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Lower GI infections Flashcards

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1
Q

What is the causative organism of Typhoid Enteritis?

A

Salmonella typhi

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2
Q

How is Typhoid Enteritis transmitted?

A

Through the faeco-oral route via contaminated food or water

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3
Q

What are the primary symptoms of Typhoid Fever?

A

High fever, headache, muscle aches, fatigue, abdominal pain, constipation or diarrhea, and rose-colored rash

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4
Q

Where are Typhoid ulcers primarily located?

A

Mainly in the terminal ileum

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5
Q

What is the typical shape and orientation of Typhoid ulcers?

A

Round to oval, with the long axis parallel to the direction of intestinal flow (longitudinal)

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6
Q

Describe the edges of Typhoid ulcers.

A

Raised above the surrounding mucosa and sharply demarcated

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7
Q

What is found at the base of Typhoid ulcers?

A

Blackish necrotic material (slough)

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8
Q

What microscopic feature is seen in Typhoid ulcers?

A

Macrophages containing phagocytosed organisms and red blood cells

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9
Q

What are Typhoid nodules?

A

Clusters of macrophages containing phagocytosed organisms and erythrocytes, seen in intestines, liver, spleen, and bone marrow

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10
Q

What are the intestinal complications of Typhoid Fever?

A

Bleeding, perforation, peritonitis, and paralytic ileus

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11
Q

What systemic complications can Typhoid Fever cause?

A

Acute cholecystitis, hepatitis, hepatosplenomegaly, endotoxic shock, necrosis in liver/kidneys/bone marrow, and Zenker’s degeneration

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12
Q

What is a carrier state in Typhoid Fever?

A

A state where the individual continues to harbor Salmonella typhi and can spread the infection without showing symptoms

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13
Q

What are the main types of Intestinal Tuberculosis?

A

Primary (from infected milk, uncommon) and Secondary (from ingested infected sputum)
Miliary tuberculosis
Direct spread from an affected lymph node or fallopian tube

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14
Q

What is the most common macroscopic type of Secondary Intestinal Tuberculosis?

A

Ulcerating type

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15
Q

Where are the ulcers in Secondary Intestinal Tuberculosis primarily located?

A

Terminal ileum, affecting both small and large intestines

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16
Q

What is the orientation of ulcers in Secondary Intestinal Tuberculosis?

A

Transverse or circumferential

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17
Q

What happens during the healing of tubercular ulcers?

A

Formation of strictures due to fibrosis

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18
Q

What is Hypertrophic Ileocecal Tuberculosis?

A

A type of tuberculosis causing grey-white thickened walls of the ileum and cecum, mimicking carcinoma

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19
Q

What microscopic feature is typical of Secondary Intestinal Tuberculosis?

A

Transmural inflammation with typical TB granulomas and caseous necrosis

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20
Q

What are common complications of Secondary Intestinal Tuberculosis?

A

Anemia (ulcer bleeding), intestinal obstruction (strictures/adhesions), malabsorption, and rare perforation leading to peritonitis

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21
Q

What are differential diagnoses for granulomas in the intestines?

A

Tuberculosis, Crohn’s disease, fungal infections, and sarcoidosis

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22
Q

What causes Bacillary Dysentery?

A

Shigella species

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23
Q

How is Bacillary Dysentery transmitted?

A

Via the faeco-oral route

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24
Q

What are the primary clinical symptoms of Bacillary Dysentery?

A

Blood and mucus diarrhea

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25
Which part of the intestine is mainly affected by Bacillary Dysentery?
Large intestine
26
What are the macroscopic features of Bacillary Dysentery?
Oedema and redness of mucosa, irregular shallow ulcers with pus, and fibrin tags on the bowel surface
27
What are the complications of Bacillary Dysentery?
Toxic megacolon, perforation, strictures with obstruction, dehydration, septicaemia, Reiter syndrome, and haemolytic uremic syndrome
28
What is Reiter syndrome in Bacillary Dysentery?
A triad of sterile arthritis, urethritis, and conjunctivitis as an immune response
29
What organism causes Pseudomembranous Colitis?
Clostridium difficile
30
What often precipitates Pseudomembranous Colitis?
Antibiotic therapy (e.g., clindamycin, ampicillin, cephalosporins)
31
What are the macroscopic features of Pseudomembranous Colitis?
Elevated yellowish plaques of pus (pseudomembranes) on the colon/rectum mucosa with reddish intervening mucosa
32
What is the microscopic appearance of Pseudomembranous Colitis?
Volcano-shaped exudate eruptions between crypts, with neutrophils, fibrin, debris, and acute inflammation in the lamina propria
33
What are the complications of Pseudomembranous Colitis?
Malabsorption, dehydration, electrolyte imbalance, shock, perforation, and toxic megacolon
34
What causes Intestinal Amoebiasis?
Entamoeba histolytica
35
What are the clinical symptoms of Intestinal Amoebiasis?
Diarrhea with blood and mucus, and abdominal pain
36
Which parts of the intestine are primarily affected by Amoebiasis?
Caecum and ascending colon, followed by sigmoid colon, rectum, and appendix
37
What is the characteristic shape of ulcers in Amoebiasis?
Flask-shaped with a narrow neck and wide base
38
What is seen microscopically at the edge of amoebic ulcers?
Amoebae containing phagocytosed red blood cells
39
Why are neutrophils sparse in amoebic ulcers?
Due to liquefactive necrosis
40
What are the complications of Intestinal Amoebiasis?
Bleeding, pancolonic ulceration/dilatation, perforation, peritonitis, amoeboma, liver abscess, abscesses in lung/brain/kidneys, arthritis, and chronic carrier state
41
What is an Amoeboma?
A tumor-like growth in the caecum or rectum due to localized granulation tissue and fibrosis, causing obstruction
42
How does Typhoid Enteritis spread systemically?
Via primary bacteremia to mesenteric lymph nodes, then secondary bacteremia seeding the liver, spleen, gall bladder, and bone marrow
43
What is the pathogenesis of Bacillary Dysentery?
Direct invasion of mucosa by Shigella and production of toxins leading to inflammation and ulcers
44
What is the pathogenesis of Pseudomembranous Colitis?
Clostridium difficile exotoxin production post-antibiotics leading to pseudomembrane formation
45
What is the pathogenesis of Intestinal Amoebiasis?
Ingestion of cysts leads to trophozoites in the colon, which attach to and damage epithelium, invade the wall, and cause flask-shaped ulcers via liquefactive necrosis
46
How do Typhoid ulcers differ from Tubercular ulcers in orientation?
Typhoid ulcers are longitudinal, while Tubercular ulcers are transverse or circumferential
47
What mimics carcinoma in Intestinal Tuberculosis?
Hypertrophic ileocecal tuberculosis due to thickened bowel walls
48
What causes intestinal obstruction in Tuberculosis?
Strictures and adhesions due to healing by fibrosis
49
What causes blood and mucus diarrhea in Bacillary Dysentery?
Irregular shallow ulcers with pus on the mucosal surface of the large intestine
50
What causes blood and mucus diarrhea in Amoebiasis?
Flask-shaped ulcers in the colon with undermined edges and liquefactive necrosis
51
What is a common complication across Typhoid, Tuberculosis, and Amoebiasis?
Perforation leading to peritonitis
52
What is a systemic complication unique to Typhoid Fever?
Zenker’s degeneration (coagulative necrosis of abdominal muscles)
53
What immune response complication is seen in Bacillary Dysentery?
Reiter syndrome (arthritis, urethritis, conjunctivitis)
54
What is a rare complication of Amoebiasis seen in AIDS patients?
Amoeboma, a tumor-like growth causing obstruction
55
What is the primary site of Typhoid nodules apart from intestines?
Liver, spleen, and bone marrow
56
What is the primary site of granulomas in Intestinal Tuberculosis?
Intestinal wall and regional lymph nodes
57
What feature distinguishes Pseudomembranous Colitis macroscopically?
Yellowish pseudomembranes (plaques) on the mucosal surface
58
What is a shared complication of Pseudomembranous Colitis and Bacillary Dysentery?
Toxic megacolon due to bowel wall weakening and dilatation
59
What is the mode of spread for Secondary Intestinal Tuberculosis?
Ingestion of infected sputum
60
How does healing affect Bacillary Dysentery outcomes?
Healing can lead to strictures causing intestinal obstruction
61
What non-intestinal complication is common in Amoebiasis?
Liver abscess
62
PATHOGENESIS OF SECONDARY INTESTINAL TUBERCULOSIS
Generally, the organisms are introduced to the mucosal lymphoid aggregates found in both the small and large intestines.They give rise to granulomatous inflammation, resulting in the ulceration of the mucosa above.Healing by fibrosis results in the formation of strictures.

Pathology GI (7 decks)

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