Small and Large Intestinal Pathologies Flashcards by Maggie Gilman

What pathology is an atresia of the small intestine associated with?

Down’s syndrome

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An atresia of the small intestine is associated with (Non-bilious/Bilious) vomiting?

Bilious

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A newborn infant is experiencing digestive issues. They are drinking their milk and then throwing it back up. The milk looks the same as it came in. Palpation reveals an olive shaped mass on the child’s abdomen. What is the likely diagnosis?

Congenital pyloric stenosis

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A newborn infant is experiencing digestive issues. They are drinking their milk and then throwing it back up. The milk is a greenish color. What is the likely diagnosis?

Small intestine atresia

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What is Meckel’s Diverticulum?

Outpouching of all three layers of the bowel wall due to failure of the vitelline duct to involute

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Meckel’s diverticulum arises due to failure of what embryological structure to involute?

Vitelline duct

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What is the most common congenital anomaly of the GI tract?

Meckel’s Diverticulum

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Where is the most common location for a Meckel’s Diverticulum?

Ileum within two feet of the iliocecal valve

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When does a Meckel’s Diverticulum present in life?

First two years

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What pathology is associated with a weeping umbilicus following meals?

Meckel’s Diverticulum

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1 year old infant presents to the ER crying. Her mother believes that the child has an issue with her stomach. Endoscopy reveals a diverticula located a foot away from the iliocecal valve. Furthermore, there is a fluid leaking out of the baby’s belly button. What is the likely diagnosis?

Meckel’s Diverticulum

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What is enterocolitis?

Non-specific inflammation of the entire gut tube in an infant

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What population is enterocolitis most prevalent in?

Premature and low birth-weight babies

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What pattern of necrosis is seen in the bowel of a patient with enterocolitis?

Gangrenous necrosis (black/blue)
(ischemic damage)

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A baby that is three weeks premature is presenting with ischemia of their small bowel. The inflammation is nonspecific throughout the whole gut. What is the likely diagnosis just based on this information alone?

Enterocolitis

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What is the most common etiologic agent of pseudomembrane colitis?

Clostridium difficile

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What is the patient history of a person with a clostridium difficile infection of any kind?

History of long term repeated courses of antibiotics

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Patient presents to your office complaining of abdominal cramps and severe, bloody diarrhea. The patient is practically bent over in pain. He was released from the hospital a week ago recovering from a case of bacterial pneumonia. In his history you notice repeated bouts of antibiotics for various issues in the past 6 months. The patient is febrile at 102.1 degrees. A CBC shows leukocytosis with WBC count at 16,000. A blood culture shows a C.Difficile population in his colon upon biopsy with exudative mucosal plaques of white purulent exudate on the proximal colon. What is the likely diagnosis?

Pseudomembrane colitis

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What characterizes pseudomembrane colitis?

Exudative mucosal plaques
(white/leukocytic plaques on colon)

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Mucosal infarction of the GI occurs with marked (Hypertension/Hypotension)?

Hypotension

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What are the clinical features of intestinal ischemia/infarct?

abdominal pain
bloody diarrhea (melena/hematochezia)
decreased bowel sounds (indicates dead/dying tissue)
may progress to perforation, peritonitis, sepsis & shock

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A patient presents to the ER with severe hypotension. A few days ago he decided to stop taking corticosteroids for Crohn’s disease because he was “feeling good”. The patient has been declared in an acute Addisonian crisis. The complaint that brought him into the ER was severe abdominal pain and explosive bloody diarrhea. Auscultation reveals a lack of bowel sounds. As he is going into shock, what is the concern in his GI tract?

Intestinal ischemia/infarct

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What is a tropical sprue?

Damage to the small bowel villi due to an unknown organism resulting in malabsorption

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What are common geographic locations to get a tropical sprue?

Tropics or on vacation

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What are the clinical features of malabsorption syndromes such as Celiac disease, Tropical sprue and Whipple disease?

- children: abdominal distension, diarrhea, failure to thrive - adults: chronic diarrhea & bloating - dermatitis herpetiformis (herpes-like vesicles in non-dermatomal fashion

How is a tropical sprue treated?

Antibiotics

29 year old female patient presents to your office complaining of diarrhea. She recently returned from a cruise to the Caribbean islands. Upon palpation you notice small vesicles on her skin that don't seem to align with any dermatomal pattern. What is the likely diagnosis based on the patient history? What would be the best treatment for this patient?

Tropical sprue treated with antibiotics

What is Whipple disease?

Systemic tissue damage characterized by macrophages loaded with **tropheryma whippelii** organisms with partially destroyed organisms present in macrophage lysosomes

How does someone contract Whipple disease?

Consumption of contaminated water with tropheryma whippelii

What is the classic site of involvement for Whipple disease?

Small bowel lamina propria

In Whipple disease, macrophages compress ____, which are involved in ____

Lacteals Fat absorption

What does Whipple disease result in?

Fat malabsorption and steatorrhea

Patient presents to your office with complaints of arthritis. During the history, the patient also reports in passing that he has been having some foul smelling bowel movements as of late. The patient agrees to a CBC and you notice macrophages with partially destroyed Tropheryma whippelii. What is the likely diagnosis for this patient?

Whipple disease

What are two subtypes of inflammatory bowel disease?

Ulcerative colitis and Crohn's disease

What gender and age group is more at risk for IBD?

Women in their teens to 30s

What is ulcerative colitis?

Ulcero-inflammatory disease limited to the colon and affecting only the mucosa and submucosa except in the most severe cases

What layers of the colon are affected by ulcerative colitis?

Mucosa and submucosa

What type of hypersensitivity reaction is ulcerative colitis?

Type III

What inflammatory bowel disease has the highest correlation with colon cancer?

Ulcerative colitis

What is unique to the histological presentation of ulcerative colitis?

- Ulceration of the mucosa of the distal colon - **Crypt abscesses** - Epithelial changes signifying **dysplasia** and the progression to frank carcinoma

Where will pain present in a patient with ulcerative colitis?

Lower left quadrant

What is the unique stool finding for a patient with ulcerative colitis?

Recurrent hematochezia with pus and mucus

Where does ulcerative colitis commonly begin?

Distal colon

27 year old female patient presents to your office complaining of recurrent cases of diarrhea and abdominal pain. Furthermore, she reports pain in her joints that comes and goes as well as a nagging itchy patch of skin on her left leg. For her abdominal complaints a colonoscopy is ordered. Colonoscopy reveals ulceration of the mucosa in the distal colon. When you inquire further about her recent cases of diarrhea, the patient reports that the diarrhea is bright red and mucousy. Her pain is mainly in the lower left quadrant of her abdomen. What is the likely diagnosis?

Ulcerative colitis

What is Crohn's disease also called?

Regional ileitis

What pathology presents with skip lesions?

Crohn's disease

What is the most common site for Crohn's disease?

Distal ileum

What parts of the wall are involved in Crohn's disease?

All of them (Transmural)

What is the gross appearance of the mucosa of a patient with Crohn disease?

Cobble stoning

Where will a patient with Crohn's disease experience pain?

Right lower quadrant

25 year old female patients presents to your office with complaints of lower right quadrant abdominal pain. An endoscopy shows serpentine ulcers in the cecum, distal ileum, and sigmoid colon. The mucosa has a "cobblestone" appearance. The patient reports diarrhea but denies any blood in the stool. What is the likely diagnosis?

Crohn's disease

What pathology are serpentine ulcers associated with?

Crohn's disease

Untreated Crohn's disease can result in ____

Burrowing fistulas

What is a volvolus?

Twisting of a bowel along its mesentery resulting in obstruction and infarction

Where is a volvolus most common in an elderly patient?

Sigmoid colon

Where is a volvolus most common in a young adult?

Cecum

Where is an elderly patient with a volvolus most likely to experience pain?

Left Lower quadrant

Where is a young adult with a volvolus mot likely to experience pain?

Right lower quadrant

What is the clinical presentation of volvolus?

rapidly onset of vomiting, distension, severe abdominal pain

67 year old male patient presents to your office vomiting uncontrollably out of nowhere. The patient's abdomen is visibly distended and he is reporting severe pain in the left lower quadrant of his abdomen. What is the likely diagnosis based on this presentation alone?

Volvolus in the sigmoid colon

28 year old male patient presents to your office vomiting uncontrollably out of nowhere. The patient's abdomen is visibly distended and he is reporting severe pain in the lower right quadrant of his abdomen. What is the likely diagnosis based on this presentation?

Volvolus in the cecum

What is intussusception?

Telescoping of a proximal segment of bowel forward into a distal segment causing obstruction and disruption with infarction

What is the most common cause of intussusception in a child?

Lymphoid hyperplasia from a viral infection such as rotavirus

Where does intussusception most commonly occur?

Terminal ileum and cecum

What is the most common cause of intussusception in an adult?

Tumor

Currant jelly stools are indicative of what pathology?

Intussusception

9 year old female child presents to your office complaining of a tummy ache. Palpation reveals a tender mass in the abdomen. The family just returned from a cruise in the pacific just yesterday. The patient is sent to the ER and further tests are performed. The patient has a bowel movement showing stool that looks like currant jelly. The patient also tested positive for a rotavirus infection. What is the likely diagnosis? What is causing this?

Intussusception caused by rotavirus infection

Volvolus and intussusception may lead to __________________?

Infarction

39 year old female patient presents to your office with abdominal pain. Upon palpation you notice a tender mass on the abdomen. The patient reports stool that looks like currant jelly. She has been experiencing pain in the past but it recently just went to a whole new level in the last day prompting her visit today. What is the likely diagnosis? What is causing this?

Intussusception likely caused by a tumor

What is left sided appendicitis?

Diverticulitis

Diets low in fiber may predispose a patient to what colon pathology?

Diverticulosis

Diverticulitis commonly presents with pain where?

Left lower quadrant

What is the main cause of diverticulitis?

Fecalith lodging in a diverticulum

Where is diverticulitis most common?

Sigmoid colon

40 year old male patient presents to your office complaining of lower left quadrant abdominal pain and rectal bleeding with bright red blood. The patient has been on a carnivore diet kick for the last year. He is not febrile. But his abdomen is sharply tender to the touch. A colonoscopy shows outpouchings that are inflamed in the sigmoid colon. What is the likely diagnosis? What can you recommend to this patient after a doctor treats the condition?

Diverticulitis; No nuts or seeds and eat more fiber

What is Hirshprung disease?

Congenital megacolon caused by defective relaxation and peristalsis of the rectum and distal sigmoid colon

What is the pathogenesis of Hirshprung disease?

Congenital failure of ganglion cells to descend into the myenteric and submucosal plexus resulting in relaxation of peristalsis

Hirshprung disease is based on failure to pass ____

Meconium

What is a meconium?

First feces of a newborn with amniotic fluid

What is the main etiology of acquired or toxic megacolon?

Opioid drug use

A newborn infant presents passing all of his benchmarks in the first 24 hours. That being said, the baby still has not performed his first bowel movement and as a result his abdomen is grossly distended. A barium swallow shows a grossly enlarged colon due to failure to pass the meconium. What is the likely diagnosis based on this presentation?

Hirshprung disease

What is the most common cause of acute abdominal pain?

Appendicitis

What is the most common cause of appendicitis in a child and an adult?

Child = Lymphoid hyperplasia Adult = Fecalith

What is McBurney's point?

Point 2/3 between the umbilicus and ASIS used in diagnosing appendicitis

Patient presents to your office holding his stomach and complains of lower right quadrant pain and pain around his belly button. The patient is nauseous and febrile. CBC shows blood cell counts over 35000. The patient is poked at McBurney's point and nearly jumps out of his seat in pain. What is the likely diagnosis?

Appendicitis

What is a polyp?

Benign solitary adenoma of the colon

What is a sessile polyp?

Broad bump

What is a pedunculated polyp?

Hook like polyp with a stalk

What is Murphy's point?

Right upper quadrant point that can help diagnose gall bladder issues

What is FAPC disease?

Familial adenomatous polyposis coli with numerous polyps in the colon due to an APC mutation

What gene is mutated in a condition of colon polyps?

APC

FAPC disease leads to ____

Adenocarcinoma

When should a colonoscopy screening be ordered?

45-50 years of age

What is the treatment for FAPC?

Removal of the entire colon

What is the 3rd most common type and cause of cancer death?

Colon carcinoma

When does colon carcinoma chiefly arrive in regards to age?

60-70

What are the clinical features of a left-sided carcinoma?

Napkin ring lesion or apple core defect Pencil thin Decreased stool caliber Left lower quadrant pain Hematochezia

What are the clinical features of a right-sided carcinoma?

Raised pedunculated lesion Iron deficiency anemia Vague pain Melena

An older adult with iron deficiency anemia has colorectal carcinoma until proven otherwise (TRUE/FALSE)?

65 year old male patient presents to your office complaining of lower left quadrant pain in the abdomen and bright red blood in the stool. The patient reports that this problem has been progressing for some time. A colonoscopy shows a "napkin ring" lesion. Biopsy shows tissue of the colon that is poorly differentiated. What is the likely diagnosis?

Left-sided colon carcinoma

65 year old male presents to your office complaining of lower right quadrant pain in the abdomen and black tarry stool. The patient reports that this problem has been getting worse for some time. The patient also reports fatigue as of late and unexplained weight loss. A colonoscopy shows raised lesions in the colon that are poorly differentiated upon biopsy. What is the likely diagnosis?

Right-sided colon carcinoma