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DERS (GIT) > L8- GIT Pathology IV (intestines) > Flashcards

L8- GIT Pathology IV (intestines) Flashcards

1
Q

IBD includes what diseases (include brief definition- inflammation type, location)

A

Idiopathic Inflammatory Bowel Disease

Crohn’s (CD):

  • granulomatous inflammation
  • affects any part of GIT mouth to anus (discontinuous)

Ulceratice colitis (UC):

  • nongranulomatous inflammation
  • limited to colon, always includes rectum, continous
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2
Q

IBD pathogenesis:

  • these three factors, (1), activate (2)
  • (2) releases (3) which causes (4), a negative effect in the GIT
A

1- genetics, abnormal host reactivity, infections?

2- inflammatory cells / PMNs

3- CKs + mediators

4- general tissue injury

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3
Q

CD:

  • (1) alternate names
  • (2) common age / gender affected
  • (3) common ethnicity
  • (4) common genetic defect
A

1- terminal ileitis, regional ileitis, granulomatous colitis

2- adolescents, young adults, females (1.6:1)
3- Jews

4- HLA- DR7 / DQ4

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4
Q

CD characteristic features (not Sxs)

A
  • sharply delimited: ileal + colonic ‘skip lesions’
  • transmural involvement (inflammation –> fibrosis)
  • non-necrotizing granulomas:
    i) mesentic fat wraps around bowel serosa = creeping fat
    ii) thick walls (edema, hypertrophy, firosis, inflammation) including fibrotic mesentary

-fissuring ulcers, fistula, stricture + upper GI involvement and extraintestinal manifestations

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5
Q

list CD location distribution

A
  • SI only, 30%
  • SI + colon, 40%
  • colon only, 30%
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6
Q

key CD radiographic feature

A

long narrowed thickened segments of SI (TB- short), string sign of radiography

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7
Q

UC:

  • affects (1) part of colonic walls
  • (2) common age, race
  • (3) associated disease
  • (4) associated gene
A

1- mucosa, submucosa
2- whites, 20-25y/o
3- Primary Sclerosing Cholangitis (PSC- infamed / fibrotic bile ducts)
4- HLA-DRB1

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8
Q

describe UC disease distribution, including associated name (hint- 6)

A
  • rectum, ulcerative proctitis
  • rectosigmoid, ulcerative proctosigmoiditis
  • up to splenic flexure, L-sided UC
  • up to hepatic flexure, extended UC
  • up to cecum, pancolitis
  • terminal ileum, backwash ileitis
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9
Q

describe UC histology:

  • (1) involved colonic layers
  • architectural distortion due to (2)
  • (3) are extra features, (4) is importantly absent
A

1- mucosa, submucosa
2- dense chronic inflammation with basal plasmacytosis
3- cryptitis, crypt abscesses
4- granulomas

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10
Q

describe gross appearance of UC

A
  • mucosa red, granular, friable
  • broad based ulcers
  • isolated islands of intervening regenerating mucosa bulge —> pseudopolyps
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11
Q

IBD clinical features:

  • episodic with (1) as common causes to flare ups
  • (2) common Sxs
  • (3) severe Sxs
  • (4) unique to CD
A

1- physical / mental stress

2- bloody mucoid diarrhea, lower abdominal pain / cramps, tenesmus (chronic urge to defecate)

3- fever, weight loss

4- malabsorption, subacute intestinal obstruction

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12
Q

IBD extraintestinal manifestations, include if its more common in CD or UC (hint- 6)

A

(more in UC)

  • migratory polyarthritis
  • sacroileitis
  • ankylosing spondylitis
  • erythema nodosum
  • clubbing of fingertips
  • primary sclerosing cholangitis

Also, inc risk of developing a malignancy: inc with duration and severity of disease

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13
Q

list all the non-IBD colitis types

A
  • infectious
  • pseudomembrane colitis
  • ischemic colitis
  • eosinophilic colitis
  • radiation enterocolitis
  • microscopic colitis: collagenous colitis, lymphatic colitis
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14
Q

list the classic clinical features of colitis (non-IBD)

A
  • diarrhea: mucoid, bloody
  • abdominal pain (below umbilicus) + cramps
  • tenesmus (painful defecation + urge to defecate)
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15
Q

list the common causes of acute infectious colitis

A

Bacterial: E. coli, Campylobacter, Salmonella, Shigella, Yersinia, Aeromonas, Mycobacteria

Viral: CMV

Parasite: ameoba

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16
Q

(1) is the most common cause of parasitic infectious colitis, with (2) transmission type. On biopsy it can mimic (3) while having (4) features. It will also involve (5) systems and is treated with (6).

A 
1- entameoba histolytica
2- fecal-oral
3- IBD
4- chronic destructive colitis with flask shaped ulcers* (+ erythrophagocytosis)
5- lungs, liver, brains
6- anti-parasitic agents
17
Q

Typhoid Fever (enteric fever):

  • (1) Sxs
  • (2) lesion descriptions
A

1- fever, HA, abdominal pain, rash, diarrhea

2- longitudinal ulcers, typically over Peyer patches

18
Q 
Tuberculosis (abdominal):
-(1) main Sx
-(2) common affected segments
-(3) or (4) lesion descriptions
(necrotizing granulomatous inflammation)
A

1- chronic abdominal pain
2- jejunum to ileum, mostly terminal ileum (B12 def.)

(annular circular / oval ulcers, lying transversely)
3- single large ulcer
4- multiple small ulcers

19
Q

TB GIT lesions vs CD

A

TB:

  • larger confluent necrotizing granulomas
  • transverse ulcers
  • AFB stain / culture / PCR

CD:

  • fissuring ulcers, fistulas
  • transverse ulcers
20
Q

Pseudomembrane colitis:

  • (1) definition, include common site of transmission
  • (2) associated infections, with (3) and (4) as other contributing mediators
A

1- colitis with pseudomembrane, nosocomial infection
2-*C. difficile (mediated by toxin); E. coli, Staph, CMV
3- drugs / antibiotics
4- ischemia

21
Q

C. difficile colitis:

  • (1) part of the colon is commonly involved
  • (2) is distinguishing feature
  • (3) describe pseudomembrane
A

1- retrosigmoid
2- raised yellow plaques

3:

  • surface epithelium denuded
  • superficial crypt damage distended by mucopurulent exudate (erupts forming mushroom cloud)
  • coalescence of clouds –> pseudomembrane
22
Q

list the types of Ischemic Bowel Disease

A

-venous or arterial insufficiency

i) occlusive: arterial thrombosis, embolism; venous thrombosis
ii) non-occlusive: cardiac failure, shock, dehydration

iii) Misc: radiation, volvulus, herniation

23
Q

Ischemic bowel disease clinical features:

  • (1) common age group
  • milder presentation includes (2) involvement and (3) Sxs
  • severe presentation includes (4) involvement and (5) Sxs
A

1- elderly

2- mucosal
3- n/v, bloody stool

4- transmural
5- severe abdominal pain / tenderness, gangrene, perforation, peritonitis, shock / vascular collapse, high mortality (50-75%)

24
Q

Chronic ischemic colitis (insidious onset):

  • chronic (1) processes in colon which can lead to (2) formation
  • commonly affects (3) area of colon
  • (4) Sxs, mimicking (5)
A 
1- inflammation / fibrosis
2- stricture
3- splenic flexure (watershed areas)
4- intermittent attacks of pain (intestinal angina)
5- mimics inflammatory bowel disease
25
Q

Acute ischemic colitis:

  • related to (1)
  • (2) part of (1) leads to (3) injury and (4) in the colon
  • (5) Sxs
A

1- toxigenic organisms (like E. coli O157:H7) /// uncooked hamburgers
2- toxins
3- endothelial injury
4- hemorrhagic colitis

5- painful / bloody diarrhea, hemolysis, renal failure

26
Q

list the causes of Eosinophilic colitis

A
  • Allergy: cow’s milk protein
  • parasites

-iatrogenic: drugs, radiation

  • collagen vascular disease: RA, Churg-Strauss syndrome
  • IBD
  • Tumor / tumor-like conditions: leukemia/lymphoma, hypereosinophilic syndrome
27
Q

Microscopic colitis:

  • (1) most affected age group and gender
  • (2) appearance on endoscopy
  • (3) presenting forms
A

1- older women (+ watery diarrhea)
2- normal
3- collagenous or lymphatic

28
Q

Collagenous / Lymphocytic colitis:

  • (1) cause
  • (2) associated conditions
  • (3) Tx
  • (4) presenting course
A

1- idiopathic
2- drugs (NSAIDs), Celiac’s, Autoimmune (SLE, RA)
3- symptomatic Tx
4- intermittent relapsing course resolving in 2-3 yrs

29
Q

Intestinal Ulcers:

  • (1) are the common forms / diseases
  • (2) list infectious causes
  • (3) other causes
A

1- CD/UC, peptic ulcers (duodenal)

2- bacteria (salmonella, typhoid), Tb, amoebiasis, CMV (immuno-suppressed)

3- tumors, ischemic colitis, drugs (NSAIDs)

DERS (GIT) (21 decks)

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