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Flashcards in GI: Small and Large Intestine II Deck (50)
1

What is the infectious disease agent responsible for pseudomembranous colitis?

C. diff (toxins A and B)

2

Which parasitic infection presents with bloody diarrhea?

E. histolytica

3

What is the genetic abnormality in familial adenomatous polyposis (FAP)?

autosomal dominant

mutation of APC gene

4

What are the 2 varieties of GI protrusions?

1) diverticulum
2) hernias

5

What comprises a "true" diverticulum?

all three wall layers (ex: Meckel's)

6

If the diverticulum only penetrates the mucosa and submucosa, what is it called?

false or pseudo

7

Define diverticulosis

many diverticuli, usually in sigmoid colon where vasa recta perforate colon

(most cases in elderly, associated with low fiber diets)

8

Define diverticulitis

inflammation of diverticula (LLQ pain, fever, leukocytosis) can perforate causing peritonitis, abscesses, etc)

9

Define hernias?

serosal lined out-pouching of peritoneum (loop of intestines are trapped within hernia sac)

bowel compressed and twisted at mouth of hernia

10

What are some causes of ischemic bowel disease?

anything that causes vasculature problems (atherosclerosis, aortic aneurysm, hypercoagulable states, etc)

11

What are some symptoms of ischemic bowel disease?

sudden/severe abdominal pain
tenderness
bloody diarrhea, melanotic stools

12

What is the main watershed zone in the bowel?

splenic flexure (furthest from the blood supply - most vulnerable to ischemia)

13

What does ischemic bowel disease look like on histology?

necrotic mucosa next to intact crypts

14

Internal hemorrhoids are __________ the pectinate lines and are ____________

above

PAINLESS

15

External hemorrhoids are _________ the pectinate line and are ____________

below

PAINFUL

16

True or false: both varieties of hemorrhoids are worse with defecations

TRUE

17

Name the 4 kinds of bowel growths that are NON-neoplastic

1) inflammatory polyp
2) juvenile polyp
3) hamatomaous (psutz-Jeghers syndrome)
4) hyperplastic polyp

18

What are inflammatory polyps and how do they form?

form in the colon due to impaired relaxation of the anorectal sphincter which creates a sharp angle at the anterior rectal shelf (leads to recurrent abrasion and ulceration of the overlying rectal mucosa)

19

How are inflammatory polyps associated with prolapse?

they are pulled by the fecal stream

20

What do inflammatory polyps look like on histology?

lamina propria fibromuscular hyperplasia, inflammation and erosion and epithelial hyperplasia

21

Where do juvenile polyps occur?

rectum in kids

22

Are juvenile polyps concerning?

not if single, if multiple there is an increased risk of adenocarcinoma

23

What is Hamatomatous (Peutz-Jeghers syndrome)?

formation of many hamartomas throughout GI tract (looks like hyperpigmented melanotic macules of mouth, lips, genitalia, hands)

polyps have no malignant potential

24

What are hyperplastic polyps?

look like adenomas, proliferation of mature goblet cells

25

What are adenomatous growths?

benign polyps that are precursors to majority of colorectal adenocarcinomas

(can be pedunculated, sessile, tubular, and villous)

26

What are the two major things to monitor in adenomatous growths so that they do not become cancerous?

size and presence of high grade dysplasia

27

Sessile serrated adenomas occur predominantly where?

right colon

28

Define adenomatous dysplasia

neoplastic dysplastic epithelium which lines the glands as tall hypercrhomatic somewhat disordered cells with or without mucin production

29

What is FAP?

an AD disease that leads to thousands of polyps and ALWAYS leads to colorectal adenocarcinoma

30

How do you treat FAP?

prophylactic colectomy

31

What causes FAP?

APC mutations

32

What are 3 neoplastic GI conditions?

1) adenomatous
2) sessile serrated adenoma
3) adenomatous dysplasia

33

What are the 2 variants of FAP?

1) gardner - osteomas of mandible
2) turcots - DNA repair mutations, get glioblastomas

34

What is HNPCC?

hereditary nonpolyposis colorectal cancer (fewer polyps but cancer still occurs at younger age)

35

What causes HNPCC?

mutation in DNA mismatch repair genes

36

What are the two molecular pathways that can lead to colorectal cancer

1) APC/WNT pathway
2) DNA mismatch repair

37

True or false: for the APC/WNT pathway, both copies must be functionally inactivated to cause cancer

TRUE

38

What is APC?

a negative regulator of the beta catenin pathway

so without APC, beta catenin goes into the nucleus and activates transcription of genes such as those encoding MYC and cyclin D1

39

Which pathway is associated with increased beta catenin?

APC/WNT

40

DNA mismatch repair leads to ________

HNPCC

41

What kind of adenomas are caused by HNPCC?

sessile serrated

42

sporadic colorectal cancer is associated with _______ while sessile serrated adenoma is associated with ________

sporadic CRC --> FAP

SSA --> HNPCC

43

What doe colorectal cancer look like on barium xray

apple core (pushes on colon)

screen after 50

44

What is partially protective for CRC?

high fiber diet

45

What are some signs and symptoms of right sided CRC?

iron deficient anemia (surface ulceration and blood loss)

ulcerate because of fecal matter banging up against it

46

What are some features of left sided CRC?

change in bowel habits, blood in stool, originates from ruptured vessels

obstructive, napkin ring

47

____________ kind of cancer develops in the rectum while ____________________ develops in the anus

adenocarcinoma

SCC

48

How are GI tumors staged?

based on depth of invasion

49

Name 3 neoplasms of the appendix?

1) mucocele (benign dilatation of lumen by mucinous secretions)
2) mucinous cystadenoma (proliferation of benign neoplastic cells - dilatation by mucinous material)
3) mucinous cystadenocarcinoma (invasion fo neoplastic cells)

50

What does pseudomyxoma peritonei mean?

describes distention of peritoneal cavity by presence of semisolid mucin and epithelial mucin producing implants and/or malignant cells