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Pathology Flashcards

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1
Q

Malabsorption mechanisms?

A
  1. Intraluminal disturbance
  2. Terminal disturbance in SI: carbs, proteins
  3. Transepithelial transport: fluids, electrolytes
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2
Q

What is the allergy to in celiac?

A

Gliadin in gluten

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3
Q

Gliadin autoimmune response?

A
  • gliadin peptide induces proliferation of CD8 intraepithelial lymphocytes inducing NK to cells to injure enterocytes
  • can induce T cells to cause mucosal pathology (villous blunting)
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4
Q

Celiac IgA antibody?

A

Antitissue transglutaminase

Antiendomysial antibody

Antigliadin antibody

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5
Q

Skin feature in celiac?

A

dermatitis herpetiformis

-itchy blistering skin disease similar to herpes

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6
Q

Celiac genetics?

A

HLA-DQ2

HLA-DQ8

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7
Q

Celiac causes increased risk of what cancers?

A

T cell lymphoma

Small Intestine Adenocarcinoma

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8
Q

Severe persistent diarrhea and autoimmune disease?

A

Autoimmune enteropathy

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9
Q

Whipples disease pathophys?

A

SI mucosa and mesenteric LN are laden with macrophages that contain tropheryma whipplei (bacilli) that causes lymphatic obstruction and impaired lymph transport

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10
Q

Middle aged white male with malabsorption with CNS symptoms, polyarthritis, and hyperpigmentation?

A

Whipples disease

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11
Q

What is a hernia?

A

weakness in wall of peritoneal cavity can cause serosa lined pouch of peritoneum or hernia sac

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12
Q

What can hernia lead?

A

Entrapment (incarceration) which can cause blood flow compromise (strangulation) and infarction
-venous compromise first

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13
Q

Adhesions?

A

fibrous bridges between bowel after surgery can lead to infarction

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14
Q

Intussusception?

causes in children? adults?

A
  • portion of intestine telescopes into distal segment and peristalsis propels it forward can lead to infarction
  • children with anatomic defect or rotavirus
  • adults with intraluminal mass
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15
Q

causes of acute obstruction?

A
  • ATS
  • aortic aneurysms
  • hypercoagulability
  • OCPs
  • cardiac vegetation emboli
  • shock
  • dehydration
  • vasoconstrictive drugs
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16
Q

When is hypoxic damage minimal?

A

if hypoxia is transient

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17
Q

Greatest hypoxic injury to bowel?

A

Reperfusion injury (red infarcts)

  • inflammatory mediators
  • free radicals
  • neutrophils
  • intracellular signaling
  • TFs
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18
Q

Mucosal infarction?

A
  • any level of GI
  • only mucosa or submucosa affected
  • hemorrhagic
  • ulcerated
  • dark red or purple
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19
Q

Transmural infarction?

A
  • acute arterial occlusion
  • splenic flexure is at greatest risk (watershed area)
  • red edematous with possible perforation
  • involves muscularis propria
  • coagulation necrosis
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20
Q

Mural infarction?

A

everything but muscularis propria

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21
Q

Causes of ischemic bowel?

A

CMV: infect endothelial cells

Radiation: damages vessels

Necrotizing enterocolitis: transmural acute necrosis seen in premature and low birth weight

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22
Q

What portion of bowel is at greatest risk of transmural infarction?

A

Splenic flexure

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23
Q

Angiodysplasia? most common location?

A

malformed mucosal and submucosal blood vessels in right colon and cecum

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24
Q

Most common clinical symptom in angiodysplasia?

A

hematochezia

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25
Most common appendix tumors?
Carcinoids
26
IDB genetics?
- ATG16L1 (autophagy) for intracellular bacteria host response - IRGM (immune GTPase M) for autophagy and clearance of intracellular bacteria - Crohns: inappropriate immune reactions to luminal bacteria
27
Microbiota in IBD?
- intestinal microbiota contribute to IBD | - antibodies against bacterial flagellin associated with strictures, perforation of SI in Crohns
28
Most common sites for crohns?
terminal ileum, ileocecal valve and cecum | -could be any portion of bowel
29
Skip lesions, strictures, and transmural inflammation?
Crohns
30
Continuous inflammation of colon starting in rectum with pseudo polyps and ulcers?
UC
31
Crohns histo features?
- cobblestone mucosa: depressed below normal mucosa - fissures: fistula or perforation - transmural - creeping fat around serosa - crypt abscesses: neutrophils infiltrate crypt - noncaseating granulomas
32
Increased cancer risk in IBD?
Adenocarcinoma (UC > Crohns)
33
Backwash ileitis?
mild mucosal inflammation of ileum from UC extending past valve
34
Pancolitis?
entire colon involved in UC
35
Left sided colitis without skip lesions?
UC does not extend past transverse colon
36
UC histo features?
- broad based ulcers (red, granular) - inflammation is limited to mucosa - pseudopolyps - mucosal bridges between polyps - no mural thickening - serosal surface normal - no strictures - no granulomas
37
Complications of UC?
- Toxic megacolon - malignancy - PSC
38
Solitary rectal ulcer syndrome?
inflammatory polyp with rectal bleeding, mucous discharge and inflammatory lesion on anterior rectal well
39
Where do most juvenile polyps occur?
rectum
40
Juvenile polyposis?
- autosomal dominant 3-100 polyps - pulmonary arteriovenous malformations - marked protein loss
41
Increased cancer risk in juvenile polyposis?
colonic adenocarcinoma
42
What complications is peutz-jeghers syndrome associated with?
- Intussusception - Sex cord tumor with annular tubules (SCAT) - other malignancies
43
Manifestations of peutz-jeghers?
- hamartomatous polyps in SI - pedunculated and lobular - hyperpigmentation of lips
44
T/F Most adenomas progress to adenocarcinomas.
False | -most are clinically silent
45
Colonic adenoma dysplasia features?
- nuclear hyperchromasia - elongation - stratification
46
Gardner syndrome?
- FAP - osteomas - thyroid cancer - fibromas - supernumerary impacted teeth
47
Turcot syndrome?
- FAP | - Glioblastoma
48
Types of adenomatous polyps?
- Tubular: small pedunculated with small tubular glands - Tubulovillous: mixture - Villous: large and sessile with slender villi, more likely to invade and be dysplastic
49
Sessile serrated adenoma?
- found in right colon - malignant potential - resemble hyperplastic polyps
50
Intramucosal carcinoma?
invade lamina propria or muscularis mucosa and if cancer invades muscularis mucosa then it can metastasize
51
Dietary risk factors of adenocarcinoma of colon?
high refined carbs and fat with low fiber intake
52
Colon Adenocarcinoma genetic pathways?
1. APC/beta catenin path with WNT - classic stepwise adenoma carcinoma sequence of mutations 2. Microsatellite instability associated with DNA mismatch repair genes - stepwise mutations
53
Classic adenoma carcinoma sequence?
1. APC mutation (both copies 5q21) 2. beta catenin accumulates (normally inactivated by APC) 3. KRAS mutations promote growth and inhibit apoptosis 4. SMAD2 and SMAD4 mutations causes loss of TGF-b leading to unrestrained growth 5. p53 tumor suppressor mutation
54
DNA mismatch repair pathway?
1. Microsatellite instability | 2. TGF-beta and pro-apoptotic BAX mutations causes uncontrolled cell growth
55
Proximal vs Distal adenocarcinoma of colon?
1. Proximal (right) - polypoid exophytic masses on one edge of colon - rare obstruction - bleeds more causing iron deficiency anemia and fatigue 2. Distal (left) - annular napkin ring tumor - luminal narrowing - obstruction - occult bleeding - change in bowel habits - LLQ cramping
56
Desmoplastic response in colon ca?
firmness of tumor
57
Colon tumors with abundance of mucin prognosis?
poorer prognosis
58
Most important prognostic factors in colon ca?
1. depth of invasion | 2. presence or absence of LN metastasis
59
Most common site of colon cancer metastasis?
Liver
60
Lynch syndrome?
HNPCC - familial cluster of cancers - right colon - MMR mutations
61
What is pure squamous cell carcinoma of the anal canal associated with?
HPV

Lower GI (5 decks)

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