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Small and Large Intestine Flashcards

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1
Q

What histological features distinguish the duodenum? Jejunum? Ileum?

A

Duodenum - Brunner’s glands in the submucosa

Ileum - Peyer’s patches

Jejunum - neither

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2
Q

What is the function of Brunner’s glands?

A

Secrete mucus and HCO3- to neutralize acid coming into duodenum from stomach

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3
Q

What is the function of Peyer’s patches?

A

Large aggregates of lymphoid cells used for host defense

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4
Q

What is the function of Paneth cells?

A

Contain pink granules with lysozymes, defensins, and other things to aid digestion and help regulate microbiota of small intestine

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5
Q

Where in the GI tract are ganglion cells located?

A

Submucosa (Meissner’s/submucosal plexus)

Between the inner circular muscle and outer longitudinal muscle of the muscularis propria (Auerbach/myenteric plexus)

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6
Q

What is the main difference between gastroschisis and omphalocele?

A

Gastroschisis has exposure of abdominal contents without the peritoneum

Omphalocele has abdominal contents surrounded by the peritoneum and the amnion of the cord

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7
Q

What is intussusception?

A

Telescoping of one part of bowel into another (often part of small intestine inside large intestine)

Could cause obstruction of blood vessels and of the food bolus moving through intestines

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8
Q

What is volvulus?

A

Twisting of bowel around its mesentery, leading to obstruction and infarction

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9
Q

What is necrotizing enterocolitis?

A

Acute necrotizing inflammation of small and/or large intestines

Edema -> necrosis -> gangrenous bowel

Most common acquired GI emergency in premie or low birth weight neonate

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10
Q

Meckel Diverticulum

What is the pathologic issue?

A

Persistence of the vitelline duct

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11
Q

Meckel Diverticulum

Known as disease of 2’s because…

A

2% of population, mostly asymptomatic

2 inches long
Within 2 feet of ileocecal valve in small intestine
2:1 M:F ratio

2 major complications:
Pain with inflammation
Hemorrhage with ulcer

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12
Q

Hirschsprung Disease

What is the basic pathologic issue?

A

Absence of ganglion cells

Death of neural crest cells from cecum to rectum

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13
Q

Hirschsprung Disease

How is it diagnosed?

A

Suction biopsy needed to get a biopsy deep enough to include submucosa and muscularis propria

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14
Q

Hirschsprung Disease

What do you expect to see on histology?

A

Lack of ganglion cells in the myenteric plexus

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15
Q

Hirschsprung Disease

Treatment

A

Resection of the portion of bowel without the neurons

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16
Q

What are some general symptoms of malabsorption?

A

Chronic diarrhea
Weight loss
Abdominal pain
No villi -> steatorrhea

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17
Q

What are some signs of pancreatic insufficiency?

A

Increased neutral fat

Normal D-xylose absorption test (urinary excretion)

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18
Q

Disaccharidase Deficiency

What is the most common deficiency?

A

Lactase deficiency (Lactose intolerance)

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19
Q

What happens when a person with lactose intolerance eats lactose?

A

Due to lack of lactase enzyme, the intestines cannot digest lactose. Lactose remains in intestinal lumen, pulling water into the lumen via osmotic forces and causing an osmotic diarrhea

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20
Q

Abetalipoproteinemia

What is the basic issue?

A

Low synthesis of apolipoprotein B, which is required for chylomicron generation

Results in decreased secretion of cholesterol and fat accumulation in enterocytes

Presents as failure to thrive in early childhood

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21
Q

Celiac Disease

What is the basic issue?

A

Autoimmune disorder resulting in damage to small intestine lining when foods containing gluten are eaten

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22
Q

Celiac Disease

Diagnosis

A

Serum test
Look for IgA/IgG to tissue transglutaminase (tTG), deaminated gliadin, HLA DQ2 or DQ8

Biopsy
Look for increased intraepithelial lymphocytes and flattening of the villi

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23
Q

Celiac Disease

Clinical Features in Infants

A 
Diarrhea
Failure to thrive
Abdominal distension
Anorexia
Weight loss
Irritability
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24
Q

Celiac Disease

Clinical Features in Older Children and Adults

A

Abdominal pain
Nausea
Vomiting
Bloating/Constipation

Diarrhea
Flatulence
Weight loss
Anemia
Fatigue
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25
Celiac Disease | Describe Dermatitis Herpetiformis
Skin blistering disease caused by IgA deposition in the dermal papillae Can cause obstruction of blood vessels in dermis, causing epidermis to separate and blister
26
Tropical Sprue | What is it caused by? Where? How to treat?
Similar findings to celiac disease, caused by an unknown infectious agent Seen in Caribbean Treat with antibiotics
27
Bacterial Infectious Enterocolitis | What is seen on histology?
Acute inflammation of the colon with many PMNs in the epithelium and lamina propria
28
List two common viral causes of enterocolitis
Noravirus | Rotavirus
29
List the two common protozoan causes of enterocolitis
Giardia - commonly from drinking freshwater streams Entamoeba Histolytica - causes flash shaped ulcer on histology
30
Pseudomembranous Colitis | What often precedes the development of this disease?
Course of broad spectrum ABX
31
Pseudomembranous Colitis | Gross appearance of colon
Yellow-green false membrane of mucus and PMNs See mushroom shaped pseudomembrane on histology
32
What organism is associated with Pseudomembranous Colitis?
Clostridium difficile
33
Collagenous Colitis | Who commonly gets this? What is the main symptom?
Middle aged females with watery diarrhea
34
Collagenous Colitis | What is seen histologically?
Lymphocytes in the epithelium Subepithelial deposition of collagen
35
Lymphocytic Colitis | What is the primary symptom? What is seen histologically?
Chronic watery diarrhea Intraepithelial lymphocytes are present, but there is no subepithelial collagen
36
Whipple Disease | Describe the basic pathogenesis
Organism: Tropheryma whippleli Macrophages engulf the organism, distend the villi, congest blood vessels and lymphatics May cause enterocyte necrosis or poor absorption
37
What are two main types of IBD?
Crohn's Disease | Ulcerative Colitis
38
Crohn's Disease | Symptoms
Diarrhea (non-bloody) Cramping abdominal pain (RLQ) Low grade fever Asymptomatic periods (skip periods) with recurrent attacks or flare ups
39
Crohn's Disease | Complications and extra-intestinal manifestations
Erythema nodosum (subcutaneous nodules on lower extremities) Pyoderma gangrenosum Uveitis Kidney stones
40
Crohn's Disease | Gross appearance
Fissure moving through entire wall into the muscularis propria and serosa Narrowing of lumen (stricture)
41
Crohn's Disease | Histology
Non caseating granulomas Transmural inflammation See many PMNs in the crypt
42
Ulcerative Colitis | Symptoms
Bloody diarrhea | Recurring with asymptomatic intervals
43
Ulcerative Colitis | Complications
Primary sclerosing cholangitis
44
Ulcerative Colitis | Pathogenesis
Inflammation involving only the colon, spreading up from rectum through colon. Pseudopolyps are seen grossly (normal areas surrounded by ulcerated areas)
45
Ulcerative Colitis | Histology
Crypts filled with PMNs is primary feature More superficial process than Crohn's -- Ulcerative Colitis only involves the mucosa and submucosa
46
Crohn's vs. Ulcerative Colitis | Which is continuous?
Ulcerative colitis involves rectum and colon continuously Crohn's has skip areas
47
Crohn's vs. Ulcerative Colitis | Which involves the full thickness of the wall?
Crohn's is transmural Ulcerative Colitis is only mucosa and submucosa
48
Crohn's vs. Ulcerative Colitis | What are the extraintestinal involvements of each?
Crohn's - migratory polyarthritis and kidney stones Ulcerative Colitis - Primary sclerosing cholangitis
49
Diverticulum | Where are they most common?
Sigmoid colon
50
Diverticulum | Difference between true and false diverticula
True - involving mucosa, submucosa, and muscularis propria False- involving mucosa and submucosa only
51
Diverticulum | How does diverticulitis develop?
Diverticulum is a blind outpouching of the colon where fecal matter can get stuck, cause inflammation, thus causing diverticulitis
52
Where are direct hernias found? What about above and below those?
Hasselbach's triangle Above - indirect Below- Femoral
53
Ischemic Bowel Disease | Symptoms
``` Severe abdominal pain Tenderness Bloody diarrhea Melena Could lead to sepsis, shock, death ```
54
Ischemic Bowel Disease | What is the watershed zone?
Splenic flexure | Area furthest away from blood supply, so it is at higher risk for ischemia
55
Ischemic Bowel Disease | Pathogenesis
Something causes hypoxic or reperfusion injury to the colon Athersclerosis, AAA, hypercoagulable state, oral contraceptives, embolization, cardiac failure, shock, dehydration, vasoconstrictive drugs, vasculitis
56
What are Hemorrhoids?
Anal varices Dilated anal and perianal collateral vessels Causes pain and some abdominal bleeding
57
What is the difference between internal and external hemorrhoids?
Internal - above pectinate line; receive visceral innervation and are NOT painful External- below pectinate line; receive somatic innervation and are painful
58
Inflammatory Polyp | What syndrome is it associated with?
Solitary Rectal Ulcer Syndrome
59
Hamatomatous Polyp | What syndrome is it associated with?
Peutz-Jeghers syndrome
60
Peutz-Jeghers Syndrome | What is the inheritance? What are the symptoms?
Autosomal dominant Hyperpigmented melanotic macules of mouth, lips, genitals, hands
61
Peutz-Jeghers syndrome | What are patients at risk for?
Polyps themselves are not malignant, but there is increased risk of CRC and other malignancies (pancreas, breast, lung, ovary, uterus, testes)
62
Hyperplastic Polyp | What is the appearance on histology?
Proliferation of mature goblet cells Serrated/sawtooth appearance of goblet cells stacking on one another
63
Adenomatous Polyp | What are the two broad classifications of it's gross appearance? Which is more dangerous?
Pedunculated (on a stalk) Sessile (growing directly out of intestinal wall) Sessile is more dangerous
64
Adenomatous Polyp | Tubular vs. Villous appearance - Which is more dangerous?
Villous is more likely to grow into an adenocarcinoma
65
Sessile Serrated Adenoma | Where do they mostly occur?
Adenomatous polyp in the RIGHT colon Sawlike serrated areas
66
Familial Adenomatous Polyposis | What is the inheritance? How is it treated?
Autosomal dominant Defect in APC gene on chromosome 5 Treated with prophylactic colectomy for APC mutations
67
Gardner Syndrome | What are the symptoms?
Polyps similar to FAP Osteomas of mandible, skull Fibromatosis- non-neoplastic fibroblast proliferation
68
Turcots Syndrome | What are the symptoms?
FAP with CNS tumors Medulloblastomas Glioblastomas
69
HNPCC | What is the defect? Inheritance?
Autosomal dominant defect in DNA mismatch repair, leading to increased risk of many cancers
70
Describe the function of the APC gene product. What happens when it is knocked out?
APC binds beta-catenin and prevents it from activating transcription of many tumor promoting genes. When APC is knocked out (2 hits needed), Beta-catenin is free to activate transcription of MYC, cyclin D1, others to promote tumors
71
DNA mismatch repair defects are seen (mostly) in what disorders?
HNPCC and sessile serrated adenomas
72
APC mutations are seen mostly in what disorders?
FAP or sporadic CRC
73
DNA mismatch repair defects may be caused in mutations in what genes?
``` MLH1 MSH2 MSH6 PMS1 PMS2 ```
74
Colon Cancer | How will it appear on imaging?
Apple core lesion on barium X ray because tumor is compressing and narrowing lumen
75
Colon Cancer | How are the shapes of R sided and L sided colon cancers different?
R sided - tumor grows on one side of lumen and obstructs (exophytic tumor) L sided - "Napkin ring" lesion that causes obstructive symptoms much more quickly
76
Which side of the colon has a larger diameter?
Right, so R sided colon tumors take longer to cause obstruction
77
What are the general presenting symptoms of R and L sided colon cancers?
R sided - iron deficiency anemia L sided - obstruction
78
What types of cancers are likely to be seen in the rectum and anus?
Rectum = adenocarcinoma Anus = squamous cell carcinoma
79
List the stages of colon cancer progression
T is -- intraepithelial or lamina propria T1- submucosa T2- muscularis externa T3- serosa T4- peritoneum, other organs, perforation
80
Appendicitis | Symptoms
Nausea/vomting Periumbilical pain localizing to RLQ Obstruction leading to impaired blood flow and bacterial contamination
81
Appendicitis | Gross appearance
Appendix is enlarged with yellow-green exudate (pus)
82
Appendicitis | Histology
Transmural inflammation | Lots of PMNs and eosinophils

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