Path - Small Intestine and Colon Flashcards
1
Q
extraintestinal manifestations of juvenile polyposis
A
congenital malformations and digital clubbing
2
Q
diffusely flattened (atrophic) villi w/ intraepithelial CD8 T cells and loss of mucosal and brush border surface
A
celiac dz
3
Q
pathogenesis of graft vs host dz
A
donor T cells target antigens on recipient’s GI epithelial cells
4
Q
sporadic colon cancer: typical or mucinous adenocarcinoma?
- 70-80% of cases
- 10-15% of cases
- 5-10% of cases
A
70-80%: typical
10-15%: mucinous
5-10%: mucinous
5
Q
sx of adult celiac dz vs pediatric celiac dz vs non-classic pediatric celiac dz
A
adult: chronic diarrhea, bloating, fatigue, anemia
pediatric: chronic diarrhea, irritability, abd distension, anorexia, weight loss
non-classic pediatric: abd pain, n/v, bloating, constipation
6
Q
target gene of familial adenomatous polyposis
A
APC
7
Q
acanthocytic red cells (burr cells)
A
abetalipoproteinemia
8
Q
presence of dense subepithelial collagen later, increased intraepithelial lymphocytes, and mixed inflammatory infiltrate
A
collagenous colitis
9
Q
what is the defect(s) of nutrient absorption in chronic pancreatitis
A
intraluminal digestion
10
Q
demographic IBS
A
b/w ages 20-40
strong female predominance
11
Q
extraintestinal manifestations of classic familial adenomatous polyposis
A
congenital retinal pigmented epithelium hypertrophy
12
Q
compare genetic factor contribution b/w crohn dz and ulcerative colitis
A
crohn dz: genetic factors are more dominant, 50% in monozygotic twins
UC: 15% in monozygotic twins
13
Q
how does ulcerative colitis begin in the GI tract and subsequently travel
A
begins in the rectum and extends proximally in a continuous fashion to involve all or part of the colon
14
Q
extraintestinal manifestations of gardner syndrome (familial adenomatous polyposis)
A
osteomas, thyroid and desmoid tumors, skin cysts
15
Q
fibrous bridge b/w viscera of the intestines
A
adhesion
16
Q
development of numerous mucosal lymphoid follicles
A
diversion colitis
17
Q
when does abetalipoproteinemia present
A
in infancy
18
Q
where are colonic adenocarcinomas distributed in the colon
A
approximately equal length over the entire length of colon
19
Q
compare clinical features b/w right sided and left sided colorectal adnocarcinomas
A
right sided: fatigue and weakness due to iron deficiency anemia
left sided: occult bleeding, changes in bowel habits, cramping and LLQ abd pain
20
Q
mesenteric fat extending around serosal surface (creeping fat)
A
crohn disease
21
Q
diagnostic criteria for IBS
A
abd pain or discomfort at least 3 days per month over 3 months with improvement following defecation and change in stool frequency or form
22
Q
inheritance pattern of MYH-associated polyposis
A
AR
23
Q
sx of autoimmune enteropathy
A
severe, persistent diarrhea and autoimmune dz
24
Q
age of presentation of juvenile polyposis
A
less than 5 y/o
25
two most important prognostic factors for colonic adenocarcinoma
1. depth of invasion
| 2. presence of LN mets
26
hereditary nonpolyposis colorectal cancer: typical or mucinous adenocarcinoma?
mucinous
27
two types of microscopic colitis
collagenous colitis and lymphocytic colitis
28
familial adenomatous polyposis: typical or mucinous adenocarcinoma?
typical
29
inheritance pattern of hereditary nonpolyposis colorectal cancer
AD
30
compare location in the GI tract b/w crohn disease and ulcerative colitis
crohn: any area of GI tract, transmural
UC: limited to colon and rectum, only into mucosa and submucosa
31
physical effects to the intestine from crohn disease
fibrosing strictures, fistulae, perforations
32
diarrhea due to failure of nutrient absorption that is relieved by fasting
malabsorptive diarrhea
33
target gene of sporadic colon cancer
- 70-80% of cases
- 10-15% of cases
- 5-10% of cases
70-80%: APC
10-15%: MSH2, MLH1
5-10%: MLH1, BRAF
34
clinical features of microscopic colitis (both collagenous and lymphocytic)
chronic, nonbloody, watery diarrhea without weight loss
35
what is the defect(s) of nutrient absorption in disaccharidase deficiency
terminal digestion
36
describe the gliadin induced damage that occurs in celiac dz
gliadin peptides induce IL-15 expression --> activates CD8T cells that express NKG2D --> attack MIC-A receptor on enterocytes --> cause epithelial damage --> enhances passage of gliadin peptides into lamina propria --> peptides interact w/ HLA-DQ2 or D8 on APCs --> stimulates CD4 T cells --> more tissue damage
37
what is the defect(s) of nutrient absorption in whipple dz
lymphatic transport
38
NOD2 polymorphism
crohn disease
39
predominant site of familial adenomatous polyposis
none
40
permanent entrapment of bowel segment due to venous stasis and edema
incarcerated hernia
41
GI lesions in peutz-jeghers syndrome
arborizing polyps most commonly in the small intestine
42
define Tis, T1, T2, T3, and T4 in regards to classification of colorectal carcinomas
Tis: in situ dysplasia or intramucosal carcinoma
T1: invades submucosa
T2: invades into, but not through, muscularis propria
T3: invades through muscularis propria
T4: penetrates visceral peritoneum or invades adjacent organs
43
two types of IBD
crohn disease and ulcerative colitis
44
clinical sx of intestinal obstruction
abd distension, vomiting, pain, constipation, tympanic by percussion
45
define MX, M0, M1 in regards to classification of colorectal carcinoma distant mets
MX: distant mets cannot be assessed
M0: no distant mets
M1: distant mets
46
describe how fasting affects each type of diarrhea
secretory: persists
exudative: persists
osmotic: lessens (abates)
malabsorptive: stops
47
genetic defect:
SMAD4, BMPR1A, TGF-B signaling pathway
juvenile polyposis
48
genetic defect:
APC/WNT pathway
familial adenomatous polyposis (FAP)
49
pathogenesis of IBD
combined effects of:
- alterations in host interactions with intestinal microbiotica
- intestinal epithelial dysfunction
- aberrant mucosa immune responses
- altered composition of gut microbiome
50
extraintestinal manifestations of peutz-jeghers syndrome
pigmented macules, risk of colon, breast, lung, pancreatic, and thyroid CA
51
skip lesions
crohn disease
52
most common malignancy of GI tract
adenocarcinoma
53
pathogenesis of IBS
poorly defined, but related to:
psychologic stressors, diet, perturbation of gut microbiome, increased enteric sensory responses to GI stimuli, abnormal GI motility
54
what are the only two diarrheal dzs that have defects in intraluminal digestion
chronic pancreatitis and CF
55
predominant site of involvement in sporadic colon cancer
- 70-80% of cases
- 10-15% of cases
- 5-10% of cases
70-80%: left side
10-15%: right side
5-10%: right side
56
complete twisting of a bowel loop about its mesenteric vascular base
volvulus
57
morphologic features of colonic diverticular dz
small, flask like outpouchings that occur in regular distribution alongside taeniae coli, most common in sigmoid colon
58
diarrhea due to excessive osmotic forces exerted by unabsorbed luminal solutes that abates w/ fasting
osmotic diarrhea
59
define NX, N0, N1, and N2 in regards to classification of colorectal carcinoma mets to LNs
NX: LN cannot be assessed
N0: no regional LN mets
N1: mets in 1-3 regional LNs
N2: mets in 4+ regional LNs
60
clinical features crohn disease
intermittent attacks of relatively mild diarrhea, fever, abd pain
20% pts w/ RLQ pain, fever, and bloody diarrhea
61
arterial and venous compromise due to pressure at the neck of a hernia
strangulation hernia
62
what is the defect(s) of nutrient absorption in abetalloproteinemia
transepithelial transport
63
clinical features of ulcerative colitis
bloody diarrhea with stringy, mucoid material, lower abd pain, cramping
64
diarrhea due to inflammatory disease leading to purulent, bloody stools that persist during fasting
exudative diarrhea
65
clinical features of colonic diverticular dz
most remain asymptomatic
20% have intermittent cramping, continuous lower abd discomfort, constipation, distention, or sensation of never being able to completely empty the rectum
66
class II HLA-DQ2 and HLA-DQ8 are associated with
celiac dz
67
what is the defect(s) of nutrient absorption in celiac dz
terminal digestion and transepithelial transport
68
compare presence of granulomas b/w crohn disease and UC
crohn: granulomas
UC: no granulomas
69
compare colonic adenocarcinoma tumors in the proximal colon and distal colon
proximal: polypoid, exophytic masses
distal: annular lesions
70
what is IPEX and what does it stand for
a severe familial form of autoimmune enteropathy
- immune dysregulation
- polyendocrinopathy
- enteropathy
- x-linked
71
extraintestinal manifestations of turcot syndrome (familial adenomatous polyposis)
medulloblastoma, glioblastoma
72
intestinal segment telescoping into immediately distal segment
intussusception
73
describe the classic adenoma-carcinoma sequence that causes colonic adenocarcinoma
mutation in APC --> accumulation of B-catenin and translocation to nucleus --> forms complex w/ TCF and activates transcription of genes including MYC and cyclin D1 --> promoted proliferation
74
extraintestinal manifestations of crohn disease
1. uveitis
2. migratory polyarthritis
3. sacroiliitis
4. ankylosing spondylitis
5. erythema nodosum
6. clubbing of fingertips
75
clinical features of graft vs host dz
watery diarrhea that can become bloody in severe cases
76
age of presentation of familial adenomatous polyposis
- classic
- attenuated
- gardner syndrome
- turcot syndrome
- MYH-associated polyposis
- classic: 10-15
- attenuated: 40-50
- gardner syndrome: 10-15
- turcot syndrome: 10-15
- MYH-associated polyposis: 30-50
77
ATG16L1 and IRGM polymorphisms
crohn disease
78
dietary factors associted with colonic adenocarcinoma
low intake of unabsorbable vegetable fiber
high intake of refined carbohydrates and fats
79
which IBD has risk of toxin megacolon
ulcerative colitis
80
what is the defect(s) of nutrient absorption in viral, bacterial, and parasitic gastroenteritis
terminal digestion and transepithelial transport
81
age of presentation of peutz-jeghers syndrome
10-15
| 11 is most common
82
predominant site of involvement in hereditary nonpolyposis colorectal cancer
right side
83
molecular defect in sporadic colon cancer
- 70-80% of cases
- 10-15% of cases
- 5-10% of cases
70-80%: APC/WNT pathway
10-15%: DNA mismatch repair
5-10%: hypermethylation
84
sx of abetalipoproteinemia
failure to thrive, diarrhea, steatorrhea
85
TTG antibodies
celiac dz
86
what is the defect(s) of nutrient absorption in cystic fibrosis
intraluminal digestion
87
compare ulcers b/w crohn disease and UC
crohn: deep, knife life ulcers
UC: superficial, broad-based ulcers
88
causes of intussusception in young children vs older children/adults
children: spontaneous or associated w/ viral infection or rotavirus vaccine
older children/adults: intraluminal mass or tumor
89
cobblestone appearance of mucosa w/ thickened intestinal wall
crohn disease
90
most common cause of intestinal obstruction in children under 2
intussusception
91
what is the only diarrheal dz that has a defect in terminal digestion
disacchardiase deficiency
92
effect of NSAIDs on risk for colonic adenocarcinoma
they REDUCE risk
- carcinomas use COX2 to make prostaglandins for proliferation of the polyp
- NSAIDs inhibit COX2
93
sx of environmental enteropathy
malabsorption, malnutrition, stunted growth, defective intestinal mucosal immune function
94
what is the defect(s) of nutrient absorption in IBD
intraluminal digestion and terminal digestion and transepithelial transport
95
molecular defect in MYH-associated polyposis
DNA mismatch repair
96
subepidermal blisters and granular IgA deposits
celiac dz
97
cause of diversion colitis
post-surgical ostomy with blind distal segment of colon from which normal fecal flow is diverted
98
normal thickness subepithelial collagen layer and great increase in intrapeithelial lymphocytes
lymphocytic colitis
99
genetic defect:
STK11; AMP kinase related pathways
peutz-jeghers syndrome
100
FOXP3 mutation
IPEX (familial form of autoimmune enteropathy)
101
dermatitis herpetiformis is associated with
celiac dz
102
what is the only diarrheal dz with a defect in lymphatic transport
whipple dz
103
what two pathways have been describes that can lead to colonic adenocarcinoma
APC/B-catenin pathway
microsatellite instability pathway
104
most frequent cause of intestinal obstruction worldwide vs in the US
worldwide: hernias
US: adhesions
105
what external triggers can re-activate crohn disease
physical or emotional stress, dietary items, and cigarette smoking
106
crohn disease can mimic what disease processes
appendicitis or bowel perforation
107
noncaseating granulomas in intestinal wall
crohn disease
108
paneth cell metaplasia
crohn disease
109
target gene of MYH-associated polyposis
MYH
110
predominant site of MYH-associated polyposis
none
111
HNFA polymorphism
ulcerative colitis
112
celiac dz most often affects what part of the GI tract
2nd part of duodenum to the proximal jejunum
113
compare sx b/w congenital lactase deficiency and acquired lactase deficiency
congenital: explosive diarrhea w/ watery, frothy stools and abd distension (after milk ingestion)
acquired: abd fullness, diarrhea, flatulence (after milk digestion)
114
protrusion of serosa lined pouch of peritoneum that can trap bowel segments externally
hernia
115
molecular defect in hereditary nonpolyposis colorectal caner
DNA mismatch repair
116
inheritance pattern of familial adenomatous polyposis
AD
117
target gene of hereditary nonpolyposis colorectal cancer
MSH2, MLH1
118
MYH-associated poyposis: typical or mucinous adenocarcinoma?
mucinous
119
isotonic (compared to plasma) stool that persists during fasting
secretory diarrhea
120
"napkin-ring" constrictions
adenocarcinomas in distal colon
121
what is the defect(s) of nutrient absorption in autoimmune enteropathy
terminal digestion and transepithelial transport
122
GI lesions in familial adenomatous polyposis
multiple adenomas
123
what is the defect(s) of nutrient absorption in environmental enteropathy
terminal digestion and transepithelial transport
124
most common areas for volvulus
redundant loops of sigmoid colon
125
chronic, relapsing abdominal pain, bloating and changes in bowel habits
IBS
126
child with mucocutaneous pigmentation and multiple hamartomatous polyps and intussusception
peutz-jeghers syndrome
127
lot of blood per rectum with malformed submucosa or mucosal vessels in cecum or right colon, 6th decade of life
angiodysplasia
128
celiac dz is most often associated with what malignancy
T cell lymphoma
129
erythema nodosum is associated with
crohn dz
