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Flashcards in path slide set 3 Deck (367):
1

What adenocarcinoma produces occult bleeding, changes in bowel habits, or cramping and left lower quadrant discomfort

Left sided colorectal adenocarcinoma

2

Defects in intestinal epithelial tight junction barrier function are present in what IBD

Crohn and a subset of their healthy 1st degree relatives

3

Th17 cells likely contribute to disease pathogenesis in IBD. consistent with this, polymorphisms in what confer REDUCTIONS in the risk of both Crohn and UC

IL-23 receptor

4

Most common cause of intestinal obstruction in the U.S.

adhesions

5

Polyp: thought to result from decreased epithelial cell turnover and delayed shedding of surface epithelial cells, leading to a "piling up" of goblet cells and absorptive cells

hyperplastic polyp

6

MTP mutations

Abetalipoproteinemia

7

3 classifications of adenomas

-tubular
-tubulovillous
-villous

8

IBD: mural thickening is NOT present. serosal surface is normal. strictures do NOT occur

UC

9

where is highest incidence of adenocarcinoma

North America

10

histology of lymphocytic colitis

similar to collagenous colitis but the subepithelial collagen layer is of normal thickness and the increase in intraepithelial lymphocytes is greater

11

Ectatic nests, tortuous veins, venules, and capillaries
-limited injury may result in significant bleeding

Angiodysplasia

12

These result from the unique structure of the colonic muscularis propria and elevated intraluminal pressure in sigmoid colon

Colonic diverticula

13

What is the most frequent cause of intestinal obstruction WORLDWIDE

hernias

14

what can be used both diagnostically and therapeutically for idiopathic intussusception in infants and young children

contrast enemas

15

intestinal hypoperfusion can be associated with what?

-cardiac failure
-shock
-dehydration
-vasoconstrictive drugs

16

Most common site of metastasis for colonic adenocarcinoma

liver

17

small, flask-like outpouchings in regular distribution alongside the taeniae coli

Colonic diverticula

18

IBD: fistulae

Crohn

19

explosive diarrhea with watery, frothy stools and abdominal distention upon milk ingestion

congenital lactase deficiency

20

What may develop in extensive small bowel Crohn

-serum protein loss
-hypoalbuminemia
-generalized nutrient malabsorption
-malabsorption of B12 and bile salts

21

after how many years does the risk of colitis associated neoplasia sharply increase?

8-10 years

22

depth of transmural infarction

all three wall layers

23

Polyps are most common where

colo-rectal regions

24

which IBD: repeated cycles of crypt destruction and regeneration lead to DISTORTION OF MUCOSAL ARCHITECTURE

Crohn

25

important causes of acute arterial obstruction

-severe atherosclerosis (prominent at origin of mesenteric vessels)
-AA
-hypercoaguable states
-oral contraceptive use
-embolization of cardiac vegetations or aortic atheromas (happens alot with malignancy)

26

risk factors for C. diff associated colitis

-advanced age
-hospitalization
-antibiotic treatment

27

upper anal canal epithelium

columnar rectal

28

What is an extraintestinal manifestation of FAP that can be detected at birth and therefore may be an adjunct to early screening

congenital hypertrophy of the retinal pigment epithelium

29

Waxing and Waning diarrhea that can mimic new-onset ulcerative colitis

shigella

30

histology of collagenous colitis

dense subepiethelial collagen layer, increased numbers of intraepithelial lymphocytes, and a mixed inflammatory infiltrate within lamina propria

31

bright red seen on toilet tissue

hemorrhoids

32

What effectively cures intestinal disease of UC but extraintestinal manifestations may persist

colectomy

33

4 major categories of diarrhea

-Secretory
-Osmotic
-Malabsorptive
-exudative

34

Diarrhea is defined as an increase in stool mass, frequency, or fluidity, greater than what amount

200 grams per day

35

IBD: toxic megacolon

UC

36

Polyp that occur sporadically or as components of various genetically determined or acquired syndromes

Hamartomatous polyps

37

at least 100 polyps

FAP

38

Describe the cysts of Giardia and what this causes

-resistant to chlorine
-endemic in unfiltered public water supplies

39

a patient with celiac disease starts on gluten free diet. How long before restoration of normal mucosa

6 to 24 months

40

The failure of intraluminal digestion that occurs in cystic fibrosis can be effectively treated with what?

oral enzyme supplementation

41

Giardia trophozoites can be identified where

duodenal biopsies

42

inferior hemorrhoid plexus below anorectal line

external hemorrhoids

43

from 3 to 100 hamartomatous polyps and may require colectomy

autosomal dominant syndrome of jevenile polyposis

44

What is an additional mutation in the pathogenesis of colon adenocarcinoma that is a late event and promotes growth and prevents apoptosis?

KRAS

45

Distribution of adenocarcinomas

approximately equally over entire colon

46

in both acute and chronic ischemia, bacterial superinfection and enterotoxin release by induce what?

pseudomembrane formation that resembles clostridium difficile

47

Gluten-free diet in patients with celiac will reduce risk for what

-anemia
-female infertility
-osteoporosis
-cancer

48

itchy, blistering skin lesion called dermatitis herpetiformis

celiac disease

49

When does Abetalipoproteinemia present?

What symptoms

at infancy

-failure to thrive, diarrhea, steatorrhea

50

when definite diagnosis between UC and Crohn is not possible due to so much overlap

Indeterminate Colitis

51

Cancer and Crohn

increased risk of colonic adenocarcinoma

52

NOD2 leads to what pathway

NF-kB

53

Abrupt onset of watery diarrhea and vomiting following an incubation period of 1 to 5 days
-voluminous RICE WATER stools
-FISHY odor

Cholera

54

Polyp: distinctive histologic features include mixed inflammatory infiltrates, erosion, and epithelial hyperplasia together with lamina propria fibromuscular hyperplasia

inflammatory polyp

55

most juvenile polyps are located where?

present with what?

rectum

rectal bleeding

56

What develops in 100% of untreated FAP patients often before age 30 and nearly always by age 50

colorectal adenocarcinoma

57

HLAs and celiac disease

DQ2 and DQ8

58

antibodies against the bacterial protein flagellin are most common in which IBD

Crohn patients who have NOD2 variants

59

mucosal and mural infarctions cann follow what

acute or chronic hypoperfusion

60

most common approach for surveillance of adenomas

colonoscopy

61

Colonic diverticula prevalence is about 50% at what age in Western populations

older than 60

62

underlying cause of solitary rectal ulcer syndrome which then leads to inflammatory polyps

impaired relaxaton of the anorectal sphincter that creates a sharp angle at the anterior rectal shelf and leads to recurrent agrasion and ulceration of the overlying rectal mucosa

63

association of celiac disease and what other immune diseases

-type 1 diabetes
-thyroiditis
-Sjogren
-IGA nephropathy

64

most frequent predisposing influences for hemorrhoids?

-straining at defacation because of constipation
-venous stasis of pregnancy
-portal HTN

65

What are the most common chronic malabsorptive disorders in the U.S.

-pancreatic insufficiency
-celiac disease
-Crohn Disease

66

in Whipple disease, where can bacteria laden macrophages accumulate

-mesenteric lymph nodes
-synovial membranes of affected joints
-cardiac valves
-brain

67

Courvoisier's sign

Jaundice and a palpable gallbladder . . pancreatic cancer

68

morphological signature of ischemic intestinal disease

surface epithelial atrophy, or even necrosis and sloughing, with normal or hyperproliferative crypts

69

eruption reminiscent of a volcano eruption from the crypt

C. diff

70

Most sensitive noninvasive serologic test for celiac, prior to biopsy

measure for IgA antibodies against tissue transglutaminase

IgA anti-endomysial antibodies also present

71

what type of diarrhea in shigella

Bloody

72

what is the most common cause of intestinal obstruction in children younger than 2 years of age

intussusception

73

Most striking feature of diversion colitis, besides mucosal erythema and friability

development of numerous lymphoid follicles

74

IBD; polyps fuse to form mucosal bridges

UC

75

transmural infarction is typically caused by what

acute vascular obstruction

76

What is a hallmark of the APC/B-catenin pathway

chromosome instability

77

treatment of hemorrhoidal bleeding

-sclerotherapy
-rubber band ligation
-infrared coagulation

78

2 types of lactase deficiency

congenital and acquired

79

what kind of herniation does an adhesion cause

internal

80

what is the only disease that has defect in Lymphatic transport

Whipple disease

81

Abetalipoproteinema leads to deficiencies in what?

fat soluble vitamins as well as lipid membrane defects

82

When colitis develops within diverted segment from surgical treatment of UC, Hirschprung disease, and other intestinal disorders

Diversion Colitis

83

cases of intussusception have been associated with viral infections and what vaccine

rotavirus vaccines, perhaps due to reactive hyperplasia of Peyer patches

84

Adenocarcinomas of distal colon

-annular lesion
-napkin ring constriction
-sometimes obstruction

85

What therapy is necessary when intussusception is due to a mass, which is generally the case in older children and adults

surgical intervention

86

clinical diagnosis of IBS requires what?

occurrence of abdominal pain or discomfort at least 3 days per month over 3 months with improvement following defecations and a changein stool frequency or form

87

most common locations for sessile serrated adenoma

right colon

88

NO PATHOLOGIC ABNORMALITY

IBS

89

pathogenesis of angiodysplasia

normal distention and contraction of bowel intermittently occlude submucosal veins and leads to focal dilation and tortuosity

90

what is an important cause of malabsorption and diarrhea after allogeneic hemotopoietic stem cell transplantation

intestinal graft-versus-host disease

91

Re-activation of Crohn can be associated with what external triggers

-physical or emotional stress
-specific dietary items
-CIGARETTE SMOKING

92

acute appendicitis most common in what age

adolescents and young adults

93

IPEX and FOXP3 mutations have defective functions of what cells

CD4+

94

which IBD: noncaseating Granulomas

Crohn

95

celiac disease in older children with nonclassical symptoms

Extraintestinal manifestations

-constipation instead of diarrhea
-bloating
-vomiting
-abdominal pain

-arthritis/joint pain
-apthous ulcers
-stomatitis
-iron deficiency anemia
-delayed puberty
-short stature

96

earliest lesion in Crohn

Aphthous ulcer

97

IBD with psuedopolyps and ulcers

UC

98

Classifications of NONneoplastic polyps

-inflammatory
-hamartomatous
-hyperplastic

99

This differentiation pattern is present in tumors populated by immature cells derived from the basal layer of transitional epithelium (anal canal)

Basaloid

100

diarrhea characterized by isotonic stool and PERSISTS during fasting

Secretory

101

SMAD4 and BMPR1A

Juvenile polyposis

102

complete absence of all plasma lipoproteins containing apoliprotein B

Abetalipoproteinema

103

most shigells infections and deaths occur in who?

children younger than 5

104

Which phase of intesinal response to ischemia? . . initiated by restoration of blood. . greatest damage occurs. May trigger multiorgan failure in severe cases

reperfusion injury

105

What side of the colon gives a more severe disease course in ischemic bowel disease and double mortality rate

right side . . super mesenteric A. which also supplies small intestine

106

Match symptom with deficiency: anemia and mucositis

bleeding

ostepenia and tetany

peripheral neuopathy

-pyridoxine folate and vitamin B12

-vitamin K

-calcium, magnesium, or vitamin D

-vitamin A or B12

107

Inflammatory response and neoplasia in IBD

Neutrophils confers increased risk

108

Acute colonic ischemia typically presents with what

sudden onset of cramping, LEFT LOWER abdominal pain, a DESIRE to defacate, and passage of blood or bloody diarrhea

109

young person. Family history breast and pancreas cancer.

HNPCC

110

IBD: deep, knife like ulcer

Crohn

111

Autosomal dominant disorder in which patients develop numberous colorectal adenomas as teenagers

Familial adenomatous polyposis (FAP)

112

Campylobacter infection can result in reactive arthritis is patients with what?

HLA-B27

113

most common histological finding in Graft-versus-host disease

Epithelial apoptosis particularly of crypt cells

114

a weakness or defect in the agdominal wall which may permit protrusion of a serosa-lined pouch of peritoneum

hernia

115

IBD limited to colon and rectum and extends only into the mucosa and submucosa

UC

116

results of a volvulus

luminal and vascular compromise as it acts like both obstruction and infarction

117

Percussion in bowel obstruction

tympanic

118

when does surveillance for neoplasia usually start in a patient with IBD and primary sclerosing cholangitis

at the time of diagnosis

119

caused by inherited mutations in genes that encode proteins responsible for the detection, excision, and repair of errors that occur during DNA replication

HNPCC

120

most common sites for Crohn's at presentation

-terminal Ileum
-Ileocecal valve
-Cecum

121

metastasis of carcinomas of anal region

they skip liver

122

IBD: higher risk for primary sclerosing cholangitis

UC

123

What can provide symptomatic improvement in diverticular disease

diets supplemented with fiber

124

Pediatric infectious diarrhea which may result in severe dehydration and metabolic acidosis is commonly caused by what

enteric viruses

125

What is the standard therapy for individuals carrying APC mutations

prophylactic colectomy

126

most frequent hernia in U.S.

inguinal

127

What must be considered in a patient with abdominal pain, diarrhea, and weight loss, despite having a strict gluten-free diet

cancer or refractory sprue

128

reciprocal translocation, t(11,22)
EWS and WT1 fusion gene

desmoplastic small round cell tumor

129

describe the surveillance for cancer of those with Peutz-Jeghers Syndrome

-beginning at birth for sex cord tumors of testes
-late childhood for gastric and small intestinal cancers
-2nd and 3rd decades for colon, pancreatic, breast, lung, ovarian, and uterine

130

Shigella infections most prominent in what location of the body

left colon

131

Twisting of a loop of bowel about its mesenteric point of attachment

volvulus

132

Which IBD: PANETH CELL METAPLASIA in Left colon where paneth cells are normally absent

Crohn

133

What is one of the most feared long term complication of UC and Crohn

development of neoplasia

134

most common pattern of ischemic bowel disease

segmental or patchy but can be continuous

135

-PAS-positive
-Rod-shaped bacilli

Whipple disease

136

What are the 4 phases of nutrient absorption

-intraluminal digestion
-Terminal digestion
-transepithelial transport
-lymphatic transport of absorbed lipids

137

age for celiac disease

gender

30 to 60

in adults, twice as frequent in women

138

poor prognostic factors for ischemic bowel disease

-right side
-COPD
-persistence of symptoms for more than 2 weeks

139

most common neoplastic polyp

adenoma . . which has potential to progress to cancer

140

What are the two most important prognostic factors in colonic adenocarcinoma

-depth of invasion
-presence of lymph node metastases

141

Intussusception is rare in older children and adults and is generally caused by what?

intraluminal mass or tumor that serves as the leading edge

142

semi distinguishing symptoms of those with diverticular disease

-sensation of never being able to completely empty the rectum
-alternating constipation and diarrhea

143

periumbilical pain that ultimately localizes to right lower quadrant

appendicitis

144

Rare autosomal dominant syndrome presents with multiple GI hamartomatous polyps and mucocutaneous hyperpigmentation

Peutz-Jeghers syndrome

145

This occurs when dysplastic epithelial cells breach the basement membrane to invade the lamina propria or muscularis mucosa

intramucosal carcinoma

146

Biopsy of what segments is generally diagnostic of celiac disease

second portion of duodenum and proximal jejunum

147

multiple, separate, sharply delineated areas of disease, resulting in SKIP LESIONS

Crohn

148

surveilance of adenomas in the US

all adults by age 50

149

therapy for autoimmune enteropathy

-cyclosporine
-in rare cases, hematopoietic stem cell transplantation

150

Despite the severe diarrhea, Vibrio (cholera) organismas are what?

noninvasive and remain within the intestinal lumen

151

Where are the fibrosing strictures of Crohn found

terminal ileum

152

MYH-associated polyposis compared to FAP

-polyp development at later ages
-fewer than 100 adenomas
-delayed appearance of colon cancer, often at 50 or older

153

extraintestinal complications of campylobacter

-erythema nodosum
-GUILLAIN-BARRE syndrome, a flaccid paralysis caused by immunologically mediated inflammation of peripheral nerves

154

Colorectal adenoma are characterized by the presence of what

epithelial dysplasia

155

biggest complication of shigella

Hemolytic uremic syndrome (HUS)

156

characterized by chronic, relapsing abdominal pain, bloating, and changes in bowel habits

Irritable bowel syndrome (IBS)

157

which type of juvenile polyps are usually solitary and may also be referred to as retention polyps

sporadic

158

Diverticula location in Western populations

sigmoid

159

what polyp: intussusception, intestinal obstruction, or polyp prolapse through the anal sphincter may occur

juvenile polyps

160

many colon cancers withough APC mutations harbor what?

B-catenin mutations

161

most pancreatic cancers are what

adenocarcinomas

162

most common age for ischemic disease of the colon

gender

older than 70

slightly more in women

163

what type of people are often severely affected by Giardia

-immunosuppressed
-agammaglobulinemic
-malnourished

164

What pharmocologic agents have protective effects against colorectal cancer

aspirin or other NSAIDs

165

pediatric celiac disease age and gender

6-24 months

males=females

166

-intraepithelial CD8+ lymphocytes
-crypt hyperplasia
-Villous atrophy

Celiac disease

167

After an incubation period of up to 1 week, Shigella causes self-limited disease characterized by what?

1 week of diarrhea, fever, and abdominal pain

168

Rare autosomal recessive disease characterized by an inability to secrete triglyceride-rich lipoproteins

Abetalipoproteinemia

169

IBD: Marker Lymphoid reaction, fibrosis, and serositis

Crohn

170

age and gender of collagenous colitis

middle aged and older women

171

Pure squamous cell carcinoma of the anal canal is frequently associated with what infection?

This can also cause what precursor lesion?

HPV

Condyloma acuminatum

172

peritonitis caused by leakage of bile or pancreatic enzymes

sterile peritonitis

173

ethnicity for IBD

-most common in caucasians in US
-3-5 times more in Ashkenazi Jews in Europe

174

Psuedomembranous colitis

C. diff

175

What part of GI tract is most often involved in obstruction

small intestine

176

Painful, bloody, small-volume diarrhea

dysentery

177

What patients are particularly susceptible to Salmonella osteomyelitis

Sickle cell patients

178

-common shaped- flagellated gram-negative
-incubation period of up to 8 days
-watery-diarrhea, either acute or following an influenza-like prodrome

campylobacter

179

progression of colonic diverticular disease

will resolve spontaneously

180

in transmural infarction, what does the infarcted bowel look like initially?

Later?

intensely congested and dusky to purple-red

blood tinged mucus or frank blood accumulated in lumen and wall becomes edematous, thickened, and rubbery

181

Initial attack of UC

may be severe enough to constitute a medical or surgical emergency

182

-APC mutation
-medulloblastoma
-glioblastoma

Turcot syndrome

183

IBD: recurrence after surgery common

Crohn

184

When does surveillance for neoplasia usually start with IBD

8 years after diagnosis

185

two phases of intestinal response to ischemia

-hypoxic injury (initial)
-reperfusion injury (second)

186

Polyp: ARBORIZATION and presence of SMOOTH muscle intermixed with lamina propria

Peutz-Jeghers

187

What may develop in colonic Crohn

iron deficiency anemia

188

What are the principal cause of traveler's diarrhea and spread via contaminated food and water

ETEC

189

another name for Hereditary non-polyposis colorectal cancer (HNPCC)

Lynch syndrome

190

Creeping fat

Crohn

191

Tell me about the risk of neoplasia after a colectomy in a FAP patient

-risk at other sites
-Adenomas may develop in GI tract, particularly adjacent to the ampulla of Vater and in the stomach

192

prognosis for tumors of peritoneal cavity

Grave

193

Location of Indeterminate colitis

NO small bowel
-continuous colonic disease
-patchy histology and Crohn features

194

normal true diverticulum of cecum prone to acute and chronic inflammation

appendix

195

2 Hamartomatous polyp syndromes

-juvenile polyps
-Peutz-Jeghers syndrome

196

in Graft-versus-Host disease, what part of GI is usually involved

small bowel and colon

197

individuals with celiac have higher than normal rate of what?

malignancy

198

what IBD; strictures

Crohn

199

what is the goal of surveillance biopsies

to identify dysplastic epithelium which is a precursor to colitis associated carcinoma

200

age for Peutz-Jeghers syndrome

10-15 (median of 11)

201

hallmark of malabsorption

Steatorrhea

202

IBD: NO GRANULOMAS

UC

203

Acanthocytic red cell (burr cell)

Abetalipoproteinemia

204

What is the most common epigenetic event that may enhance progression along either pathway in the pathogeneis of colorectal adenocarcinoma

methylation induced gene silencing

205

arthritis, urethritis, and conjunctivitis in HLA-B27-positive men between 20 and 40

Shigella

206

archaic term given to an anal canal tumor that the entirety displays basaloid pattern

cloacogenic carcinoma

207

APC and Wnt pathway

FAP

208

diarrhea in salmonella

-clinically indistinguishable from other enteric pathogens
-range from loose stools to cholera-like profuse diarrhea to dysentery

209

intraepithelial neoplasms that range from small, often pedunculated polyps to large sessile lesions

adenomas

210

ECM1, which inhibits matrix metalloproteinase 9

UC, but NOT Crohn

211

Clinical manifestations of intestinal obstruction

-abdominal pain and distention
-vomiting
-constipation

212

chronic bowel ischemia is accompanied by what

fibrous scarring of the lamina propria

213

alcohol-soluble fraction of gluten that contains most of the disease producing components

Gliadin

214

region most often affected by volvulus

-large redundant loops of sigmoid colon

-then cecum, small bowel, stomach or rarely transverse colon

215

Spontaneous bacterial peritonitis is seen most often in what patients

-cirrhosis
-less frequent in children with nephrotic syndrome

216

What are things that may lead to development of adhesion between bowel segmens

-surgical procedures
-infection
-peritoneal inflammation such as endometriosis

217

surveilance for adenomas in those with family history of colorectal adenocarcinoma

at least 10 years before the youngest age at which a relative was diagnosed

218

superior hemorrhoidal plexus within distal rectum

internal hemorrhoids

219

FOX3P mutation

IPEX . . severe familial form of autoimmune enteropathy
-immune dysregulation, polyendocrinopathy, enteropathy, and X-linkage

220

IBD with fissures and ulcers

Crohn

221

this microscopic colitis shows strong association with celiac disease and autoimmune diseases including Graves, RA, and gastritis

lymphocytic colitis

222

Geography for IBD

most common in North America, northern Europe, and Australia

223

chronic condition resulting from inappropriate mucosal immune activation

Inflammatory Bowel Disease (IBD)

224

Serrated surface architecture is the morphologic hallmark of these . . serration restricted to upper third or less of the crypt

hyperplastic polyp

225

describe the KRAS mutation and its relationship to size of adenocarcinoma

-mutation in less than 10% of adenomas less than 1 cm
-but in 50% of adenomas greater than 1 cm

226

what ethnic groups get the acquired form of lactase deficiency which is due to down-regulation of lactase gene expression

-Native Americans
-African Americans
-Chinese

227

histologic criteria for sessile serrated adenoma

serrated architecture throughout the full length of the glands

228

What IBD: microscopically, clusters of neutrophils within a crypt referred to as CRYPT ABSCESSES

Crohn

-similar to UC actually but with this it will be diffuse and will only involve mucosa and submucosa

229

Adonocarcinomas of proximal colon grow how?

Obstruction?

polypoid, exophytic masses

No

230

This disease can lead to intestinal obstruction but commonly results in formation of pancreatic intraductal concretions . . .leads to exocrine pancreatic insufficiency in 80%

Cystic fibrosis

231

watershed areas most vulnerable to ischemia by generalized hypoperfusion

-splenic flexure (inferior and superior mesenteric)

-less commonly sigmoid colon and rectum (inferior mesenteric, pudendal, and iliac arteries)

232

Polyp: forms as part of the solitary rectal ulcer syndrome (SRUS): triad of rectal bleeding, mucus discharge, and an inflammatory lesion of the anterior rectal wall

Inflammatory polyp

233

Hypermethylation and pancreatic cancer

-CDKN2A leads to silencing and loss of function

234

in HNPCC where do majority of mutations due to impaired DNA repair occur

microsatellites

235

-APC mutation
-Osteomas
-thyroid and desmoid tumors
-skin cysts

Gardner syndrome

236

Linear mucosal ulcer which impart a cobbliestone appearance

Crohn

237

most common parasitic pathogen in humans

Giardia lamblia

238

describe the classic adenoma-carcinoma sequence . . . mutation of APC

-no degredation of B-catenin so it accumulates and goes into nucleus
-activates MYC and cyclin D1
-these promote proliferation

239

Hyperplastic polyps are significant because they need to be differentiated from what, which are histologically similar and DO have malignant potential

sessile serrated adenoma

240

Microscopic colitis encompasses what two entities

-collagenous colitis
-lymphocytic colitis

241

age of colon cancer in HNPCC compared to sporadic colon cancers

-younger ages

242

IBD: 20% with right lower quadrant pain, fever, and bloody diarrhea that may mimic acute appendicitis

Crohn

243

risk of dysplasia in IBD is related to what factors

-duration of disease
-extend of disease
-Nature of the inflammatory response

244

Describe the steps of how gliadin causes celiac disease

-induce epithelial cells to express IL-15
-this activates CD8+ cells which express NKG2D
-NKG2D is a receptor for MIC-A
-Enterocytes that have been induced to express MIC-A, in response to stress, are attacked by the NKG2D CD8+ cells
-this enhances passage of gliadin into lamina propria where is can get deaminated by tissue transglutaminase

245

most common malignancy of the GI tract and major cause of morbidity and mortality

adenocarcinoma

246

Vast majority of juvenile polyps occur in what age

children younger than 5

247

what responses are important for clearance of Giardia

secretory IgA and mucosal IL-6

248

ischemic disease and highly atypical "radiation fibroblasts" within the stroma

radiation enterocolitis

249

disorder prevalent in areas and populations with poor sanitation and hygiene (sub-saharan Africa, Gambia, Northern Australia, South american and Asia, Brazil, Guatemala, India, Pakistan)

Environmental enteropathy

250

those with environmental enteropathy often suffer from what/

-malabsorption and malnutrition
-stunted growth
-defective intestinal mucosal immune functions

251

time frame for death in cholera infection

within first 24 hours

252

2 main compenents of pathogenesis of IBD

-mucosal immune responses
-Epithelial defects

253

IBD: broad based ulcers

UC

254

The underlying cause of iron deficiency anemia in an older man or postmenopausal woman is what until proven otherwise

GI cancer

255

under 50, right sided colon cancer

-MLH1 and MSH2
-sessile serrated adenoma

256

Colonic diverticula are rare younger than what age

30

257

lower third anal canal epithelium

stratified squamous epithelium

258

acquired lactase deficiency can develop following what

enteric viral or bacterial infections

259

Do a majority of adenomas progress to become adenocarcinomas

No

260

Smoking and UC

-initial onset has occurred shortly after cessation
-smoking can partially RELIEVE symptoms

261

Rose spots: erythematous maculopapular lesions on chest and abdomen

Salmonella typhi (typhoid fever)

262

Association of celiac disease and neurologic disorders

-Ataxia
-Autism
-depression
-epilepsy
-Down syndrome
-Turner syndrome

263

What is positive in more than 90% of affected individuals during the febrile phase of Typhoid fever?

What can prevent further disease progression?

Blood cultures

Antibiotic treatment

264

Epidemiology for Whipple

caucasian men, particularly farmers

265

What has revolutionized treatment of Crohn disease

Anti-TNF antibodies

266

hyperplastic polyp and malignancy

WITHOUT malignant potential

267

X-linked disorder characterized by severe persistent diarrhea . . often in young children

Autoimmune enteropathy

268

what type of places is Cholera common

-poor sanitation
-inadequate public health measures
-natural disasters

269

30-50% of patients with juvenile polyposis develop what?

colonic adenocarcinoma by age 45

270

Most common bacterial enteric pathogen in developed countries and an important cause of traveler's diarrhea

Campylobacter Jejuni

271

segment of intestine, constricted by a wave of peristalsis, telescopes into immediately distal segement

intussusception

272

location of HNPCC cancers

right colon

273

What is the most common acquired GI emergency in neonates, particularly those who are premature or of low birth weight

when does it present

Necrotizing enterocolitis (NEC)

when oral feeding is initialed

274

what are the two genetic pathways in the pathogenesis of colorectal adenocarcinoma

-APC/B-catenin pathway
-microsatellite instability pathway

275

diarrhea and defects in physical and cognitive development . . . childhood deaths worldwide

environmental enteropathy

276

age for colorectal cancer

Peaks at 60 to 70

277

Autoantibodies to what are common in autoimmune enteropathy

enterocytes and goblet cells

278

underlying mechanism of reperfusion injury include what

-leakage of gut lumen bacterial products (lipopolysaccharide) into systemic circulation
-free radical production
-neutrophil infiltration
-release of inflammatory mediators

279

The link of angiodysplasia and what, suggests possibility of a developmental component

Meckel diverticulum

280

HNFA

UC, but NOT Crohn

-strongly associted with maturity onset diabetes of the young (MODY)

281

What is the most important characteristic of an adenoma that correlates to risk of malignancy?

give specifics

Size

cancer extremely rare in adenomas less than 1 cm

40% of lesions larger than 4 cm contain foci of cancer

282

Cholera primarily transmitted how

contaminated drinking water

283

likely to cause large outbreaks of bloody diarrhea, Hemolytic uremic syndrome (HUS), and ischemic colitis

0157:H7 EHEC

284

What are the major variables in ischemic bowel disease

-severity of vascular compromise
-time frame which it develops
-vessels affects

285

excessive fecal fat and bulky, frothy, greasy, yellow or clay colored stools

steatorrhea

286

gender for acute appendicitis

males slightly more than females

287

most common soft tissue tumor of peritoneum

describe it

desmoplastic small round cell tumor

aggressive
occurs in children and young adults
resembles Ewing sarcoma

288

most infections of Campylobacter are from what?

ingestion of improperly cooked chicken. outbreaks also caused by unpasteurized mild or contaminated water

289

gram-negative UNencapsulated, nonmotile, facultative anaerobe

Shigella

290

treatment needed for cholera

fluid replacement

291

Giardia infection is usually documented by what

immunofluorescent detection of cysts in stool samples

292

ATG16L1 and IRGM;

what type of pathways

Crohn

autophagy

293

most common agents that infect the peritoneum following perforation

-E. coli
-Strep
-Staph
-enterococci
-C. perfringens

294

These adenocarcinomas are most often called to clinical attention by appearance of fatique and weakness due to iron deficiency anemia

cecal and right sided colon cancers

295

IBD that may involve any area of GI tract and is transmural

Crohn

296

underlying causes of environmental enteropathy

unknown

297

Diverticula in Asia and Africa affect what part of colon

right

298

transmission of Giardia

fecally contaminated water or food

299

Variants of FAP from other APC mutations

-Gardner syndrome
-Turcot syndrome

300

serrated polyps with KRAS mutations are frequently present in what

MUTYH-associated polyposis

301

Extent of disease and Neoplasia in IBD

pancolitis has greater risk than those with only left-sided disease

302

Acquired pseudodiverticular outpouchings of the colonic mucosa and submucosa

Diverticular disease

303

depth of mural infarction

mucosa and submucosa

304

Most common affected of Shigella

-children in daycare
-migrant workers
-travelers to developing countries
-those in nursing homes

305

describe shape and gram of Salmonella

gram-negative bacillia

306

what two aspects of intestinal vascular anatomy contribute to the distribution of ischemic damage

-watershed zones
-intestinal capillaries

307

characterized by malformed submucosal and mucosal blood vessels

Angiodysplasia

308

age and gender for adenomas

small male predominance
-30% of adults by age 60

309

asbestos

mesotheliomas

310

malabsorptive diarrhea due to impaired lymphatic transport

Whipple disease

311

UC of entire colon

Pancolitis

312

Except for pregnant women, hemorrhoids are rarely encounter in persons younger than what age?

30

313

extraintestinal complications include encephalopathy, meningitis, seizures, endocarditis, myocarditis, pneumonia, and cholecytisis

Typhoid fever

314

Extraintestinal manifestations of Crohn

similar to UC

-Uveitis
-Migratory polyarthritis
-sacroilitis
-ankylosing spondylitis
-erythema nodosum
-clubbing of fingertips

315

mutations of base-excision repair gene MYH (or MUTYH)?

referred to as what

polyposis patients without APC loss

MYH-associated polyposis

316

Pathogenesis of IBS is poorly defined but there in clear interplay between what?

psychologic stressors and diet

317

most common celiac associated cancer

enteropathy-associated T-cell lymphoma

also small intestinal adenocarcinoma

318

If a celiac patient has IgA deficiency, what serological evidence will help diagnose

IgG against anti-tissue transglutaminase

319

depth of mucosal infarction

no deeper than muscularis mucosa

320

Location and age for angiodysplasia

-most often cecum or right colon
-after the sixth decade of life

321

What is a key negative regulator of B-catenin, a component of the Wnt signaling pathway

APC

322

polyps of peutz-Jeghers most common where

small intestine

323

When should surgical intervention be considered in ischemic bowel disease

if peristaltic sounds diminish or disappear . . paralytic ileus
-guarding or rebound tenderness

324

-dense accumulation of distended, foamy macrophages in the small intestinal lamina propria

Whipple disease

325

2 forms of IBD

ulcerative colitis (UC) and Crohn disease

326

Serology found Crohn but not UC

antibodies to Saccharomyces cerevisiae

327

Acquired hernias typically occur anteriorly via what?

-inguinal and femoral canals
-umbilicus
-sites of surgical scars

328

-occurs with lactase deficiency
-due to excessive osmotic forces exerted by unabsorbed luminal solutes
-diarrhea fluid is more than 50 mOsm more concentrated than plasma and ABATES (gets better) during fasting

Osmotic

329

which type of lactase deficiency: Abdominal fullnes, diarrhea, and flatulence

acquired

330

follows generalized failure of nutrient absorption and is associated with steatorrhea and is RELIEVED by fasting

malabsorptive diarrhea

331

Hemorrhoids develop secondary to what?

persistantly elevated venous pressure within the hemorrhoidal plexus

332

ischemic bowel disease may occur from endothelial damage and small vessel occlusion after what infections

-CMV
-E. coli 0157:H7

333

serology found in 75% of UC but only 11% of Crohn

peri-nuclear anti-neutrophil cytoplasm antibodies

334

hamartomatous polyps that can cause intussusception and is occasionally fatal. . . Also has MARKEDLY increased risk of several malignancies

Peutz-Jeghers syndrome

335

Most common tumor of appendix

well differentiated neuroendocrine tumor (carcinoid)

336

age for IBD

present in teens and early 20s

337

Chronic malabsorption can be accompanied by what?

-weight loss
-anorexia
-abdominal distention
-borborygmi
-muscle wasting

338

What is the most common syndromic form of colon cancer

Lynch syndrome/HNPCC

339

Hypertrophy of the circular layer of muscularis propria in affected bowel is common

colonic diverticula

340

symptoms of cholera infectious enterocholitis

-dehydration
-hypotension
-muscular cramping
-anuria
-shock
-loss of consciousness
-DEATH

341

middle third anal canal epithelium

transitional

342

inheritance for congenital lactase deficiency

autosomal recessive

343

location and size for hyperplastic polyp

Left colon and less than 5 mm

344

-pear shape
-2 equally sized nuclei

Giardia

345

transmission of salmonella

ingestion of contaminated food, particularly raw or undercook meat, poultry, eggs, and milk

346

time frame for coagulative necrosis to occur in muscularis propria in transmural infarction

1 to 4 days

347

also referred to as antibiotic-associated colitis or antibiotic associated diarrhea

Psuedomembranous colitis

348

Which type of juvenile polyp is dysplasia extremely rare?

Common?

sporadic

juvenile polyposis syndrome

349

NOD2

Crohn

350

Which phase of intesinal response to ischemia? . . some damage but epithelial cells lining intestine are relatively resistant to transient hypoxia

hypoxic injury

351

These polyps are associated with syndromes that often have increased cancer risk and are thus considered to be pre-malignant neoplastic lesions, much like adenoma

hamartomatous polyps

352

Dark blue to brown macules on the lips, nostrils, BUCCAL MUCOSA, palmar surfaces of hands, genitalia, and perianal region

Peutz-Jeghers syndrome

353

cutaneous granulomas that form nodules in Crohn disease are called what

metastatic Crohn disease
-misnomer because it is NOT cancer

354

comma-shaped gram-negative bacteria endemic in Ganges Valley of India and Bangladesh

Cholera

355

flagellated protozoans that cause decreased expression of brush border enzymes, including lactase

Giardia

356

Polyp: benign epithelial proliferations that are typically discovered in the 6th and 7th decades of life

hyperplastic polyp

357

STK11

Peutz-Jeghers syndrome

358

3 disease that have defects in intraluminal digestion

-Chronic pancreatitis
-Cystic fibrosis

359

Most, if not all, polyps begin as small elevations of the mucosa referred to as what?

sessile

360

age and gender for IBS

females 20-40

361

MSH2 or MLH1

HNPCC

362

due to inflammatory disease and is characterized by purulent, bloody stools that CONTINUE during fasting

exudative diarrhea

363

Relapsing disorder characterized by attacks of bloody diarrhea with stringy mucoid material, lower abdominal pain, and cramps that are temporarily relieved by defacation

UC

364

primary malignant tumors arising from peritoneal lining

mesotheliomas

365

Oil red-O stain . . especially after a meal

Abetalipoproteinemia

366

complications of a hernia

-obstruction
-incarceration
-strangulation

367

dietary factors most closely associated with increased rates of colorectal cancer

-low intake of unabsorbable vegetable fiber
-high intake of refine carbohydrates