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Path of small intestines Flashcards

1
Q

What is the clinical course of gastric carcinoma?

A

Asymptomatic until late

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2
Q

What is the prognosis of gastric carcinoma? Why?

A

Depends on depth, and mets, but usually found late d/t lack of symptoms until late

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3
Q

What are the three nodes that usually have mets from gastric carcinomas?

A

Virchow nodes
Sister Mary Joseph nodule
Krukenbery tumors

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4
Q

What a the sister mary joseph nodule?

A

mets around the umbilicus (reddening

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5
Q

What are Krukenberg tumors?

A

Mets to the ovaries from gastric carcinomas

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6
Q

What are the usually histologically characteristics of Krukenburg tumors?

A

Signet rings that are PAS positive (from diffuse type)

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7
Q

What lymphomas are associated with gastric tumors? Why?

A

B cell lymphoma (MALTomas) d/t B cell proliferation in response to H.Pylori infection

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8
Q

What are the B cell markers?

A

CD19 CD20, CD21

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9
Q

What are carcinoid tumors?

A

Neuroendocrine tumors from gastric cells that can secrete 5HT and bradykinin

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10
Q

What are the histological characteristics of gastric lymphomas?

A

Lymphoid cells infiltrate through glands and walls (uniform B cell)

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11
Q

What is the cause of GIST? (genetic, cell type)

A

Cells of Cajal get a c-KIT oncogene

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12
Q

What is the treatment for GIST?

A

Imatinib

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13
Q

What is the major prognostic factor for GIST?

A

Size

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14
Q

What cells are constantly proliferating in the GI Tract?

A

Basal cells

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15
Q

What is idiopathic IBD?

A

Chronic, relapsing inflammatory disorders of the intestinal tract of obscure origin

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16
Q

What are the two types of IBD?

A

Crohn’s disease

Ulcerative colitis

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17
Q

What is the supposed cause of IBD?

A

Unregulated and exaggerated immune response to normal gut flora

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18
Q

Which has extraintestinal inflammatory manifestations: Crohn’s or Ulcerative colitis?

A

Both

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19
Q

Which has epithelial changes that can lead to carcinoma: crohn’s disease or Ulcerative colitis

A

Both

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20
Q

How do you diagnose IBD?

A

H&P
x-ray
histology

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21
Q

What is the antibody that is associated with Crohn’s? UC?

A 
UC = ANCA
Crohn's = anti-saccharomyces
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22
Q

What cell has an abnormal response in IBD?

A

T cells

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23
Q

What do Th2 cells drive?

A

Humoral response

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24
Q

What type of hypersensitivity reaction is suspected in IBD?

A

delayed type hypersensitivity

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25
What is Crohn's disease? Where in the GI tract can this occur?
Trans-mural chronic ulceration IBD characterized by bowel inflammation, non-caseous granulomas, Can occur anywhere in the GI tract
26
What is the most affected region in Crohn's disease?
terminal ileum
27
Who usually gets Crohn's disease?
Female Jews who smoke
28
What are the ssx of Crohn's disease?
Diarrhea, fever, pain.
29
What is the major complication of Crohn's disease?
Transmural fistula development
30
What are the malabsorption problems that can occur with Crohn's disease?
Steatorrhea | Pernicious anemia
31
Which has a stronger predisposition to develop into cancer: UC or Crohn's disease?
UC
32
What are skip lesions? What disease is it seen in?
a wound or inflammation that is clearly patchy, "skipping" areas that thereby are unharmed. It is a typical form of intestinal damage in Crohn's disease
33
What disease has early aphthoid ulcers?
Crohn's disease
34
Cobblestone mucosa is characteristic of what disease?
Crohn's disease
35
What is the string sign of Crohn's disease?
Thickened luminal narrowing of the intestines seen in Crohn's disease when using radiolabeled dye
36
What is the "creeping fat" found in Crohn's disease?
Dull gray granular serosa that surround that entire intestines
37
Linear ulcers in the intestines are characteristics of what disease? What are these called?
Crohn's disease | Aphthous ulcers
38
What causes of the rubber hose symptom of Crohn's disease?
Thickening of the walls of the intestines
39
What are the histological characteristics of Crohn's disease?
Early PMN infiltration of epithelial layer, and crypt abscess formation
40
What are the signs of chronic mucosal damage of Crohn's disease?
Metaplasia Mucosal atrophy Architectural distortion
41
Non-caseating granulomas occur in which IBD?
Crohn's disease
42
What are the extraintestinal manifestation of Crohn's disease? (3)
Migratory polyarthritis Sacroiliitis ankylosing spondylitis
43
Clubbing of the fingertips can be seen in what intestinal disease?
Crohn's disease
44
What is ulcerative colitis?
Ulceroinflammatory disease limited to colon and affecting only mucosa and submucosa
45
Are the granulomas in Ulcerative colitis?
No
46
Which IBD has granuloma formation?
Crohn's disease
47
How does ulcerative colitis spread through the intestines?
In a contiguous fashion, as opposed to the skip lesions seen in Crohn's disease
48
Thickening of the bowel is more common in what IB? Thinning?
``` Thickening = Crohn's Thinning = UC ```
49
Who is usually affects with UC?
20-25 years olds
50
What are the ssx of UC?
Bloody, mucoid diarrhea
51
What is the morphology of Ulcerative colitis? What part(s) of the GI tract are involved?
Contiguous ulcer starting at the rectum and spreading upward to possibly involve the entire colon.
52
What are the pseudopolyps of ulcerative colitis?
Coalescence of ulcers
53
What are the common complications of ulcerative colitis?
Toxic megacolon | Perforation
54
What is the "backwash" ileitis seen in UC?
Inflammatory soup of colon goes back into the ileum
55
What are the gross characteristics of UC?
Edema, hyperemia, crypt abscesses, ulceration
56
What are the histological characteristics of acute ulcerative colitis? (4)
1. early PMN infiltration in the lamina propria 2. Crypt abscesses 3. Ulcerations 4. Granulation tissue (NO granulomas)
57
What are the histological characteristics of chronic ulcerative colitis? (4)
Ulcerations Submucosal fibrosis Gland disarray Possibly carcinoma
58
What are the inflammatory pseudopolyps seen in ulcerative colitis?
granulation tissue formation and regenerative hyperplasia as a result of previus ulceration
59
What layers of the GI tract are unaffected by ulcerative colitis?
Muscularis propria and serosa
60
What happens to the overall thickness of the intestines in UC?
Normal to decreased
61
How do crypt abscesses appear histologically?
Circular glands filled with PMNs
62
What are the mucosal changes seen with UC?
Crypt distortion with dysplasia Mucosal simplification and dysplasia
63
What are the histological characteristics of dysplasia?
Piling up of cells | hyperchromatic nuclei
64
What are the ssx of ulcerative colitis?
Remitting, lower abdominal pain relieved by defecation Bloody mucoid diarrhea
65
What are the two characteristics of cells in UC?
DNA damage and microsatellite instability of mucosal cells
66
What IBD can develop adhesions? Intestinal fistulas? Perianal abscesses? Ulceration of the GI tract outside the intestines?
All Crohn's disease
67
Which IBD has a predisposition to developing toxic megacolon? Stenosis?
``` Megacolon = UC Stenosis = Crohn's ```
68
Transmural inflammation = ?
Crohn's disease
69
What is ischemic bowel disease?
Occlusion of the mesenteric vessels
70
What are the two watershed areas of the bowel? What are these, and what is their significance?
Splenic flexure Rectosigmoid Areas of the bowel that receive blood via anastomoses of two blood vessel = susceptible to ischemia
71
What arteries supply the splenic flexure?
SMA and IMA
72
What arteries supply the rectosigmoid area?
IMA and hypogastric artery
73
What are the causes of ischemic bowel disease?
1. Emboli/thrombi 2. Low flow states (CHF, a-fib) 3. Volvulus, radiation
74
What is the usual cause of mural or mucosal infarction of the intestines?
Acute or chronic hypoperfusion
75
What does transmural infarction of the bowel lead to?
gangrenous necrosis
76
What are mural infarcts?
Infarcts of the bowel down to the muscularis propria
77
What is most often the cause of mural and mucosal infarction?
Non-occlusive hypoperfusion
78
What happens when there is a mural or mucosal infarct? Is the serosa involved?
Luminal hemorrhage and mucosal necrosis No serosal involvement
79
True or false: mural and mucosal infarctions are reversible if caught early
True
80
What are the ssx of mural/mucosal infarctions? (2)
Nonspecific abdominal complaints | Hematochezia
81
What is the usual cause of transmural infarctions?
Compromise of major blood vessels supplying the intestines d/t thrombosis/embolism
82
What are the signs of a transmural infarct?
Hemorrhagic | Fibrinopurulent exudate
83
Who usually gets ischemic bowel disease?
Older adults
84
What are the ssx of chronic ischemia of the bowel?
Mimic IBD ssx
85
What happens grossly with chronic ischemia of the bowel?
Atrophic surface epithelium, fibrous scarring of the lamina propria
86
Is chronic ischemic bowel usually continuous or patchy?
Patchy
87
What is the common complication with chronic ischemia of the bowel?
Strictures
88
What is angiodysplasia?
Non-neoplastic proliferation of blood vessels beneath the mucosa and submucosa
89
What are the ssx of angiodysplasia?
BRBPR
90
What are the complications of angiodysplasia?
- Massive bleeding | - Intermittent occlusion
91
What are ectatic nests?
Area of blood vessel proliferation in angiodysplasia

Gastrointestinal (42 decks)

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