Term
| What is colonic diverticula? |
|
Definition
| herniation of mucosa and submucosa through weak points, alongside the taeniae coli, where the vasa recta penetrate the inner circular layer |
|
|
Term
| Which countries have high frequency of diverticula? |
|
Definition
| estern industrialized (as opposed to asia and nonindustrialized) |
|
|
Term
| Where are diverticula more often found? |
|
Definition
| in the sigmoid and descending colon, rare in the rectum |
|
|
Term
| What populations are more likely to have right sided diverticula? |
|
Definition
|
|
Term
| What factors predispose one to diverticula? |
|
Definition
| aging, diets low in insoluble fiber, other factors such as low physical activity, obesity, and constipation |
|
|
Term
| What are the symptoms of diverticula? |
|
Definition
| most are asymptomatic but some have non-specific symptoms referred to the left lower abdomen. 10-25% become symptomatic. |
|
|
Term
| What are the complications of diverticula? |
|
Definition
| inflammation (diveritculitis), perforation, peritonitis, pericolonic abscesses, fistulae, hemorrhage (more common in the right colon) |
|
|
Term
| What predisposes you to diverticulitis? |
|
Definition
|
|
Term
| What are the symptoms of mechanical intestinal obstruction? |
|
Definition
| colic, distention, vomiting, failure to pass feces or flatus |
|
|
Term
| What four disease processes accoutn for 80% of intestinal obstructions? |
|
Definition
| hernias, intestinal adhesions, intussusception, volvulus |
|
|
Term
|
Definition
| protrusion through a weak point in the peritoneal wall, into a peritoneum-lined pouch called a hernial sac |
|
|
Term
| What is an inguinal hernia? |
|
Definition
more common in men (9:1);
can be indirect: along the inguinal canal (75%)
can be direct: above the inguinal ligament |
|
|
Term
| Who gets umbilical hernias? |
|
Definition
| about equal sex distribution; more common in blacks. Can be congenital, most are small, close spontaneously by age 4 or 5. Occur in adults, multiparous women, and cirrhotic patients |
|
|
Term
| What type of hernia occurs in women almost exclussively? |
|
Definition
|
|
Term
| What hernia is very prone to strngulation? |
|
Definition
|
|
Term
| What population gets obturator hernias? |
|
Definition
|
|
Term
| What do you call a herniation of bowel through a closed surgical incision that has broken open? |
|
Definition
|
|
Term
| Which hernia is often not visible externally? |
|
Definition
|
|
Term
| A hernias motility can be described as... |
|
Definition
| reducible (spontaneously or manually), incarcerated (no longer reducible), strangulated (with compromise of the vascular supply) |
|
|
Term
| What do you call bands of fibrous tissue among bowel segments or between bowel segments and the abdominal wall? |
|
Definition
|
|
Term
| T/F Adhesions are often congenital. |
|
Definition
| False (ladd bands are relatively rare) |
|
|
Term
| What causes most intestinal adhesions? |
|
Definition
| previous surgeries, infection, endometriosis |
|
|
Term
| What do adhesions result in? |
|
Definition
| trapping, obstruction, volvulus, strangulation |
|
|
Term
| What is an intussusception? |
|
Definition
| a segment of intestine telescoped into the immediately distal segment |
|
|
Term
| What is the most common cause of intestinal obstruction in young children? |
|
Definition
|
|
Term
| Where is the most common place for intussusception? |
|
Definition
| terminal ileum (ileo-ileal, ileo-colic) |
|
|
Term
| What are the symptoms of intussusception? |
|
Definition
| colic and "currant jelly" stools |
|
|
Term
| T/F Intussusception is more common in male infants. |
|
Definition
|
|
Term
| What is a main cause of intussusception in children? adults? |
|
Definition
lymphoid hyperplasia
intraluminal polyps or tumors |
|
|
Term
| What are complications of intussusception? |
|
Definition
| obstruction, strangulation |
|
|
Term
|
Definition
| complete twisting of a loop of bowel about its mesenteric axis that results in obstruction and infarction |
|
|
Term
| What's a common clinical story behind a colonic volvulus? |
|
Definition
| sigmoid or cecum volvulus in an elderly patient due to constipation/impacted feces |
|
|
Term
| What are common clinical presentations of a vovlulus of the small intestine? |
|
Definition
| children due to malrotation (mid-gut volvulus), meckle diverticulum or adhesion |
|
|
Term
| What is the most common type of volvulus? |
|
Definition
| mid gut vovulus due to malrotation |
|
|
Term
| What's a typical clinical scenario of a gastric volvulus? |
|
Definition
| adults with a paraesophageal (rolling) hiatal hernia |
|
|
Term
| What do you call a polyp that is lacking a stem, stalk or pedicle? |
|
Definition
|
|
Term
| What are the different types of polyps? |
|
Definition
| inflammatory, hamartomatous, hyperplastic, serrated, adenomatous |
|
|
Term
| What's another term for inflammatory polyps? |
|
Definition
|
|
Term
|
Definition
| mucosal erosion, inflammation, granulation tissue proliferation, reactive epithelial hyperplasia, fibrosis of the lamina propria |
|
|
Term
| What's another name for a retention polyp? |
|
Definition
|
|
Term
| What does a juvenile polyp look like histologically? |
|
Definition
| hamartomatous, cystically dilated glands, glands and stroma in disarray |
|
|
Term
| What do juvenile polyps look like grossly? |
|
Definition
| large, ulcerated, inflamed, smooth spherical, pedunculated |
|
|
Term
| T/F Most juvenile polyps are removed because of their malignant potential. |
|
Definition
| false, they aren't malignant (unless you have juvenile polyposis syndrome, which is very rare) |
|
|
Term
| Where do retention polyps occur? how many usually occur? |
|
Definition
| rectum; usually sporadic and single |
|
|
Term
| What patient population is typical of juvenile polyps? |
|
Definition
| children less than 5 yrs old |
|
|
Term
| What is the presentation of juvenile polyp? |
|
Definition
| bright red bleeding during or after bowel movement |
|
|
Term
| What do should you suspect if there are a lot of juvenile polyps? |
|
Definition
| if there are 50-100 then suspect autosomal dominant juvenile polyposis syndrome. |
|
|
Term
| Juvenile polyps are associated with an increased risk of... |
|
Definition
| colorectal adenocarcinoma |
|
|
Term
| What are Peutz-Jeghers polyps? |
|
Definition
| hamartomatous (abnormal proliferation of the muscularis mucosae) |
|
|
Term
| What are the gross features of peutz-jeghers polyps? |
|
Definition
| pedunculated, large, lobulated |
|
|
Term
| How many peutz-jeghers polyps do you find in one patient? |
|
Definition
| can be single/few/sporadic or can be part of the autosomal dominant Peutz-Jegher's syndrome |
|
|
Term
| What mutation causes Peutz-Jeghers syndrome? |
|
Definition
| LKB1/STK11 tumor suppressor gene |
|
|
Term
| What are the signs/symptoms of peutz-jeghers syndrome? |
|
Definition
multiple polyps in the stomach, duodenum, jejunum, ileum, and colon
pigmented macules around the lips, oral mucosa, face, genitalia, palms and soles (lentigines and lentiginosis) |
|
|
Term
| Peutz-jeghers syndrome increases your risk of... |
|
Definition
| carcinomas in the breast, ovary, uterus, cervix, lung, and pancreas. Increased risk of esophageal and GI cancer (hamartoma-adenoma-carcinoma sequence) |
|
|
Term
| What does a hyperplastic polyp look like grossly? |
|
Definition
|
|
Term
| What does a hyperplastic polyp look like histologically? |
|
Definition
| crypt hyperplasia, serrated crypt profiles, and serrated architecture is limited to the upper half of the crypts |
|
|
Term
| What are the symptoms of hyperplastic polyps? |
|
Definition
| most are asymptomatic/incidental |
|
|
Term
| Where in the GI tract are hyperplastic poyps most often found? |
|
Definition
|
|
Term
| What other polyp type mirrors the demographic, risk factors, and anatomic distribution of adnemoatous polyps? |
|
Definition
| hyperplastic polyps (but they have no significant malignant potential) |
|
|
Term
| What is the histology of sessile serrated adneomas? |
|
Definition
| similar to hyperplastic polyp; serrated architecture extends to the crypt base, crypt dilatation and branching |
|
|
Term
| Where are sessile serrated adenomas more likely? |
|
Definition
|
|
Term
| T/F Sessile serrated adenomas have premalignant potential. |
|
Definition
| true--associated with microsatellite instability pathway of colorectal carcinogenesis |
|
|
Term
| What is the histology of dysplastic adenomatous polyps? |
|
Definition
| cell proliferation, psuedostratification, variable nuclear enlargement, hyperchromasia and disarray |
|
|
Term
| T/F Adenomatous polyps can be either sessile or pedunculated |
|
Definition
|
|
Term
| What are the three subtypes of adenomatous polyps? |
|
Definition
| tubular (tubular glands), villous (long villous projections), tubulovillous (a mixture of both) |
|
|
Term
| What is the most common subtype of an adenomatous polyp? |
|
Definition
|
|
Term
| Where are most adenomatous polyps found? |
|
Definition
| colon, infrequent in small intestine except for the periampullary region |
|
|
Term
| What patient population is predisposed to adenomatous polyps? |
|
Definition
|
|
Term
| T/F Most patients with adenomatous polyps seek initially medical care for their hematochezia. |
|
Definition
| false, most adenomatous polyps are asymptomatic |
|
|
Term
| T/F Carcinogenesis from adenomatous polyps is slow, allowing for early detection. |
|
Definition
|
|
Term
| Risk of an adenomatous polyp for being malignant is proportional to... |
|
Definition
| polyp size, proportion of villous component, presence of high-grade dysplasia, i.e. cancer is rare in tubular adenomas less than 1 cm but are common in villous adenomas more than 4 cm |
|
|
Term
| T/F Cancer limited to the mucosa (intramucosal carcinoma) has no metastatic potential. |
|
Definition
|
|
Term
| Colon carcinoma invasion beyond the __________ carries the risk of lymphatic invasion and metastases |
|
Definition
|
|
Term
| What is the inheritance pattern of familial adenomatous polyposis? |
|
Definition
|
|
Term
| What is the mutation of FAP? |
|
Definition
|
|
Term
|
Definition
| a minimum of 100 adenomatous polyps |
|
|
Term
| Where are the polyps located in FAP/ |
|
Definition
| mostly in the colon but also in the stomach and small intestine (particularly in the periampullary region) |
|
|
Term
|
Definition
| risk of progression to adenocarcinoma close to 100% so prophylactic colectomy is necessary |
|
|
Term
| What percent of cancers approximately is due to colon cancer? |
|
Definition
| 10% of cancers (10% women, 9% men) |
|
|
Term
| What % of cancer deaths are due to colon cancer? |
|
Definition
|
|
Term
| What are the risk factors for colorectal cancer? |
|
Definition
| older age (60-79), obesity, low physical activity, high intake of animal fat/protein/meat (red or white), decreased folate and Ca, smoking, alcohol, urbanization, high socioeconomic status, IBD, chromosomal abnormalities/polyposis syndrome |
|
|
Term
| What is primary prevention for colorectal carcinoma? |
|
Definition
| NSAIDS (aspirin, piroxicam, sulindac) to prevent/regerss polyps, fiber fresh fruits and vegetables, post menopausal hormonal supplementation, removal of polyps |
|
|
Term
| WHen should you start having a screeining colonoscopy? |
|
Definition
|
|
Term
| If no adnoma/carcinoma found on colonoscopy, repeat in ___. |
|
Definition
|
|
Term
| If you find 1-2 small (<1cm) tubular adenoma and no high-grade dysplasia, you should repeat the colonoscopy in... |
|
Definition
|
|
Term
| If there are 3-10 adenomas, any villous component, any greater than or equal to 1cm or any with high-grade dysplasia? |
|
Definition
|
|
Term
| If you find >10 adenomas on colonoscopy... |
|
Definition
| repeat in < 3 years, consider possibility or personal risk factors such as IBD |
|
|
Term
| When in doubt if you removed an entire polyp, you can make sure by waiting ________ in order to ___________. |
|
Definition
3-6 months
perform a colonoscopy |
|
|
Term
| What are secondary prevention for colon cancer? |
|
Definition
| fecal occult blood tests, fecal DNA tests (detects mutations commonly found in colorectal cancer) |
|
|
Term
| How do we know adenomatous polyps cause cancer? |
|
Definition
| prevalence, anatomic distribution, and peak incidence are all comparable. Also, early invasive carcinoma is often surrounded by adenomatous tissue. The risk of cancer is related to the number of polyps |
|
|
Term
| What mutation(s) causes colon cancer? |
|
Definition
the APC/beta-catenin (suppressor) pathway
loss of APC gene, beta catenin mutations, activation of K-ras gene, loss of DCC, SMADs genes, loss of TP53 gene, activation of telomerase |
|
|
Term
|
Definition
| hereditary nonpolyposis colorectal cancer (lynch syndrome). Associated with extraintestinal cancers, particularly endometrial cancer |
|
|
Term
| What mutations are involved in HNPCC? |
|
Definition
| defect of DNA mismatched repair genes (90% of mutations involve hMSH2 and hMLH1) |
|
|
Term
| What characterizes HNPCC tumors? |
|
Definition
| located proximal to the splenic flexure and are associated with serrated adenomas |
|
|
Term
| What are overal demographic trends of colorectal cancer? |
|
Definition
| more common in men, until recently no major racial difference, decreaseing incidence trend, greater among whites. decreasing mortlity rates particularly among whites, greater mortality rates among blacks than among whites |
|
|
Term
| The decline in inicdence rates of colorectal cancer among whites has occurred in all anatomic sub-sites but has been more pronounced in the ____________________. |
|
Definition
|
|
Term
| Right sided colon carcinomas are more common in which populations? |
|
Definition
| incidences increases with age, more common among blacks |
|
|
Term
| What are the characteristics of cancer in the proximal colon? |
|
Definition
| exophytic, obstruction is uncommon, major manifestation is anemia (occult blood loss) |
|
|
Term
| What are the characteristics of cancer in the distal colon? |
|
Definition
| infiltrative, annular (apple core, napkin ring) obstruction and changes in bowel habits are common; gross bleeding is frequent |
|
|
Term
| Iron deficiency anemia in older men and post menopausal women is ________ until proven otherwise. |
|
Definition
|
|
Term
|
Definition
| carcinoembryonic antigen: used for monitoring patients with resected colorectal cancer |
|
|
Term
| What is the most prognostic indicator of colon cancer? |
|
Definition
| extent of the tumor spread (depth of invasion and lymph node or distant metastases) |
|
|
Term
| What types of cancers occur in the anal canal? |
|
Definition
squamous cell carcinomas distally associated with HPV infection
adenocarcinomas proximally
transitional carcinomas, originating in the transitional epithelium between the squamous and the columnar epithelium |
|
|
Term
| What are carcinoids? Where do they occur? What is their gross appearance? |
|
Definition
| originate in neuroendocrine cells, most occur in appendix (at tip) and the ileum. Less often in stomach, colon and rectum. Characteristic gross yellow-tan appearance |
|
|
Term
| Where in the intestinal wall are carcinoids located? |
|
Definition
|
|
Term
| What is the organization of carcinoid tumors? |
|
Definition
| cells monotonously similar, arranged in discrete islands, trabeculae or glands |
|
|
Term
| What do carcinoid tumors generally secrete into the circulation? |
|
Definition
| serotonin and other histamine-like substances |
|
|
Term
| How do carcinoids "behave"? |
|
Definition
|
|
Term
| Which carcinoids metastasize and which do not? |
|
Definition
| appendiceal and rectal carcinoids almost never metastasize, small bowel carcinoids are the most often associated with metastses. Size >2cm and deep local penetration correlates with metastasis |
|
|
Term
| Carcinoid syndrome occurs when... |
|
Definition
| liver metabolic capacity is overwhelmed or bypassed (large primary tumors, extensive liver metastases, carcinoids outside the portal vein system-extraintestinal) |
|
|
Term
| What are the clinical features of carcinoid syndrome? |
|
Definition
| vasomotor disturbances (flush), intestinal hypermotility (diarrhea, cramps, nausea, vomiting), bronchoconstrictive attacks, endocardial fibrosis (right ventricle), pulmonic and tricuspid valves thickening and stenosis |
|
|
Term
| What is the prognosis for carcinoids? |
|
Definition
carcinoids without associated metastases = excellent prognosis
with hepatic metastases and carcinoid syndrome= survival for 10-15 years is not unusual |
|
|
Term
|
Definition
| lymphomas of mucosa-associated lymphoid tissue= GI lymphomas |
|
|
Term
| T/F The gut is the most common location for extranodal lymphomas. |
|
Definition
|
|
Term
| Where do most maltomas occur? |
|
Definition
| the stomach and small bowel |
|
|
Term
| What type of lymphoma are maltomas? |
|
Definition
|
|
Term
| What patients get T cell maltomas? |
|
Definition
|
|
Term
| What are the risk factors for maltoma? |
|
Definition
| helicobacter pylori (gastric lymphomas), campylobacter jejuni (small intestinal/mediterranean lymphoma), celiac disease (t cell), immunodeficiency |
|
|
Term
| Which has a better outcome, GI lymphomas or nodal lymphomas? |
|
Definition
|
|
Term
| Which GI lymphoma has the best prognosis? |
|
Definition
| gastric is better than small or large bowel |
|
|
Term
| What is the prognosis of T cell GI lymphomas? |
|
Definition
|
|
Term
| What determine lymphoma prognosis? |
|
Definition
| grade and stage of dissemination |
|
|
Term
| Where is mediterranean lymphoma endemic? |
|
Definition
| middle-east and mediterranean |
|
|
Term
|
Definition
| immunoproliferative small intestinal disease (IPSD)= massive infiltration of the proximal small intestine by lymphocytes and plasma cells |
|
|
Term
| What is mediterranean lymphoma? |
|
Definition
| overt B-cell lymphoma, truncated IgA heavy chain (alpha H chain disease) associated with campylobacter jejuni, sometimes regresses after antibiotic therapy |
|
|
Term
| What are common tumors of the appendix? |
|
Definition
| carcinoid, mucocele, mucinous tumors, pseudomyxoma peritonei |
|
|
Term
| What causes acute appendicitis? |
|
Definition
| obstruction of the appendiceal lumen, usually by a fecalith. lower frequency in cultrues with high fiber diets. More common in teenagers and young adults and men |
|
|
Term
| What is the histologic criterion of acute appendicitis? |
|
Definition
| neutrophilic infiltration of the mucularis propria |
|
|
Term
| What are the complications of acute appendicitis? |
|
Definition
rupture and peritonitis
pylephlebitis, thrombosis of the portal vein, liver abscess, and portal hypertension |
|
|
Term
| What is a mucocele of the appendix? |
|
Definition
| cystic dilatation of the appendix by inspissated mucus |
|
|
Term
| What causes a mucocele in the appendix? |
|
Definition
obstruction of the lumen, rare
mucin-producing hyperplastic epithelium |
|
|
Term
| What is a mucinous cystadenoma? |
|
Definition
| possible extravasation of mucin into the abdominal cavity (no malignant cells) |
|
|
Term
| What is a mucinous cystadenocarcinoma? |
|
Definition
| common extravasation of mucin and malignant cells into the abdominal cavity |
|
|
Term
| What is peritoneal mucinous carcinomatosis? |
|
Definition
| mucinous cystadenocarcinoma, neoplastic cells identified in the mucinous fluid |
|
|
Term
|
Definition
| mucinous cystadenoma, no neoplastic cells are identified in the mucinous fluid |
|
|
Term
|
Definition
| any condition in which the abdominal cavity is filled with extracellular mucin |
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