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GI 2 COPY > path slide set 3 > Flashcards

path slide set 3 Flashcards

1
Q

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

A

Left sided colorectal adenocarcinoma

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2
Q

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

A

Crohn and a subset of their healthy 1st degree relatives

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3
Q

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

A

IL-23 receptor

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4
Q

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

A

adhesions

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5
Q

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

A

hyperplastic polyp

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6
Q

MTP mutations

A

Abetalipoproteinemia

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7
Q

3 classifications of adenomas

A
  • tubular
  • tubulovillous
  • villous
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8
Q

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

A

UC

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9
Q

where is highest incidence of adenocarcinoma

A

North America

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10
Q

histology of lymphocytic colitis

A

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

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11
Q

Ectatic nests, tortuous veins, venules, and capillaries

-limited injury may result in significant bleeding

A

Angiodysplasia

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12
Q

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

A

Colonic diverticula

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13
Q

What is the most frequent cause of intestinal obstruction WORLDWIDE

A

hernias

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14
Q

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

A

contrast enemas

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15
Q

intestinal hypoperfusion can be associated with what?

A
  • cardiac failure
  • shock
  • dehydration
  • vasoconstrictive drugs
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16
Q

Most common site of metastasis for colonic adenocarcinoma

A

liver

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17
Q

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

A

Colonic diverticula

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18
Q

IBD: fistulae

A

Crohn

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19
Q

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

A

congenital lactase deficiency

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20
Q

What may develop in extensive small bowel Crohn

A
  • serum protein loss
  • hypoalbuminemia
  • generalized nutrient malabsorption
  • malabsorption of B12 and bile salts
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21
Q

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

A

8-10 years

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22
Q

depth of transmural infarction

A

all three wall layers

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23
Q

Polyps are most common where

A

colo-rectal regions

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24
Q

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

A

Crohn

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25
Q

important causes of acute arterial obstruction

A
  • 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)
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26
Q

risk factors for C. diff associated colitis

A
  • advanced age
  • hospitalization
  • antibiotic treatment
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27
Q

upper anal canal epithelium

A

columnar rectal

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28
Q

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

A

congenital hypertrophy of the retinal pigment epithelium

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29
Q

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

A

shigella

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30
Q

histology of collagenous colitis

A

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

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31
Q

bright red seen on toilet tissue

A

hemorrhoids

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32
Q

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

A

colectomy

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33
Q

4 major categories of diarrhea

A
  • Secretory
  • Osmotic
  • Malabsorptive
  • exudative
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34
Q

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

A

200 grams per day

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35
Q

IBD: toxic megacolon

A

UC

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36
Q

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

A

Hamartomatous polyps

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37
Q

at least 100 polyps

A

FAP

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38
Q

Describe the cysts of Giardia and what this causes

A
  • resistant to chlorine

- endemic in unfiltered public water supplies

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39
Q

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

A

6 to 24 months

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40
Q

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

A

oral enzyme supplementation

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41
Q

Giardia trophozoites can be identified where

A

duodenal biopsies

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42
Q

inferior hemorrhoid plexus below anorectal line

A

external hemorrhoids

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43
Q

from 3 to 100 hamartomatous polyps and may require colectomy

A

autosomal dominant syndrome of jevenile polyposis

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44
Q

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

A

KRAS

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45
Q

Distribution of adenocarcinomas

A

approximately equally over entire colon

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46
Q

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

A

pseudomembrane formation that resembles clostridium difficile

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47
Q

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

A
  • anemia
  • female infertility
  • osteoporosis
  • cancer
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48
Q

itchy, blistering skin lesion called dermatitis herpetiformis

A

celiac disease

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49
Q

When does Abetalipoproteinemia present?

What symptoms

A

at infancy

-failure to thrive, diarrhea, steatorrhea

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50
Q

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

A

Indeterminate Colitis

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51
Q

Cancer and Crohn

A

increased risk of colonic adenocarcinoma

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52
Q

NOD2 leads to what pathway

A

NF-kB

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53
Q

Abrupt onset of watery diarrhea and vomiting following an incubation period of 1 to 5 days

  • voluminous RICE WATER stools
  • FISHY odor
A

Cholera

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54
Q

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

A

inflammatory polyp

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55
Q

most juvenile polyps are located where?

present with what?

A

rectum

rectal bleeding

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56
Q

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

A

colorectal adenocarcinoma

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57
Q

HLAs and celiac disease

A

DQ2 and DQ8

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58
Q

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

A

Crohn patients who have NOD2 variants

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59
Q

mucosal and mural infarctions cann follow what

A

acute or chronic hypoperfusion

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60
Q

most common approach for surveillance of adenomas

A

colonoscopy

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61
Q

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

A

older than 60

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62
Q

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

A

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

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63
Q

association of celiac disease and what other immune diseases

A
  • type 1 diabetes
  • thyroiditis
  • Sjogren
  • IGA nephropathy
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64
Q

most frequent predisposing influences for hemorrhoids?

A
  • straining at defacation because of constipation
  • venous stasis of pregnancy
  • portal HTN
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65
Q

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

A
  • pancreatic insufficiency
  • celiac disease
  • Crohn Disease
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66
Q

in Whipple disease, where can bacteria laden macrophages accumulate

A
  • mesenteric lymph nodes
  • synovial membranes of affected joints
  • cardiac valves
  • brain
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67
Q

Courvoisier’s sign

A

Jaundice and a palpable gallbladder . . pancreatic cancer

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68
Q

morphological signature of ischemic intestinal disease

A

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

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69
Q

eruption reminiscent of a volcano eruption from the crypt

A

C. diff

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70
Q

Most sensitive noninvasive serologic test for celiac, prior to biopsy

A

measure for IgA antibodies against tissue transglutaminase

IgA anti-endomysial antibodies also present

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71
Q

what type of diarrhea in shigella

A

Bloody

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72
Q

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

A

intussusception

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73
Q

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

A

development of numerous lymphoid follicles

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74
Q

IBD; polyps fuse to form mucosal bridges

A

UC

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75
Q

transmural infarction is typically caused by what

A

acute vascular obstruction

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76
Q

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

A

chromosome instability

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77
Q

treatment of hemorrhoidal bleeding

A
  • sclerotherapy
  • rubber band ligation
  • infrared coagulation
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78
Q

2 types of lactase deficiency

A

congenital and acquired

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79
Q

what kind of herniation does an adhesion cause

A

internal

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80
Q

what is the only disease that has defect in Lymphatic transport

A

Whipple disease

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81
Q

Abetalipoproteinema leads to deficiencies in what?

A

fat soluble vitamins as well as lipid membrane defects

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82
Q

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

A

Diversion Colitis

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83
Q

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

A

rotavirus vaccines, perhaps due to reactive hyperplasia of Peyer patches

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84
Q

Adenocarcinomas of distal colon

A
  • annular lesion
  • napkin ring constriction
  • sometimes obstruction
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85
Q

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

A

surgical intervention

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86
Q

clinical diagnosis of IBS requires what?

A

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

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87
Q

most common locations for sessile serrated adenoma

A

right colon

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88
Q

NO PATHOLOGIC ABNORMALITY

A

IBS

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89
Q

pathogenesis of angiodysplasia

A

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

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90
Q

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

A

intestinal graft-versus-host disease

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91
Q

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

A
  • physical or emotional stress
  • specific dietary items
  • CIGARETTE SMOKING
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92
Q

acute appendicitis most common in what age

A

adolescents and young adults

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93
Q

IPEX and FOXP3 mutations have defective functions of what cells

A

CD4+

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94
Q

which IBD: noncaseating Granulomas

A

Crohn

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95
Q

celiac disease in older children with nonclassical symptoms

Extraintestinal manifestations

A
  • constipation instead of diarrhea
  • bloating
  • vomiting
  • abdominal pain
  • arthritis/joint pain
  • apthous ulcers
  • stomatitis
  • iron deficiency anemia
  • delayed puberty
  • short stature
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96
Q

earliest lesion in Crohn

A

Aphthous ulcer

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97
Q

IBD with psuedopolyps and ulcers

A

UC

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98
Q

Classifications of NONneoplastic polyps

A
  • inflammatory
  • hamartomatous
  • hyperplastic
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99
Q

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

A

Basaloid

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100
Q

diarrhea characterized by isotonic stool and PERSISTS during fasting

A

Secretory

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101
Q

SMAD4 and BMPR1A

A

Juvenile polyposis

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102
Q

complete absence of all plasma lipoproteins containing apoliprotein B

A

Abetalipoproteinema

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103
Q

most shigells infections and deaths occur in who?

A

children younger than 5

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104
Q

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

A

reperfusion injury

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105
Q

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

A

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

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106
Q

Match symptom with deficiency: anemia and mucositis

bleeding

ostepenia and tetany

peripheral neuopathy

A
  • pyridoxine folate and vitamin B12
  • vitamin K
  • calcium, magnesium, or vitamin D
  • vitamin A or B12
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107
Q

Inflammatory response and neoplasia in IBD

A

Neutrophils confers increased risk

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108
Q

Acute colonic ischemia typically presents with what

A

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

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109
Q

young person. Family history breast and pancreas cancer.

A

HNPCC

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110
Q

IBD: deep, knife like ulcer

A

Crohn

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111
Q

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

A

Familial adenomatous polyposis (FAP)

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112
Q

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

A

HLA-B27

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113
Q

most common histological finding in Graft-versus-host disease

A

Epithelial apoptosis particularly of crypt cells

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114
Q

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

A

hernia

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115
Q

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

A

UC

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116
Q

results of a volvulus

A

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

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117
Q

Percussion in bowel obstruction

A

tympanic

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118
Q

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

A

at the time of diagnosis

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119
Q

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

A

HNPCC

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120
Q

most common sites for Crohn’s at presentation

A
  • terminal Ileum
  • Ileocecal valve
  • Cecum
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121
Q

metastasis of carcinomas of anal region

A

they skip liver

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122
Q

IBD: higher risk for primary sclerosing cholangitis

A

UC

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123
Q

What can provide symptomatic improvement in diverticular disease

A

diets supplemented with fiber

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124
Q

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

A

enteric viruses

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125
Q

What is the standard therapy for individuals carrying APC mutations

A

prophylactic colectomy

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126
Q

most frequent hernia in U.S.

A

inguinal

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127
Q

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

A

cancer or refractory sprue

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128
Q

reciprocal translocation, t(11,22)

EWS and WT1 fusion gene

A

desmoplastic small round cell tumor

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129
Q

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

A
  • 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
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130
Q

Shigella infections most prominent in what location of the body

A

left colon

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131
Q

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

A

volvulus

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132
Q

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

A

Crohn

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133
Q

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

A

development of neoplasia

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134
Q

most common pattern of ischemic bowel disease

A

segmental or patchy but can be continuous

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135
Q
  • PAS-positive

- Rod-shaped bacilli

A

Whipple disease

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136
Q

What are the 4 phases of nutrient absorption

A
  • intraluminal digestion
  • Terminal digestion
  • transepithelial transport
  • lymphatic transport of absorbed lipids
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137
Q

age for celiac disease

gender

A

30 to 60

in adults, twice as frequent in women

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138
Q

poor prognostic factors for ischemic bowel disease

A
  • right side
  • COPD
  • persistence of symptoms for more than 2 weeks
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139
Q

most common neoplastic polyp

A

adenoma . . which has potential to progress to cancer

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140
Q

What are the two most important prognostic factors in colonic adenocarcinoma

A
  • depth of invasion

- presence of lymph node metastases

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141
Q

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

A

intraluminal mass or tumor that serves as the leading edge

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142
Q

semi distinguishing symptoms of those with diverticular disease

A
  • sensation of never being able to completely empty the rectum
  • alternating constipation and diarrhea
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143
Q

periumbilical pain that ultimately localizes to right lower quadrant

A

appendicitis

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144
Q

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

A

Peutz-Jeghers syndrome

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145
Q

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

A

intramucosal carcinoma

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146
Q

Biopsy of what segments is generally diagnostic of celiac disease

A

second portion of duodenum and proximal jejunum

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147
Q

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

A

Crohn

148
Q

surveilance of adenomas in the US

A

all adults by age 50

149
Q

therapy for autoimmune enteropathy

A
  • cyclosporine

- in rare cases, hematopoietic stem cell transplantation

150
Q

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

A

noninvasive and remain within the intestinal lumen

151
Q

Where are the fibrosing strictures of Crohn found

A

terminal ileum

152
Q

MYH-associated polyposis compared to FAP

A
  • polyp development at later ages
  • fewer than 100 adenomas
  • delayed appearance of colon cancer, often at 50 or older
153
Q

extraintestinal complications of campylobacter

A
  • erythema nodosum

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

154
Q

Colorectal adenoma are characterized by the presence of what

A

epithelial dysplasia

155
Q

biggest complication of shigella

A

Hemolytic uremic syndrome (HUS)

156
Q

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

A

Irritable bowel syndrome (IBS)

157
Q

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

A

sporadic

158
Q

Diverticula location in Western populations

A

sigmoid

159
Q

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

A

juvenile polyps

160
Q

many colon cancers withough APC mutations harbor what?

A

B-catenin mutations

161
Q

most pancreatic cancers are what

A

adenocarcinomas

162
Q

most common age for ischemic disease of the colon

gender

A

older than 70

slightly more in women

163
Q

what type of people are often severely affected by Giardia

A
  • immunosuppressed
  • agammaglobulinemic
  • malnourished
164
Q

What pharmocologic agents have protective effects against colorectal cancer

A

aspirin or other NSAIDs

165
Q

pediatric celiac disease age and gender

A

6-24 months

males=females

166
Q
  • intraepithelial CD8+ lymphocytes
  • crypt hyperplasia
  • Villous atrophy
A

Celiac disease

167
Q

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

A

1 week of diarrhea, fever, and abdominal pain

168
Q

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

A

Abetalipoproteinemia

169
Q

IBD: Marker Lymphoid reaction, fibrosis, and serositis

A

Crohn

170
Q

age and gender of collagenous colitis

A

middle aged and older women

171
Q

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

This can also cause what precursor lesion?

A

HPV

Condyloma acuminatum

172
Q

peritonitis caused by leakage of bile or pancreatic enzymes

A

sterile peritonitis

173
Q

ethnicity for IBD

A
  • most common in caucasians in US

- 3-5 times more in Ashkenazi Jews in Europe

174
Q

Psuedomembranous colitis

A

C. diff

175
Q

What part of GI tract is most often involved in obstruction

A

small intestine

176
Q

Painful, bloody, small-volume diarrhea

A

dysentery

177
Q

What patients are particularly susceptible to Salmonella osteomyelitis

A

Sickle cell patients

178
Q
  • common shaped- flagellated gram-negative
  • incubation period of up to 8 days
  • watery-diarrhea, either acute or following an influenza-like prodrome
A

campylobacter

179
Q

progression of colonic diverticular disease

A

will resolve spontaneously

180
Q

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

Later?

A

intensely congested and dusky to purple-red

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

181
Q

Initial attack of UC

A

may be severe enough to constitute a medical or surgical emergency

182
Q
  • APC mutation
  • medulloblastoma
  • glioblastoma
A

Turcot syndrome

183
Q

IBD: recurrence after surgery common

A

Crohn

184
Q

When does surveillance for neoplasia usually start with IBD

A

8 years after diagnosis

185
Q

two phases of intestinal response to ischemia

A
  • hypoxic injury (initial)

- reperfusion injury (second)

186
Q

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

A

Peutz-Jeghers

187
Q

What may develop in colonic Crohn

A

iron deficiency anemia

188
Q

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

A

ETEC

189
Q

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

A

Lynch syndrome

190
Q

Creeping fat

A

Crohn

191
Q

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

A
  • risk at other sites

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

192
Q

prognosis for tumors of peritoneal cavity

A

Grave

193
Q

Location of Indeterminate colitis

A

NO small bowel

  • continuous colonic disease
  • patchy histology and Crohn features
194
Q

normal true diverticulum of cecum prone to acute and chronic inflammation

A

appendix

195
Q

2 Hamartomatous polyp syndromes

A
  • juvenile polyps

- Peutz-Jeghers syndrome

196
Q

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

A

small bowel and colon

197
Q

individuals with celiac have higher than normal rate of what?

A

malignancy

198
Q

what IBD; strictures

A

Crohn

199
Q

what is the goal of surveillance biopsies

A

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

200
Q

age for Peutz-Jeghers syndrome

A

10-15 (median of 11)

201
Q

hallmark of malabsorption

A

Steatorrhea

202
Q

IBD: NO GRANULOMAS

A

UC

203
Q

Acanthocytic red cell (burr cell)

A

Abetalipoproteinemia

204
Q

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

A

methylation induced gene silencing

205
Q

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

A

Shigella

206
Q

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

A

cloacogenic carcinoma

207
Q

APC and Wnt pathway

A

FAP

208
Q

diarrhea in salmonella

A
  • clinically indistinguishable from other enteric pathogens

- range from loose stools to cholera-like profuse diarrhea to dysentery

209
Q

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

A

adenomas

210
Q

ECM1, which inhibits matrix metalloproteinase 9

A

UC, but NOT Crohn

211
Q

Clinical manifestations of intestinal obstruction

A
  • abdominal pain and distention
  • vomiting
  • constipation
212
Q

chronic bowel ischemia is accompanied by what

A

fibrous scarring of the lamina propria

213
Q

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

A

Gliadin

214
Q

region most often affected by volvulus

A
  • large redundant loops of sigmoid colon

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

215
Q

Spontaneous bacterial peritonitis is seen most often in what patients

A
  • cirrhosis

- less frequent in children with nephrotic syndrome

216
Q

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

A
  • surgical procedures
  • infection
  • peritoneal inflammation such as endometriosis
217
Q

surveilance for adenomas in those with family history of colorectal adenocarcinoma

A

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

218
Q

superior hemorrhoidal plexus within distal rectum

A

internal hemorrhoids

219
Q

FOX3P mutation

A

IPEX . . severe familial form of autoimmune enteropathy

-immune dysregulation, polyendocrinopathy, enteropathy, and X-linkage

220
Q

IBD with fissures and ulcers

A

Crohn

221
Q

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

A

lymphocytic colitis

222
Q

Geography for IBD

A

most common in North America, northern Europe, and Australia

223
Q

chronic condition resulting from inappropriate mucosal immune activation

A

Inflammatory Bowel Disease (IBD)

224
Q

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

A

hyperplastic polyp

225
Q

describe the KRAS mutation and its relationship to size of adenocarcinoma

A
  • mutation in less than 10% of adenomas less than 1 cm

- but in 50% of adenomas greater than 1 cm

226
Q

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

A
  • Native Americans
  • African Americans
  • Chinese
227
Q

histologic criteria for sessile serrated adenoma

A

serrated architecture throughout the full length of the glands

228
Q

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

A

Crohn

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

229
Q

Adonocarcinomas of proximal colon grow how?

Obstruction?

A

polypoid, exophytic masses

No

230
Q

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

A

Cystic fibrosis

231
Q

watershed areas most vulnerable to ischemia by generalized hypoperfusion

A
  • splenic flexure (inferior and superior mesenteric)

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

232
Q

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

A

Inflammatory polyp

233
Q

Hypermethylation and pancreatic cancer

A

-CDKN2A leads to silencing and loss of function

234
Q

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

A

microsatellites

235
Q
  • APC mutation
  • Osteomas
  • thyroid and desmoid tumors
  • skin cysts
A

Gardner syndrome

236
Q

Linear mucosal ulcer which impart a cobbliestone appearance

A

Crohn

237
Q

most common parasitic pathogen in humans

A

Giardia lamblia

238
Q

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

A
  • no degredation of B-catenin so it accumulates and goes into nucleus
  • activates MYC and cyclin D1
  • these promote proliferation
239
Q

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

A

sessile serrated adenoma

240
Q

Microscopic colitis encompasses what two entities

A
  • collagenous colitis

- lymphocytic colitis

241
Q

age of colon cancer in HNPCC compared to sporadic colon cancers

A

-younger ages

242
Q

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

A

Crohn

243
Q

risk of dysplasia in IBD is related to what factors

A
  • duration of disease
  • extend of disease
  • Nature of the inflammatory response
244
Q

Describe the steps of how gliadin causes celiac disease

A
  • 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
Q

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

A

adenocarcinoma

246
Q

Vast majority of juvenile polyps occur in what age

A

children younger than 5

247
Q

what responses are important for clearance of Giardia

A

secretory IgA and mucosal IL-6

248
Q

ischemic disease and highly atypical “radiation fibroblasts” within the stroma

A

radiation enterocolitis

249
Q

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)

A

Environmental enteropathy

250
Q

those with environmental enteropathy often suffer from what/

A
  • malabsorption and malnutrition
  • stunted growth
  • defective intestinal mucosal immune functions
251
Q

time frame for death in cholera infection

A

within first 24 hours

252
Q

2 main compenents of pathogenesis of IBD

A
  • mucosal immune responses

- Epithelial defects

253
Q

IBD: broad based ulcers

A

UC

254
Q

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

A

GI cancer

255
Q

under 50, right sided colon cancer

A
  • MLH1 and MSH2

- sessile serrated adenoma

256
Q

Colonic diverticula are rare younger than what age

A

30

257
Q

lower third anal canal epithelium

A

stratified squamous epithelium

258
Q

acquired lactase deficiency can develop following what

A

enteric viral or bacterial infections

259
Q

Do a majority of adenomas progress to become adenocarcinomas

A

No

260
Q

Smoking and UC

A
  • initial onset has occurred shortly after cessation

- smoking can partially RELIEVE symptoms

261
Q

Rose spots: erythematous maculopapular lesions on chest and abdomen

A

Salmonella typhi (typhoid fever)

262
Q

Association of celiac disease and neurologic disorders

A
  • Ataxia
  • Autism
  • depression
  • epilepsy
  • Down syndrome
  • Turner syndrome
263
Q

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

What can prevent further disease progression?

A

Blood cultures

Antibiotic treatment

264
Q

Epidemiology for Whipple

A

caucasian men, particularly farmers

265
Q

What has revolutionized treatment of Crohn disease

A

Anti-TNF antibodies

266
Q

hyperplastic polyp and malignancy

A

WITHOUT malignant potential

267
Q

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

A

Autoimmune enteropathy

268
Q

what type of places is Cholera common

A
  • poor sanitation
  • inadequate public health measures
  • natural disasters
269
Q

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

A

colonic adenocarcinoma by age 45

270
Q

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

A

Campylobacter Jejuni

271
Q

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

A

intussusception

272
Q

location of HNPCC cancers

A

right colon

273
Q

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

when does it present

A

Necrotizing enterocolitis (NEC)

when oral feeding is initialed

274
Q

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

A
  • APC/B-catenin pathway

- microsatellite instability pathway

275
Q

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

A

environmental enteropathy

276
Q

age for colorectal cancer

A

Peaks at 60 to 70

277
Q

Autoantibodies to what are common in autoimmune enteropathy

A

enterocytes and goblet cells

278
Q

underlying mechanism of reperfusion injury include what

A
  • leakage of gut lumen bacterial products (lipopolysaccharide) into systemic circulation
  • free radical production
  • neutrophil infiltration
  • release of inflammatory mediators
279
Q

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

A

Meckel diverticulum

280
Q

HNFA

A

UC, but NOT Crohn

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

281
Q

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

give specifics

A

Size

cancer extremely rare in adenomas less than 1 cm

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

282
Q

Cholera primarily transmitted how

A

contaminated drinking water

283
Q

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

A

0157:H7 EHEC

284
Q

What are the major variables in ischemic bowel disease

A
  • severity of vascular compromise
  • time frame which it develops
  • vessels affects
285
Q

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

A

steatorrhea

286
Q

gender for acute appendicitis

A

males slightly more than females

287
Q

most common soft tissue tumor of peritoneum

describe it

A

desmoplastic small round cell tumor

aggressive
occurs in children and young adults
resembles Ewing sarcoma

288
Q

most infections of Campylobacter are from what?

A

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

289
Q

gram-negative UNencapsulated, nonmotile, facultative anaerobe

A

Shigella

290
Q

treatment needed for cholera

A

fluid replacement

291
Q

Giardia infection is usually documented by what

A

immunofluorescent detection of cysts in stool samples

292
Q

ATG16L1 and IRGM;

what type of pathways

A

Crohn

autophagy

293
Q

most common agents that infect the peritoneum following perforation

A
  • E. coli
  • Strep
  • Staph
  • enterococci
  • C. perfringens
294
Q

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

A

cecal and right sided colon cancers

295
Q

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

A

Crohn

296
Q

underlying causes of environmental enteropathy

A

unknown

297
Q

Diverticula in Asia and Africa affect what part of colon

A

right

298
Q

transmission of Giardia

A

fecally contaminated water or food

299
Q

Variants of FAP from other APC mutations

A
  • Gardner syndrome

- Turcot syndrome

300
Q

serrated polyps with KRAS mutations are frequently present in what

A

MUTYH-associated polyposis

301
Q

Extent of disease and Neoplasia in IBD

A

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

302
Q

Acquired pseudodiverticular outpouchings of the colonic mucosa and submucosa

A

Diverticular disease

303
Q

depth of mural infarction

A

mucosa and submucosa

304
Q

Most common affected of Shigella

A
  • children in daycare
  • migrant workers
  • travelers to developing countries
  • those in nursing homes
305
Q

describe shape and gram of Salmonella

A

gram-negative bacillia

306
Q

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

A
  • watershed zones

- intestinal capillaries

307
Q

characterized by malformed submucosal and mucosal blood vessels

A

Angiodysplasia

308
Q

age and gender for adenomas

A

small male predominance

-30% of adults by age 60

309
Q

asbestos

A

mesotheliomas

310
Q

malabsorptive diarrhea due to impaired lymphatic transport

A

Whipple disease

311
Q

UC of entire colon

A

Pancolitis

312
Q

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

A

30

313
Q

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

A

Typhoid fever

314
Q

Extraintestinal manifestations of Crohn

similar to UC

A
  • Uveitis
  • Migratory polyarthritis
  • sacroilitis
  • ankylosing spondylitis
  • erythema nodosum
  • clubbing of fingertips
315
Q

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

referred to as what

A

polyposis patients without APC loss

MYH-associated polyposis

316
Q

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

A

psychologic stressors and diet

317
Q

most common celiac associated cancer

A

enteropathy-associated T-cell lymphoma

also small intestinal adenocarcinoma

318
Q

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

A

IgG against anti-tissue transglutaminase

319
Q

depth of mucosal infarction

A

no deeper than muscularis mucosa

320
Q

Location and age for angiodysplasia

A
  • most often cecum or right colon

- after the sixth decade of life

321
Q

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

A

APC

322
Q

polyps of peutz-Jeghers most common where

A

small intestine

323
Q

When should surgical intervention be considered in ischemic bowel disease

A

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

324
Q

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

A

Whipple disease

325
Q

2 forms of IBD

A

ulcerative colitis (UC) and Crohn disease

326
Q

Serology found Crohn but not UC

A

antibodies to Saccharomyces cerevisiae

327
Q

Acquired hernias typically occur anteriorly via what?

A
  • inguinal and femoral canals
  • umbilicus
  • sites of surgical scars
328
Q
  • 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
A

Osmotic

329
Q

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

A

acquired

330
Q

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

A

malabsorptive diarrhea

331
Q

Hemorrhoids develop secondary to what?

A

persistantly elevated venous pressure within the hemorrhoidal plexus

332
Q

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

A
  • CMV

- E. coli 0157:H7

333
Q

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

A

peri-nuclear anti-neutrophil cytoplasm antibodies

334
Q

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

A

Peutz-Jeghers syndrome

335
Q

Most common tumor of appendix

A

well differentiated neuroendocrine tumor (carcinoid)

336
Q

age for IBD

A

present in teens and early 20s

337
Q

Chronic malabsorption can be accompanied by what?

A
  • weight loss
  • anorexia
  • abdominal distention
  • borborygmi
  • muscle wasting
338
Q

What is the most common syndromic form of colon cancer

A

Lynch syndrome/HNPCC

339
Q

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

A

colonic diverticula

340
Q

symptoms of cholera infectious enterocholitis

A
  • dehydration
  • hypotension
  • muscular cramping
  • anuria
  • shock
  • loss of consciousness
  • DEATH
341
Q

middle third anal canal epithelium

A

transitional

342
Q

inheritance for congenital lactase deficiency

A

autosomal recessive

343
Q

location and size for hyperplastic polyp

A

Left colon and less than 5 mm

344
Q
  • pear shape

- 2 equally sized nuclei

A

Giardia

345
Q

transmission of salmonella

A

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

346
Q

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

A

1 to 4 days

347
Q

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

A

Psuedomembranous colitis

348
Q

Which type of juvenile polyp is dysplasia extremely rare?

Common?

A

sporadic

juvenile polyposis syndrome

349
Q

NOD2

A

Crohn

350
Q

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

A

hypoxic injury

351
Q

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

A

hamartomatous polyps

352
Q

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

A

Peutz-Jeghers syndrome

353
Q

cutaneous granulomas that form nodules in Crohn disease are called what

A

metastatic Crohn disease

-misnomer because it is NOT cancer

354
Q

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

A

Cholera

355
Q

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

A

Giardia

356
Q

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

A

hyperplastic polyp

357
Q

STK11

A

Peutz-Jeghers syndrome

358
Q

3 disease that have defects in intraluminal digestion

A
  • Chronic pancreatitis

- Cystic fibrosis

359
Q

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

A

sessile

360
Q

age and gender for IBS

A

females 20-40

361
Q

MSH2 or MLH1

A

HNPCC

362
Q

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

A

exudative diarrhea

363
Q

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

A

UC

364
Q

primary malignant tumors arising from peritoneal lining

A

mesotheliomas

365
Q

Oil red-O stain . . especially after a meal

A

Abetalipoproteinemia

366
Q

complications of a hernia

A
  • obstruction
  • incarceration
  • strangulation
367
Q

dietary factors most closely associated with increased rates of colorectal cancer

A
  • low intake of unabsorbable vegetable fiber

- high intake of refine carbohydrates

GI 2 COPY (14 decks)

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