positive actinomycetes Tropheryma Whippelii

31

who is affected by whipple's disease?

white males (M:F=10:1), 30-50yrs

32

what are the hallmark features of Whipple's disease?

distended macrophages in lamina propria contain PAS (+) granules • - tiny rod shaped bacilli in EM

33

what are the clinical features of Whipple's disease?

malabsorption syndrome • fever • joint pains • cardiac and neurologic S&S • weight loss

34

what is the most common presenting feature of Whipple's disease?

weight loss

35

what is the Rx for Whipple's disease?

broad spectrum antibiotic therapy

36

what is disaccharidase?

apical membrane enzyme that cleaves lactose

37

what happens in disaccharidase deficiency?

leads to accumulation of lactose in the gut lumen, exerting an osmotic purgative effect--> diarrhea and malabsorption

38

what is the presentation of the congenital forms of disaccharide deficiency?

infants on exposure to milk or milk products

39

what is the most common presentation of disaccharide deficiency?

acquired form

40

what are the features of the acquired form of disaccharidase deficiency?

more common • affects adults • blacks>white

41

what are the features of intestinal mucosa in disaccharidase deficiency?

no morphologic abnormalities

42

what is abetalipoproteinemia?

congenital deficiency of betalipoprotein which is required for intestinal transport of chylomicrons

43

what happens in abetalipoproteinemia?

the inability to synthesize apoprotein (required to assemble lipoproteins) by the enterocytes leads to accumulation of TG's in the cells, with lipid vacuolation

44

abetalipoproteinemia results in what?

marked lowering of serum LDL, VLDL, and chylomicrons--> defective lipid-membranes of cells (including RBC)--> acanthocytic RBC (burr cells) and widespread cell injury

45

how does abetalipoproteinemia present?

in infancy with malabsorption and wasting

46

what are the idiopathic inflammatory bowel diseases?

Crohn's disease • Ulcerative colitis

47

What are idiopatchic inflammatory bowel diseases characterized by?

a chronic relapsing inflammatory condition

48

what is the etiology of idopathic inflammatory bowel disease?

unknown

49

speculations as to the etiology of idopathic inflammatory bowel disease include what?

genetic factors • unknown infectious agents • special susceptibility factors • altered immuno-reactivity to dietary or infectious antigens and altered regulatory controls of the inflammatory responses

50

what are the 2 clinicopathologic entities into which idiopathic inflammatory bowel disease are distinguished?

Crohn's disease (CD) • Ulcerative Colitis (UC)

51

what is Crohn's disease?

transmural granulomatous inflammation of the bowel, with mucosal ulcerations, fissures and fistulas in young white females

52

skip lesions (cobblestone appearance) are characteristic of which idiopathic inflammatory bowel disease?

CD

53

what are the features of UC?

crypt abscesses, pseudopolyps & increased risk of carcinoma (adenocarcinoma)

54

is there gross blood in the stool in UC vs CD?

UC= Yes • CD= Occasionally

55

is there mucus in UC vs CD?

UC= Yes • CD= Occasionally

56

how often are there systemic symptoms in UC vs CD?

UC= Occasionally • CD= Frequently

57

how often is there pain in UC vs CD?

UC= Occasionally • CD= Frequently

58

is there abdominal mass present in UC vs CD?

UC= rarely • CD= Yes

59

is there significant perineal disease in UC vs CD?

UC: no • CD: Frequently

60

are there fistulas in UC vs CD?

UC: No • CD: Yes

61

is there small intestinal obstruction in UC vs CD?

UC: no • CD: Frequently

62

is there colonic obstruction in UC vs CD?

UC: rarely • CD: Frequently

63

is there response to antibiotics in UC vs CD?

UC: no • CD: yes

64

is there recurrence after surgery in UC vs CD?

UC: No • CD: Yes

65

is there ANCA-positive result in UC vs CD?

UC: Frequently • CD: Rarely

66

What are the endoscopic features of Ulcerative Colitis?

1. Rectal Sparing: rarely • 2. Continuous disease: Yes • 3. Cobblestoning: No • 4. Granuloma on biopsy: No

67

what are the endoscopic features of Crohn's disease?

1. Rectal sparing: frequently • 2. Continuous disease: Occasionally • 3. Cobblestoning: Yes • 4. Granulomas on biopsy: Occasionally

68

what are the radiographic features of Ulcerative Colitis?

1. Small bowel significantly abnormal: No • 2. Abnormal terminal ileum: Occasionally • 3. Segmental Colitis: No • 4. Asymmetrical Colitis: No • 5. Stricture: Occasionally

69

what are the radiographic features of Crohn's disease?

1. Small bowel significantly abnormal: Yes • 2. Abnormal terminal ileum: yes • 3. Segmental Colitis: yes • 4. asymmetrical colitis: yes • 5. Stricture: frequently

70

what are the microscopic features of CD?

Fissuring Ulcer • Noncaseating Granuloma

71

what are the morphologic features of UC?

pseudopolyp • Ulcer

72

what are the intestinal vascular disorders?

1. ischemic bowel diseases • 2. angiodysplasia • 3. hemorrhoids

73

what is the extent of transmural ischemic bowel disease?

all layers

74

what is the extent of Mural/Mucosal ischemic bowel disease?

mucosa& submucosa

75

what is the cause of transmural ischemic bowel disease?

compression/obstruction

76

what is the cause of mural/mucosal ischemic bowel disease?

hypoperfusion

77

what types of thrombus are associated with ischemic bowel disease?

Transmural: • - arterial (common) • - venous

78

what vessels are associated with transmural ischemic bowel disease?

SMA>IMA

79

is gangrene associated with transmural ischemic bowel disease?

yes

80

is gangrene associated with mural/mucosal ischemic bowel disease?

no

81

is perforation associated with transmural ischemic bowel disease?

yes

82

is perforation associated with mural/mucosal ischemic bowel disease?

no

83

what is the mortality rate associated with transmural ischemic bowel disease?

50-75%

84

what is the mortality rate associated with mural/mucosal ischemic bowel disease?

very less

85

what is the differential diagnosis for transmural ischemic bowel disease?

acute abdomen

86

what is the differential diagnosis for mural/mucosal ischemic bowel disease?

enterocolitis • IBD

87

what is angiodysplasia?

tortuous dilated submucosal veins in the cecum

88

angiodysplasia may cause what?

massive bleeding

89

angiodysplasia occurs when?

in old age

90

what are hemorrhoids?

dilated varicose veins of the perianal plexus

91

what is the incidence of hemorrhoids?

affects 5% of adults

92

hemorrhoids are due to what?

chronic constipation, pregnancy, liver cirrhosis

93

what are the 2 types of hemorrhoids that can occur singly or together?

External • Internal

94

what perianal plexus is associated with internal hemorrhoids?

superior hemorrhoidal plexus

95

what perianal plexus is associated with external hemorrhoids?

inferior hemorrhoidal plexus

96

which type of hemorrhoids are painful?

external

97

what is diverticular disease?

multiple flask-like outpouchings

98

what is the age group affected by diverticular disease?

>60yr

99

diverticular disease is characterized by what?

protruding into the appendices epiploicae, in the distal colon • - they are lined by mucosa but no muscularis propria

100

diverticular disease is caused by what?

focal anatomic defect in the bowel wall at the site of penetration of blood vessels • - increased intraluminal pressure is a contributory factor (constipation and increased peristalsis)

101

what are the complications of diverticular disease?

bleeding • diverticulitis • pericolic abscess • peritonitis

102

which pathologies involve intestinal obstruction?

hernias • adhesions • intussusceptions • volvulus

103

what is the most common site of intestinal obstruction?

small intestine

104

what are hernias?

protrusion of peritoneal hernial sac into a defect in the abdominal wall (inguinal, femoral, umbilical, surgical scars, retroperitoneal space)

105

what happens when a hernia causes viscera to become trapped?

incarceration • obstruction • strangulation

106

what are adhesions?

twisting f bowel loops around peritoneal fibrous bands

107

what causes adhesions?

previous surgery • infection • endometriosis • radiation

108

what is an intussusception?

a segment of the gut telescopes into the distal one

109

what is the cause of intussusception?

may be caused by tumors

110

what is volvulus?

complete twisting of a bowel loop around its mesenteric base

111

what is the most common site of volvulus?

sigmoid colon

112

what are the two types of small intestinal tumors?

adenomas • adenocarcinomas

113

how common are neoplasms of the small intestine?

rare

114

what is the most common benign tumor of the small intestine?

adenoma

115

what is the most common site of benign tumor of the small intestine?

ampulla of Vater

116

what are the complaints associated with benign tumors of the small intestine?

occult blood loss/rarely obstruction orintussusceptions

117

benign tumors of the small intestine are associated with which condition?

familial polyposis

118

what is the clinical course of small intestinal adenoma?

premalignant

119

what is the most common malignant tumor of the small intestine?

adenocarcinoma

120

what is the most common site of malignant tumor of the small intestine?

duodenum

121

what is the clinical presentation of malignant tumors of the small intestine?

intestinal obstruction

122

what is the only sign of small intestinal malignant tumor?

occult blood loss

123

what sign is present if small intestinal malignant tumor involves the ampulla of vater?

cause fluctuating obstructive jaundice

124

what are the risk factors associated with malignant small intestinal tumor?

most tumors - no identifiable factor • - Crohn's • - celiac • - FAP • - HNPCC • - Peutz-Jeghers syndrome

125

what is Peutz-Jeghers syndrome?

autosomal dominant genetic disease characterized by the development of benign hamartomatous polyps in the gastrointestinal tract and hyperpigmented macules on the lips and oral mucosa

126

what are the benign lower intestinal tumors?

1. onneoplastic polyps • 2. adenomas • 3. familial polyps

127

what are the malignant lower intestinal tumors?

1. colorectal carcinoma • 2. carcinoid tumor • 3. GI lymphoma • 4. miscellaneous tumors • 5. anal canal tumors

128

how common are large intestine neoplasms?

common

129

what is the most common benign tumor of the large intestine?

adenoma=polyp

130

what is the most common site of GI polyps?

colon

131

what are the types of large intestine polyps?

1. non-neoplastic: hyperplastic, inflammatory, harmtomatous • 2. neoplastic/adenomatous( tubular, villous, tubulovillus)

132

with what does the malignant risk of adenomatous polyps correlate?

1. polyp size (>4cm) • 2. degree of dysplasia • 3. extent of villous component (more villous= more cancerous)

133

what is the frequency and age associated with non-neoplastic large intestine polyps?

MC (90%) • young people • mostly hyperplastic

134

what is the frequency and age associated with neoplastic large intestine polyps?

only 10% • elderly people • mostly tubular

135

what is the level of dysplasia seen in non neoplastic large intestine polyps?

without dyplasia

136

what is the level of dysplasia seen with neoplastic large intestine polyps?

with dysplasia

137

what is is the mechanism that underlies non-neoplastic large intestine polyps?

production of epithelial cells exceeds their loss

138

what is the mechanism that underlies neoplastic large intestine polyps?

mutations in genes

139

what is the complication associated with non-neoplastic large intestine polyps?

no risk of malignancy

140

what is the complication associated with neoplastic polyps of the large intestine?

premalignant

141

what are the types of neoplasms of the large intestine?

neoplastic or adenomatous (Tubular, Villous, Tubulo-Villous)

142

Are neoplasms of the large intestine true neoplasms?

yes

143

Neoplasms of the large intestine cause what?

occult bleeding, anemia, protein loss, obstruction

144

what is FAP syndrome?

100 polyps and 100% malignant risk

145

what are the features of FAP syndrome?

- Autosomal dominant inheritance • - innumerable polyps (100=1000) in the colon & other parts of the GIT • - 100% risk of progression to adenocarcinoma in 10-15 years (indication for pancolectomy) • - onset in adolescence (bleeding and anemia)

146

What is Gardner's syndrome?

FAP syndrome associated with abnormal dentition, epidermal cysts, desmoid tumors, osteomas, duodenal and thyroid cancers

147

what is Turcot's syndrome?

FAP syndrome associated with CNS gliomas

148

how common is colorectal carcinoma?

one of the most common malignancies

149

what is the peak age for colorectal carcinoma?

60-70yo for sporadic cases • 30-40yo for FAP syndromes

150

where do colorectal carcinomas arise?

preexisting adenomas

151

what is the etiology/pathogenesis of colorectal carcinoma related to?

1 - genetic factors • 2 - Diet: • - rich in carbs and fat • - low in veg, fruit, Vit A,C,E

152

what is the site of colorectal carcinoma?

distal colon

153

what type of tumors are colorectal carcinomas?

all are invasive adenocarcinomas

154

what is the clinical presentation of colorectal carcinoma?

- IDA (occult bleeding) • - abdominal discomfort • - progressive bowel obstruction • - weight loss • - liver metastases

155

what does the prognosis of colorectal carcinoma depend on?

clinical stage

156

what is the staging system for colorectal carcinoma?

Astler-Coller modification of Duke's staging system

157

What are the features of Astler-Coller stage A LI tumors?

limited to mucosa

158

what are the features of Astler-Coller stage B1 LI tumors?

Extending to (not penetrating) muscularis propria; no LN's

159

what are the features of Astler Coller stage B2 LI tumors?

Penetrating the muscularis propria, but with no LN's

160

what are the features of Astler-Coller stage C1 LI tumors?

Extending t (not penetrating) muscularis propria + LN's

161

what are the features of Astler-Coller stage C2 LI tumors?

penetrating through muscularis propria + LN's

162

what are the features of Astler Coller stage D LI tumors?

distant metastatic spread

163

what is the only hope for cure of LI tumors?

surgery

164

what is the prognosis for Astler Coller stage A LI tumors?

100% 5yr

165

what is the prognosis for Astler-Coller stage B1 LI tumors?

65% 5yr

166

what is the prognosis for Astler-Coller stage C1 LI tumors?

45% 5yr

167

what is the prognosis for Astler- Coller stage C2 LI tumors?

25% 5yr

168

what is the most common site of carcinoid Gi tumors?

appendix

169

what fraction of small intestinal malignancies are carcinoid tumors?

02-Jan

170

what is the peak age for carcinoid tumors?

6th decade

171

what do carcinoid tumors do?

arise from neuroendocrine cells and secrete active amines or peptides

172

what happens with a carcinoid tumor secretes gastrin?

Zollinger-Ellison Syndrome

173

what happens when a carcinoid secretes insulin?

hypoglycemia

174

what happens when a carcinoid secretes ACTH?

Cushing's

175

what happens when a carcinoid secretes serotonin?

carcinoid syndrome

176

how often do appendiceal and rectal carcinoids metastasize?

rarely

177

how often do ileal, gastric & colonic carcinoids metastasize?

commonly

178

what is the prognosis for carcinoid GI tumors?

5 years: • - 90% without mets • - 50% with mets

179

What is the implication for carcinoid tumor with liver mets?

will develop carcinoid syndrome

180

what are the pathologies of the appendix?

acute appendicitis • tumors

181

in what age group is acute appendicitis most common?

adolescents and young adults

182

acute appendicitis is characterized by what?

1. obstruction of lumen • 2. raised intraluminal pressure • 3. Ischemic injury and bacterial invasion

183

what is the morphology of acute suppurative appendicitis?

hyperemia • edema • PML infiltration of all layers of all layers of the wall to the peritoneum

184

what is the morphology of acute gangrenous appendicitis?

thrombosis of appendicular vessels--> gangrene--> diffuse septic peritonitis

185

what is the morphology of localized or generalized peritonitis?

when the peritoneum becomes covered by fibrino-purulent exudate

186

what is notable about the clinical features of acute appendicitis in old age?

deceptively minimal

187

what are the complications associated with acute appendicitis?

perforation • pylephlebitis • liver abscess

188

what are the 3 types of tumor of the appendix?

1. mucocele • 2. carcinoid • 3. carcinoma

189

mucocele of the appendix is characterized by what?

distension of the appendiceal lumen by mucinous secretion

190

what is the non-neoplastic cause of mucocele of the appendix?

mucosal hyperplasia

191

what is the benign neoplastic cause of mucocele of the appendix?

mucinous cystadenoma

192

what is the malignant neoplastic cause of mucocele of the appendix?

mucinous cystadenocarcinoma (fatal)

193

what are the complications of mucinous cystadenocarcinoma of the appendix?

may rupture--> peritoneal implants--> produce pseudomyxoma peritonei

194

what is the most common tumor of the appendix?

carcinoid

195

are carcinoid tumors of the appendix malignant or benign?

almost always benign and discovered accidentally on appendectomy (curative)

196

what are the features of carcinoma of the appendix?

adenocarcinomas, identical to their intestinal counterparts

197

what are the types of peritonitis?

1. sterile peritonitis • 2. septic peritonitis • 3. sclerosing retroperitonitis

198

what causes sterile peritonitis?

1. chemical irritation by bile, pancreatic juice, endometriosis (blood) • 2. ruptured ovarian cyst (dermoid) • 3. introduction of chemical substances for diagnostic (laparoscopy, salpingography) or therapeutic procedures (peritoneal dialysis)

199

what causes septic peritonitis?

bacterial infection of the peritoneum from: • - acute appendicitis • - ruptured PU • - acute cholecystitis • - diverticulitis • - bowel strangulation • - acute salpingitis • - evacuation of ascitic fluid • - peritoneal dialysis

200

what is the clinical course of septic peritonitis?

localized (loculated abscesses) and may heal by fibrous adhesions--> chronic obstruction

201

what are the potential causes of idiopathic sclerosing retroperitonitis?

- may be related to anti-migraine drugs (methysergide) • - may be autoimmune

202

sclerosing retroperitonitis is characterized by what?

excessive fibrous tissue proliferation (fibromatosis)

203

what are the complications associated with sclerosing retroperitonitis?

compromising retroperitoneal structures

204

what happens when ureters are compromised by sclerosing retroperitonitis?

hydronephrosis

205

what is the cause of mesenteric cysts?

blocked lymphatics • enteric diverticula • postinfectious cysts • postpancreatitis pseudocysts • neoplastic cysts

206

how common are primary peritoneal tumors?

rare

207

what is an example of primary peritoneal tumor and its cause?

mesothelioma= related to past asbestos exposure, identical to its counterpart in the pleura

208

how common are secondary peritoneal tumors?

very common

209

where do secondary peritoneal tumors come from?

advanced cancer of any abdominal viscera: • stomach, colon, small intestine, pancreas, liver, gallbladder, uterus, breast

210

in secondary peritoneal tumor, diffuse seeding of the peritoneal cavity leads to what?

malignant effusions (mainly ovarian)

211

how can secondary peritoneal tumors be detected?

cancer cells can be detected in the peritoneal fluid by cytological examination