GI 2

Question 1

Ulcerative colitis affects what?

Answer 1

Rectal mucosa, can expand to entire colon

Question 2

Active acute pattern of ulcerative colitis - six manifestations?

Answer 2

PACHED

Pseudopolyps
Abcess in crypts
Confluence
Hemorrhage
Edema, lymphoid
Depletion of goblet cells & mucin

Question 3

Chronic quiescent/treated ulcerative colitis state of mucosa?

Answer 3

red, granular, thinned/atrophied

Question 4

Acute active ulcerative colitis inflammation occurs where?

Answer 4

Lamina propria - increased chronic inflammation

Lumen of glands/crypt abcesses - increased acute inflammation

Question 5

One local complication of ulcerative colitis?

Answer 5

pancolitis of 8-10+ years increases cancer risk

Question 6

80% of ulcerative colitis cases have what history?

Answer 6

chronic, quiescent with infrequent relapse

Question 7

Polyps of the colon can be what two types?

Answer 7

1. non-neoplastic hyperplastic

2. neoplastic

Question 8

Two signs of Peutz-Jegher syndrome?

Answer 8

1. multiple GI hamartomatous polyps

2. perioral pigmentation

Question 9

Peutz-Jegher sydnrome associated with what risk of cancer? (8)

Answer 9

40% lifetime risk of:
GI:
1. Gastric
2. small intestine
3. pancreas
4. colon
Reproductive:
5. testicular
6. ovary
7. uterus

8.lung

Question 10

What is the biggest factor in determining risk of malignant transformation in adenomas of the colon?

Answer 10

size of polyp

Question 11

Villous tumor of colon - malignant or benign? Typical pattern?

Answer 11

Benign. Show invasion more often than tubular pattern

Question 12

4 properties of malignancies of colon

Answer 12

1. poorly differentiated
2. highly aggressive
3. mucin producing
4. adenocarcinomas

Question 13

Peak incidence (age) of malignancies of colon?

Answer 13

age > 60

Question 14

Polyp-colon cancer sequence?

Answer 14

normal mucosa –> adenoma –> adenocarcinoma

Question 15

What has to happen to normal mucosa to change it to coloncancer?

Answer 15

multiple mutations over time

Question 16

Greater risk of malignancy in adenocarcinoma associated with what

Answer 16

larger lesions

Question 17

Familial adenomatous polyposis age of onset? frequency?

Answer 17

childhood onset, hundreds by 30-40

Question 18

Familial adenomatous polyposis - what risk of adenocarcinoma?

Answer 18

100% risk lifetime, often by 35, nearly all by 50

Question 19

Two forms of inherited polyposis syndromes?

Answer 19

Turcot syndrome

Gardner syndrome

Question 20

Five properties of Gardener syndrome?

Answer 20

Adenomata in colon, rectum, and small intestine
High risk of carcinomas
Osteomas of bone
Soft tissue tumors
Supernumerary teeth

Question 21

Different clinical patterns of colon malignancies results from what?

Answer 21

Different morphology

Question 22

Main clinical features of colon malignancies for…
Right
Left

Answer 22

Right: fatigue and anemia
Left: Bleeding, change in bowel habits, or cramping

Question 23

The fact that feces are mainly ____ in the right ascending colon means what for tumor size & diagnosis?

Answer 23

fluid; tumors can be large without obstruction which means late diagnosis

Question 24

Feces are mainly ____ in left colon, means what for tumor size & diagnosis?

Answer 24

solid; tumors not as large before obstruction noted, earlier diagnosis

Question 25

Right-side colon carcinomas appearance?

Answer 25

large, polypoid, exophytic

Question 26

Left-side colon carcinomas appearance?

Answer 26

annular type "napkin ring" | circumferential, small

Question 27

Malignancies of colon prognosis?

Answer 27

best 5 year survival in US (65%) | 90% if localized, 13% if metastatic

Question 28

Diverticulosis cause?

Answer 28

abnormal gut motility

Question 29

Diverticulosis abnormally high intraluminal pressure cause?

Answer 29

contractility of muscularis propria

Question 30

Diverticulosis pathogenesis?

Answer 30

Herniation of the mucosa of the colon through the muscularis propria leading to outpouches of the bowel lumen and thickening of the muscularis propria

Question 31

One complication of diverticulosis?

Answer 31

Perforation of colon wall

Question 32

Acute appendicitis involves what?

Answer 32

Acute inflammation of the muscularis propria

Question 33

Malignant mesothelioma associated with what exposure?

Answer 33

asbestos

Question 34

Meckel diverticulum is what?

Answer 34

blind pouch in ileum, acts as apex of volvulus or site of acute inflammation or ulceration

Question 35

Intussusception - what valve most common site?

Answer 35

ileocecal