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P&T Block 3 Pulm & GI > L82 > Flashcards

L82 Flashcards

1
Q

What is Hirschsprung’s disease?

A

Congenital megacolon
- No ganglia, therefore motility disorder
- Hypertrophic nerves due to compensatory growth
Part behind this area = dilated
Often involves rectum

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2
Q

Presentation of Hirschsprung’s

A

First few months of life - BABIES

Chronic constipation

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3
Q

Treat Hirschsprung’s

A

Resection

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4
Q

IBD commonalities on histo

A

Active inflammation: cryptits, crypt abscesses
Architectural abnormalities: tells you disease is chronic b/c repairs have been happening for a while… the question is which form of IBD

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5
Q

UC histo

A

IBD histo +
Continuous lesions
Disease in mucosa only

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6
Q

Cryptitis vs crypt abscess

A

Cryptitis = PMNs in epithelium

Crypt abscess = pus in lumen

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7
Q

Crohn’s histo

A

IBD histo +
Skip lesions - draw a ling between normal/diseases areas
Granulomas
Transmural inflammation aka deeper than mucosa
Creeping gat = fat bunching up due to scarring of serosal surface

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8
Q

Why are you worried about transmural inflammation of Crohn’s

A

Scarring/stricture
Perforation
Fistulas

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9
Q

Which form of microscopic colitis has a gender bias?

A

Collagenous more common in older women

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10
Q

Lymphocytic microscopic colitis histo

A

Preserved architecture - know its not IBD

More lymphocytes in epithelium than normal (don’t need to be able to dist the difference)

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11
Q

Collagenous microscopic colitis histo

A

Subepi collagen is thicker than should be

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12
Q

2 classic features of C.diff infection

A

Pseudomembranes - viable crypts at base means bleeding when you pull one of these
Volcano lesions

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13
Q

What is the difference between acute and chronic ischemic colitis

A 
Acute = necrosis + inflam, ulceration 
Chronic = fibrosis, scarring of crypts, cellular atypia
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14
Q

What are the 2 neoplastic colon polyps

A

Adenomatous

Serrated

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15
Q

What mutation gives rise to adenoma polyps

A

Chromosomal instability pathway mutations

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16
Q

Adenoma polyp histo

A

Less mucin - cells look darker/more purple

Nuclei are bigger but uniform

17
Q

What do serrated polyps look like - where in colon found

A

Might be flat

Often on R side of colon

18
Q

Serrated polyps histo

A

Mucin rich

Serrated edges to glands

19
Q

What mutation leads to FAP

A

APC = tumor suppressor gene
Example of chromosome instability
Inherit 1 hit, life is gonna give you the 2nd

20
Q

What mutation leads to HNPCC?

A

HNPCC = Lynch syndrome

Defected mismatch repair genes

21
Q

Where in colon is Lynch usually found? What other cancers are you at risk for?

A

R side - prox colon

Increased risk endometrial and ovarian cancer

22
Q

What is juvenile polyposis syndrome? Increases risk for what type cancer?

A

Kids
Inherited - polyps throughout GI
May autoamputate - fall off in poop
Increased risk COLO-RECTAL cancer

23
Q

What is Peutz Jeghers syndrome? Increased risk of what cancers?

A

Multiple polyps also associated with intussusception

Increased risk GI + pancreatic cancers

24
Q

How does an adenoma polyp tun into cancer

A

Adenoma = by definition low grade dysplasia
High grade
Invasion = see range of atypia, “dirty necrosis”

25
Q

Is UC or Crohn’s at greater risk for developing cancer?

A

UC - related to amt colon involved and severity of inflam

26
Q

What is the conventional pathway to colon cancer

A

Chromosome instability

APC or other tumor suppressor mutations

27
Q

How does island methylator phenotype contribute to cancer?

A

One way you can get cancer b/c gene silencing via methylation
Feeds into either conventional or mismatch repair depending on which genes are silenced

28
Q

Where do cancers caused by mismatch typically appear in the colon?

A

R side

29
Q

What type of chemo is contraindicated in cancers due to mismatch repair (Lynch)

A

5FU

30
Q

If you had to design a chemo regimen for a GI cancer pt, which 2 genes would you check for mutation b/c they wouldn’t respond to anti-EGFR therapy?

A

KRAS

BRAF

31
Q

Solitary rectal ulcer syndrome

  • Where find in colon
  • Pt + presentation
  • Complication
A

Ant wall rectum
Young pts - constipation, diarrhea
Straining can lead to mucosal prolapse

32
Q

What side do you find diverticular disease on

A

Left

P&T Block 3 Pulm & GI (31 decks)

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