Term
| 3 signs of small bowel obstruction |
|
Definition
colicky pain: comes and goes
constipation
inability to fart |
|
|
Term
| 4 signs of small bowel infection, malabsorption or osmotic diarrhea |
|
Definition
diarrhea
if bloody consider infarct
volvulus
dysentery |
|
|
Term
| 1 sign of small bowel malabsorption |
|
Definition
|
|
Term
| 2 signs of large bowel infection, laxitive abuse, IBD |
|
Definition
diarrhea
if blood consider disentery |
|
|
Term
|
Definition
| bloody diarrhea with mucous |
|
|
Term
| 1 sign ulcerative colitis |
|
Definition
| tenesmus: painful ineffective straining at stool |
|
|
Term
| 1 sign of colorectal cancer or polyp |
|
Definition
|
|
Term
| 1 sign of sigmoid diverticulosis or angiodysplasia |
|
Definition
|
|
Term
| 9 congenital malformations of the lower GI |
|
Definition
malrotation
omphalocele
gastroschisis
heterotopias
atresia
stenosis
meckel diverticulum
congenital aganglionic megacolon (hirschsprung)
acquired megacolon |
|
|
Term
| malrotation: cause, 2 complications |
|
Definition
improper embryological rotation of gut
predisposition to volvulus and intestinal strangulation |
|
|
Term
|
Definition
abdominal muscle formation failure causes herniation into ventral mucous membrane
during development bowel enters umbilical cord due to lack of space then does 90deg rotation and returns to abdomen
in omphalocele intestine persists herniated into cord due to abdomnal muscle formation failure
contents COVERED BY PERITONEUM AND AMNION OF UMBILICAL CORD |
|
|
Term
|
Definition
congenintial malformation of abdominal wall
anterior, posterior, or 2 lateral folds did not fuse together leading to exposure of abdominal contents WITHOUT ANY COVERING |
|
|
Term
|
Definition
| normal pancreatic tissue (sometimes gastric) in the intestine |
|
|
Term
| atresia: define the 2 types |
|
Definition
congenital failure of small bowel (usually duodenum) causing it to end in blind loop
inperforate anus (anal atresia) failure of clocal diaphragm rupture |
|
|
Term
| 3 signs of lower GI atresia |
|
Definition
polyhydraminos
distension of stomach (double bubble sign)
vomit with bile |
|
|
Term
| lower GI stenosis causes 3 |
|
Definition
developmental failure
intrauterine vasculalr accident
intussception (telescoping) |
|
|
Term
| meckel diverticulum: cause, 2 forms and how to distinguish them |
|
Definition
in development midgut recieves nutrients from yolk sac via vitelline duct
failure to involute vitelline duct forms TRUE DIVERTICULUM (all 3 layers)
if it does not involute at all baby passes meconium through umbilicus
if it involutes some it causes palpable stool under the umbilicus |
|
|
Term
|
Definition
in meckel diverticulum
seen in 2% of population
2in long
within 2ft of ileocecal valve
2% are symptomat
within first 2y of life |
|
|
Term
| meckel diverticulum: symptoms 4 |
|
Definition
bleeding: due to heterophic pancreatic tissue or gastric mucosa causing acid damage of peptic ulcer
volvus: twisting on mesentery causes ischemia
intusseception
obstruction (mimics appendicitis) |
|
|
Term
| meckel diverticulum: which side of bowel is it on |
|
Definition
|
|
Term
|
Definition
| congenital aganglionic megacolon |
|
|
Term
| hirschsprung disease: epidemology |
|
Definition
short segment more in males
long segment more in females
10% occur in down syndrome
5% occur with neurological disorder |
|
|
Term
| hirschsprung disease: cause |
|
Definition
migration of neural crest cells stops before reaching anus or ganglion cells undergo premature death due to 8 possible mutations causing lack of nerve plexuses
no ganglion cells in portion of intestine leads to ACh absence
always effects rectum (neural crest cells migrate cephalad to caudad) |
|
|
Term
| what are the 2 nerve plexuses in the intestines, their locations, and their functions |
|
Definition
myenteric/auerbachs myenteric plexus: between lamina propria layers, motility and relaxation
submucosal/meissner plexus: submucosa, regulates absorption, blood flow, secretions |
|
|
Term
| hirschsprung disease: 3 types, which one is more rare and which most common |
|
Definition
short segment disease: rectum and sigmoid - most common
long segment disease: rectum and entire colon - rate
intermediate disease |
|
|
Term
| hirschsprung disease: diagnosis |
|
Definition
dilation and hypertrophy proximal to segment (can become thin and rupture usually near cecum)
rectal suction biopsy (regular biopsy is only mucosa) only shows ganglion cells
FAILURE TO PASS MECONIUM IMMEDIATLY NEONATAL
empty vault on digital rectal exam |
|
|
Term
| why might a baby pass meconiium but still have hirschsprung disease |
|
Definition
| if only a few cm of bowel affected pressure could allow stool passage |
|
|
Term
| hirschsprung disease: 4 complications |
|
Definition
enterocolitis
fluid/electrolyte imbalance
perforateion (usually near cecum)
peritonitis |
|
|
Term
| acquired megacolon: 4 causes and the pathological change with each |
|
Definition
chagas disease: loss of mural ganglia
bowel obstruction: neoplasm or inflammatory structure
toxic megacolon: complicating ulcerative colitis
function psychosomatic disorder |
|
|
Term
|
Definition
increase in stool mass, frequency, fluidity >250mg/d, 70-95% water
pain, urgency, perianal discomfort, incontinence, disentery |
|
|
Term
|
Definition
low volume
painful
bloody diarrhea
mixed with mucous |
|
|
Term
|
Definition
| secretory diarrhea, osmotic diarrhea, exudative (invasive) diarrhea, deranged motility, malabdorption |
|
|
Term
| secretory diarrhea: define 3 |
|
Definition
>500 ml/d fluid stool
isotonic with plasma
persists in fast |
|
|
Term
| secretory diarrhea: 3 causes |
|
Definition
microbe
laxative
carcinoid syndrome |
|
|
Term
| osmotic diarrhea: define 3 |
|
Definition
>500 ml/d fluid stool
osmotic gap with plasma
stops in fast |
|
|
Term
| osmotic diarrhea 2 causes |
|
Definition
disaccharide (lactase) deficiency
stunned gut in giardiasis |
|
|
Term
| exudative (invasive) diarrhea: define 3 |
|
Definition
mucosa destruction
bloody stool
frequent but little bolume |
|
|
Term
| exudative (invasive) diarrhea: causes 3 |
|
Definition
| pathogen invading enterocytes: shigella, camplobacter, E. histolytica |
|
|
Term
| deranged motility diarrhea: pathogenesis |
|
Definition
| improper neuromuscular function causes variable pattern of increased volume |
|
|
Term
| malabsorption diarrhea: 4 signs |
|
Definition
voluminous stool
increased osmolarity
steratorrhea
stops in fasting |
|
|
Term
| malabsorption syndrome definition |
|
Definition
| increased STEATORRHEA with vitamin, mineral, carb, and protein deficiencies |
|
|
Term
| malabsorption syndromes we are going to talk about 4 |
|
Definition
celiac disease
inflammatory bowel disease: chrons disease, ulcerative colitis
whipple disease |
|
|
Term
| 2 causes of malabsorption of fats and proteins |
|
Definition
PANCREATIC INSUFFICIENCY DUE TO CYSTIC FIBROSIS
zollinger ellison syndrome: inactivation of pancreatic enzymes by excess gastric acid |
|
|
Term
| 3 causes of malabsirption due to solibilization of fat due to defective bile secretion |
|
Definition
ileal dysfunction or resection decreases bile salt uptake
cessation of bile flow from obstruction
hepatid dysfunction |
|
|
Term
| 1 cause of malabsirption causing nutrient preabsorption of modification |
|
Definition
|
|
Term
| 3 primacy mucosa cell abnormalities leading to malabsorption |
|
Definition
defective terminal digestion: LACTOSE INTOLERANCE, bacterial overgrowth with brush border damage
defective transepithelial transport: albetalipoproteinemia |
|
|
Term
| who is disaccharidase deficiency (lactose intolerance) most common in 3 |
|
Definition
africans
native americans
asians |
|
|
Term
| 3 causes of malabsorption due to reduced SI surface area |
|
Definition
| GLUTEN SENSITIVE ENTEROPATHY (CELIAC) |
|
|
Term
| 4 infections that cause malabsorption |
|
Definition
acute enteritis
parasite
tropical sprue
whipple disease |
|
|
Term
| 2 causes of lymph obstruction that lead to malabsorption |
|
Definition
| lymphoma, TB lymphadenitis |
|
|
Term
| 23 clinical signs of malabsorption |
|
Definition
steatorrhea
diarrhea
flatulence
abdominal pain
borborygmi
weight loss
mucositis
Fe deficient anemia
pyridoxitine, B12 or folate deficiency
Bleeding: VitK deficiency
osteopenia
tetany: Ca, Mg, VitD deficiency
amenorrhea
impotence
infertility
hyperparathyroid: Ca/VitD deficiency
petechiae: vit K deficnecy
edema: protein deficiency
dermatitis/hyperkaratosis: VitA, zinc, niacin, FA deficiency
peripherial neuropathy: B12 or VitA deficiency |
|
|
Term
| what deficiencies cause peripherial neuropathy 2 |
|
Definition
|
|
Term
| what deficiencies cause dermatitis or hyperkaratosis 4 |
|
Definition
vitA
zinc
niacin
FA deficiency |
|
|
Term
| what deficicy causes edema |
|
Definition
|
|
Term
| what deficiency causes petechiae and bleeding |
|
Definition
|
|
Term
| what deficiency causes hyperparathyroid 2 |
|
Definition
|
|
Term
| what deficiency causes tatany 3 |
|
Definition
|
|
Term
| cause and appearance of setaorrhea |
|
Definition
excessive greasy stool, bulky, frothy, yellow, gray
due to maldigestion of fat by pancreatic lipase or malassimilation of fat in small bowel |
|
|
Term
| what is intraluminal digestion |
|
Definition
protein, carb, fat broken down to assimilable form
oral saliva, then gastric pepsin, then emulsion via bile salts |
|
|
Term
| what is terminal digestion |
|
Definition
| hydeolysis of carb/peptides by sisaccharidases/peptidases in brush border of SI mucosa |
|
|
Term
| that is transepithelial transport |
|
Definition
delivery of nutrients, fluid, electrolytes across epithelium to vessels
FA converted to TG, combined with cholesterol, made into chylomicron, delivered to lymphatics |
|
|
Term
| 3 ways we test for fat malabsorption |
|
Definition
quantative stool for fat: THE test, stool collected over 72h (positive if >7g fat)
qualitative stool for fat: stain with sudan III, lacks sensitivity
serum B carotine: precursor for fat soluble vitA (<20 ug/dL means malabsorption) |
|
|
Term
|
Definition
celiac surpe
gluten sensitive entropathy |
|
|
Term
| celiac disease: epidemology 7 |
|
Definition
caucasian, european descent (not native american, chinese, japanese)
usually adult women
associated with down syndrome, turner syndrome TYPE I DIABETES, other autoimmune disorders |
|
|
Term
| tropical surpe: location, 2 complications, diagnosis |
|
Definition
celiac disease occuring in tropical region after infectious diarrhea that responds to antibiotics
damage is most prominate in jejunum and ileum causing folate and B12 deficiencies |
|
|
Term
|
Definition
| genetic and envitonmental |
|
|
Term
| celiac disease: genetics associated 3 |
|
Definition
MHC-II, HLA-DRQ, HLA-DQ8
chronic autoimmune disease |
|
|
Term
| celiac disease: environmental causes |
|
Definition
fotavirus: increaes epithelial permeability to glidan
formula: breast feeding decreases risk of intestine infection that causes epithelial permeability, has Ig to stop recognition of glidin by the immune system
TIMING OF GLUTEN INTRODUCTION TO DIET: INCREASED RISK WITH GLUTEN <4MO / >7MO. risk decreased if still breast feeding when gluten introduced |
|
|
Term
| gliadin: structure, 3 places its found |
|
Definition
alcohol soluble, water insoluble
protein part of gluten in wheat, barley, rye |
|
|
Term
| explain how glidin causes effect in celiac disease |
|
Definition
tissue transglutaminase deaminates glidan increasing binding to HLA-DQ2, HLA-DQ8 on APC in SI
CD4 cells in lamina propria recognize peptides causing inflammation that damages villi and causes CRYPT HYPERPLASIA
glidin damages epithelial cells increasing IL-15 which activates CD8 |
|
|
Term
| celiac disease: 3 morphological changes and the cause of each |
|
Definition
dermatitis herpetiformis: IgA deposits on TIPS OF DERMAL PAPILLAE which destory connection between epidermis and dermis causing vesicles to form
flat villi with CRYPT HYPERPLASIA
increased epithelial lymphocytes |
|
|
Term
| celiac disease: location of most damage and why |
|
Definition
| duodenum (proximal SI) which recieves most glidin |
|
|
Term
|
Definition
diagnosed infancy to 50yo
improves on DC glidins
infant: diarrhea, abdominal distension, FTT
kid: short, neuro symptoms, anemia
adult: diarrhea, fe deficiency anemia, osteoporosis |
|
|
Term
| celiac disease: complications |
|
Definition
non-hodgkin lymphoma
SI adenocarcinoma
esophageal SCC |
|
|
Term
| celiac disease: diagnosis 4 |
|
Definition
IgA auto-Ab endomysium
tTG
gliadin
duodenal biopsy |
|
|
Term
|
Definition
developed cauntries
caucasian esp NE descent
mostly teens - 30s
genetic susceptability - multigenetic maybe NOD2 |
|
|
Term
|
Definition
idiopathic autoimmune: exaggerated CD4 response (antigen may be self or microbe)
defects in epithelial barrier function |
|
|
Term
|
Definition
chronic and relapsing
primary sclerosing cholangitis UC>CD
iritis/uveitis CD>UC
erythema nodosum
polyderma gangrenosum
SACROLITIS (HLA-B27 association) |
|
|
Term
|
Definition
chrons disease
ulcerative colitis |
|
|
Term
| chrons disease: epidemology |
|
Definition
|
|
Term
| chrons disease: thickness of tissue involved |
|
Definition
transmural (full thickness)
knife like linear fissures |
|
|
Term
|
Definition
any part of GI but USUALLY ILEUM and colon
PATCHY DISTRIBUTION (skip lesions)
rectum least comon |
|
|
Term
| chrons disease: gross features 4 |
|
Definition
thick bowel wall
narrow lumen
COBBLESTONE MUCOSA
creeping fat and strictures |
|
|
Term
| why are the creeping fat and stricturesin chrons disease |
|
Definition
| myofibroblasts come to heal via fibrosis because damage was full thickness and this pulls up fat and narrows lumen |
|
|
Term
| chrons disease: histological tissue changes 2 |
|
Definition
noncaseating granuloma
lymphoid aggregates |
|
|
Term
| chrons disease: clinical signs |
|
Definition
RLQ COLICLY PAIN (ileum)
NON-BLOODY diarrhea (unless it has progressed to colon or anus) |
|
|
Term
| chrons disease: is there malabsorption |
|
Definition
|
|
Term
| chrons disease: X-ray signs |
|
Definition
| STRING SIGN when barium goes through narrow fibrosed areas |
|
|
Term
| chrons disease: complications 4 |
|
Definition
fistula
obstruction
calcium oxalate renal caliculi: increased reabsorption oxylate in inflammed bowel
macrocytic anemia
carcinoma risk based on extent of colon involvement in >10y disease (less common than UC) |
|
|
Term
| ulcerative colitis: epidemology |
|
Definition
|
|
Term
| ulcerative colitis: thickness of GI wall affected |
|
Definition
| pseudopolyps: submucosa and mucosa ulcers |
|
|
Term
| ulcerative colitis: location |
|
Definition
| begins in rectum and extends to CECUM (CONTINOUS) |
|
|
Term
| ulcerative colitis: gross features 3 |
|
Definition
inflammatory pseudopolyps take up most of the SA of the colon
friable bloody mucosa
ulceration and hemorrhage |
|
|
Term
| ulcerative colitis: histological changes 2 |
|
Definition
crypt abscess with neutrophils
P-ANCA+ |
|
|
Term
| ulcerative colitis: symptoms 7 |
|
Definition
fever
tenesmus
weight loss
LLQ PAIN
BLOODY MUCOUS
diarrhea
cramping |
|
|
Term
| ulcerative colitis: is there malabsorption |
|
Definition
|
|
Term
| ulcerative colitis: X-ray sign |
|
Definition
| lead pipe sign due to loss of haustra |
|
|
Term
| ulcerative colitis: complications 4 |
|
Definition
toxic megacolon: damage muscularis propria neural plexus stopping motility
carcinoma risk based on extent of colon involvement and >10y with disease (more common than chrons because more in colon)
P-ANCA+: microscopic polyangiitis, churg-strauss |
|
|
Term
| 4 pathogenesis causing bowel ischemia |
|
Definition
occlusion of major supply trunk (celiac, superior/inferior mesenteric)
small bowel more likley to get ischemic damage (needs lots of ATP)
may not cause infarct at all due to anastamosing network of vessels
ischemic injury due to hypoxia and REPROFUSION INJURY |
|
|
Term
| types of ischemic bowel disease |
|
Definition
transmural - all layers
mural - mucosa and submucosa |
|
|
Term
| causes of transmural ischemic bowel disease 7 |
|
Definition
THROMBOSIS ON ATHLEROSCLEROTIC PLAQUE OR EMBOLI FROM L. HEART 50%
OCCLUSION OF MESENTERIC VESSEL (USUALLY SMA) via emboli from AFib
vasculitis: polyarteritis nodosa
ATHLEROSCLEROTIC PLAQUE
thrombi from polycythemia vera
antiphospholipid syndrome in mesenteric vein |
|
|
Term
| transmural ischemic bowel disease: pathogenesis |
|
Definition
splenic flexure of colon at greatest risk (watershed between superior and inferior mesenteric arteries
causes hemorrhages and inflammation on serosal surface |
|
|
Term
| signs of transmural ischemic bowel disease 7 |
|
Definition
SUDDEN SEVERE ABDOMINAL PAIN
NAUSEA AND VOMITING
BLOODY DIARRHEA - MELENA
absent bowel sounds
abdominal wall rigidity after eating
weight loss
barium thumb print sign on colon due to mucosal edema |
|
|
Term
| cause of mural ischemic bowel disease |
|
Definition
hypoperfusion from shock causes non-occlusive ischemia which decreases blood supply to farthest point (mucosa)
no hemorrhage or inflammatory exudates |
|
|
Term
| signs of mural ischemic bowel disease 6 |
|
Definition
non specific abdominal signs
intermittenent bloody diarrhea/guiac +
ischemic colitis: pain in splenic flexure after eating, weight loss, barium thumb print sign on colon due to mucosal edema |
|
|
Term
| prognosis of ischemic bowel disease |
|
Definition
| 50-75% death (esp in elderly with cardiovascular disease) |
|
|
Term
|
Definition
age: years of increased stretch
genetic predisposition |
|
|
Term
| angiodysplasia: associated diseases 2 |
|
Definition
| genetic predisposition is associated with aortic stenosis and meckel diverticulum |
|
|
Term
| angiodysplasia: pathogenesis |
|
Definition
dilation of mucosa and submucosa of vessel in cecum on right colon
large cecum is subject to increased wall stretch that stretches venules |
|
|
Term
|
Definition
| in <1% population but causes 20% of significant GI bleeds |
|
|
Term
| hemorrhoids: 2 risk factors |
|
Definition
constipation: straining with at stool
pregnancy: causes venous stasis (rare <30 unless pregnant) |
|
|
Term
| hemorrhoids: pathogenesis |
|
Definition
| variceal dilation of anal/perianal venous plexus due to increased pressure |
|
|
Term
| where is intestinal obstruction most common |
|
Definition
|
|
Term
| most common, second most common, and 3 runner up intestinal obstructions |
|
Definition
80% hernia
15% SI obstruction
adhesion
volvuli
intussecption |
|
|
Term
|
Definition
| peritoneal cavity weakens ana dallows pouch lined with serosa to protrude |
|
|
Term
|
Definition
inguinal canal
femoral canal
umbilicus
surgical scars |
|
|
Term
|
Definition
visceral segments (usually SI) protrude and ebcome trapped in them (most common in inguinal hernias due to narrow opening and large sac)
incarceration: premanent trapping, if pressure at pouch opening stops venous drainiage and causes edema |
|
|
Term
|
Definition
| surgery, infection, endometrosis |
|
|
Term
| pathogenesis of adhesions |
|
Definition
| fibrous bridge between bowel segment or abdominal wall causes loops where viscera can become trapped (internal herniation) |
|
|
Term
| intussception causes in children and adults 2 |
|
Definition
rotavirus: enlarges payers pateches or causes inflammation in TERMINAL ILEUM which telescopes into secum
adults: intraluminal mass or tumor serves as traction |
|
|
Term
| intussception pathogenesis |
|
Definition
segment of intestine telescopes distally and is propelled further by peristalsis
pulls mesentery with it and traps mesenteriv vessels causing infarct |
|
|
Term
|
Definition
| complete twist of bowel about mesenteric base causes obstruction and infarct |
|
|
Term
| volvulus: locations, which is most common |
|
Definition
loops of sigmoid - most common
cecum
SI
stomach
transverse colon |
|
|
Term
|
Definition
|
|
Term
| define diverticular disease |
|
Definition
| diverticulosis that is symptomatic |
|
|
Term
| define true diverticulia, what is the cause, one example disrease |
|
Definition
involve all three layers
congenital
meckel diverticulum |
|
|
Term
| acquired diverticulia: define, location most common, second most common |
|
Definition
attenuated muscularis propria
LEFT COLON ESP SIGMOID MOST COMMON
in duodenum in context of PUD |
|
|
Term
| diverticular disease: epidemology 3 |
|
Definition
rare <30yo, when >50yo 50% prevelance
japanese and non-industralized tropical countries |
|
|
Term
| define false diverticulum |
|
Definition
| outpouch of mucosa and submucosa through muscularis propria |
|
|
Term
| diverticular disease: causes 2 |
|
Definition
constipation, straining, low fiber diet increase wall stress where vasa recta vessels transverse muscularis propria
increased intraluminal pressure: increased in peristalsis and spasmodic sequestration of bowel segments (esp low fiber diet) |
|
|
Term
| diverticular disease: symptoms 8 |
|
Definition
20% asymptomatic
cramping
constipation
distension
continous lower abd discomfort
incomplete emptying sensation in rectum
bacterial infection risk causes B12 and salt deficiencies |
|
|
Term
| diverticular disease: complications 5 |
|
Definition
perforation
peritonitis
fistula
hematoschezia: rectal bleed
diverciculitis |
|
|
Term
| diverticular disease: why do fistulas form, which is most common, what is the symptom of that one |
|
Definition
when wall gets inflammed it ruptures and attaches to local structure
most common is colovesicular (bowel to bladder) causing air and stool in urine |
|
|
Term
|
Definition
| inflammation of diverticulum due to obstruction of perforation |
|
|
Term
|
Definition
stool trapped in diverticulum hardens to FECALITH and dissects into pericolic fat
may lead to fibrosis of colonic wall |
|
|
Term
| signs of diverticulitis 3 |
|
Definition
| similar to appendicitis: fever, rebound tenderness, pain in LLQ |
|
|
Term
| what are the SI tumors 4, what is their prognosis |
|
Definition
uncommon benign
adenoma, leiomuomc, lipoma, neuroma |
|
|
Term
| how are adenomas different in the lower GI |
|
Definition
| PREMALIGNANT (UNLIKE EVERYWHERE ELSE IN THE BODY) |
|
|
Term
| where is the most common location for a lower GI tumor |
|
Definition
|
|
Term
| where do most adenocarcinomas sshow up |
|
Definition
| in the colon secoundary to bronchogenic carcinoma in COD |
|
|
Term
| adenoma: location, sign, epidemology |
|
Definition
ampulla od vater
occult blood loss
30-60yo |
|
|
Term
| adenocarcinoma: location, epidemology |
|
Definition
|
|
Term
| signs of adenocarcinoma 4 |
|
Definition
intestinal obstruction presenting OR
obstructive jaundice, occlut blood loss
OR
intussception
usually penetration of bowel wall at diagnosis |
|
|
Term
| risk factors for adenocarcinoma 6 |
|
Definition
chronic inflammation in chrons
FAP
HNPCC
peutz jeghers
EtOH
tobacco |
|
|
Term
| prognosis of adenocarcinoma |
|
Definition
| wide en block excision gives 70% 5y survival |
|
|
Term
|
Definition
mass protruding into gut lumen (sessile or pedunculate/stalked)
polyp from inflammation of abnormal maturation are not neoplastic |
|
|
Term
| benign tumors of colon and rectum 2 |
|
Definition
hyperplastic polup
harmatomous polyps |
|
|
Term
|
Definition
juvenile poluposis
peutz-jeghers syndrome
cowden syndrome
cronkhite-canada syndrome |
|
|
Term
| hyperplastic polyp: epidemology |
|
Definition
| in 50% of adults >60yo (incidental finding) |
|
|
Term
| hyperplastic polyp: cause |
|
Definition
| decreased cell turn over and accumulation of mature cells |
|
|
Term
| hyperplastic polyp: appearance and location |
|
Definition
| many nipple protrusions on mucosal fods of rectosigmoid colon |
|
|
Term
| hyperplastic polyp: morphology |
|
Definition
| hyperplasia of glands causes serrated appearance |
|
|
Term
| hyperplastic polyp: prognosis |
|
Definition
| benign with no malgiant potential |
|
|
Term
| harmatomatous polup: cause |
|
Definition
| malformation of glands and stroma |
|
|
Term
| peutz-jegers syndrome: cause |
|
Definition
|
|
Term
| peutz-jegers syndrome: signs 3 |
|
Definition
harmatoma polup
melanotic mucosa
CUTANEOUS PIGMENTATION OF LIPS, ORAL MUCOSA, FACE, GENITALIA, PALMS |
|
|
Term
| peutz-jegers syndrome: appearance, location |
|
Definition
polyps are large and PEDUNCULATED
SI |
|
|
Term
| peutz-jegers syndrome: complications 2 |
|
Definition
intussceptions cause mortality
increased risk of pancreas, lung, ovary, uterine cancer |
|
|
Term
| malignant and premalignant lesions of the lower GI 2 |
|
Definition
adenoma - premalignant
colorectal carcinoma |
|
|
Term
|
Definition
| neoplastic proliferation of glands that can progress to adenocarcinoma via adenocarcinoma progression sequence |
|
|
Term
| adenoma: how is severity determined 2 |
|
Definition
size and type of dysplasia
least risk: tubular <1cm
high risk: villous >4cm |
|
|
Term
|
Definition
tubumar: mostly in colon
villous: mostly in rectum and rectosigmoid colon |
|
|
Term
|
Definition
villous mostly symptomatic
rectal bleeding
hypoteinamia
hypokalemia due to mucous secretion |
|
|
Term
|
Definition
| complete resection due to premalignant potential |
|
|
Term
| what is the adenoma carcinoma progression sequence (3 steps) |
|
Definition
2 sporatic APC mutation needed to increase risk (in familial adenomatous polyposis syndrome one is already mutated)
K-ras mutation leads to formation of polyp
P53 mutation increases COX and allows carcinoma |
|
|
Term
| what can halt progression of adenoma, why |
|
Definition
| aspirin halts progression by stopping COX that is increased by the P53 mutation |
|
|
Term
| colorectal carcinoma: epidemology 4 |
|
Definition
60-80yo
M > F
low risk: mexico, S America, Africa, Japan
high risk: US, australia, E Europe, New Sealand |
|
|
Term
| colorectal carcinoma: risk factors 4 |
|
Definition
high calories
refined carbs
red meat
low fiber
aspirin and NSAIDS protective |
|
|
Term
| what are the 2 pathways of pathogenesis in colorectal carcinoma |
|
Definition
APC/B-catenin pathway
microsatelite instability pathway |
|
|
Term
| APC/B-catenin pathway explination |
|
Definition
loss of APC increases epithelial cells causing dysplasia and allowing adenoma to carcinoma sequence
PRECURSOR ADENOMA NEEDED |
|
|
Term
| explain the microsatellite instability pathway |
|
Definition
DNA mismatch repair gene mutation causes cell growth
microsatellites prone to misalignent of BAX and TGF-B II receptor
CAN GO STRAIGHT TO CANCER WITHOUT PRECURSOR ADENOMA |
|
|
Term
| what familial syndromes increase risk of entering APC/B-catenin pathway or microsatellite instability pathway |
|
Definition
familial adenomatous polyposis: APC/B-catenin
hereditary nonpolyposis colorectal cancer: microsatelite instability pathway |
|
|
Term
| familial adenomatous polyposis: cause |
|
Definition
|
|
Term
| familial adenomatous polyposis: signs |
|
Definition
100s of adenomas in colon 100% CANCEROUS
100 polyp minimum (MOSTLY TUBULAR) |
|
|
Term
| familial adenomatous polyposis: TX |
|
Definition
| require prophylactic colectomy |
|
|
Term
| familial adenomatous polyposis: associated disease and its symptoms 5 |
|
Definition
| multiple oestomas, epidemal cysts, fibromatosis, abnormal dentition, thyroid cancer |
|
|
Term
| familial adenomatous polyposis: attenuated disease |
|
Definition
~30 polyps in PROXIMAL colon
50% risk of cancer |
|
|
Term
| hereditary nonpolyposis colorectal cancer: cause |
|
Definition
| DNA mismatch repair mutation |
|
|
Term
| hereditary nonpolyposis colorectal cancer: signs 7 |
|
Definition
few polyps, earlier appearance
MALIGNANCY INDIPENDENT OF APPEARING POLYPS
malignancy: endometrial, SI, ureter, renal pelvis |
|
|
Term
| hereditary nonpolyposis colorectal cancer: morphology 2 |
|
Definition
tumor has poor differentiation
mucin present |
|
|
Term
| right side or proximal (cecum/ascending colon) colorectal cancer: what syndrome is associated with it |
|
Definition
|
|
Term
| right side or proximal (cecum/ascending colon) colorectal cancer: morphology 5 |
|
Definition
raised lesion
MICROSATELLITE INSTABILITY PATHWAY
diploid DNA
polyploid exophytic mass ON ONE WALL
LESS AGRESSIVE |
|
|
Term
| right side or proximal (cecum/ascending colon) colorectal cancer: symptoms 5 |
|
Definition
older adult
Fe deficiency anemia
vague pain
fatigue
weakness |
|
|
Term
| left side or distal (rectum/sigmoid) colorectal cancer: associated syndromes 2 |
|
Definition
|
|
Term
| left side or distal (rectum/sigmoid) colorectal cancer: morphology 4 |
|
Definition
napkin ring lesions (causes long thin stool)
APC/B-catenin adenoma progression
ANEUPLOID DNA
MORE AGRESSIVE |
|
|
Term
| left side or distal (rectum/sigmoid) colorectal cancer: symptoms 4 |
|
Definition
long thin stool
LLQ pain
blood streaked stool
diarrhea/constipation |
|
|
Term
| what is a rare but bad type of colorectal cancer, why |
|
Definition
mucin production bodies present
dissects through gut wall so cancer can spread
bad prognosis |
|
|
Term
| colorectal carcinoma: patterns of metastasis |
|
Definition
even if it invades lamina propria there is little metastasic potential because there is no lymph channels in colonic mucosa
spread by extension into adjacent structures
metastasis through little lymph there is goes nodes > liver > lung > bone
most drain to portal vein and go o the liver
low lying rectal cancer drains to IVC and goes to the lung |
|
|
Term
| colorectal carcinoma prognosis |
|
Definition
stage is most important indicator, based on depth of invasion
CEA tumor marker is good to assessing tx and reoccurance risk (NOT staging) |
|
|
Term
| what is the cause of Fe deficiency anemia in older med |
|
Definition
| GI cancer until proven otherwise |
|
|
Term
| acute appendicitis: epidemology 2 |
|
Definition
adolescents to young adults
M>F |
|
|
Term
| acute appendicitis: pathogenesis |
|
Definition
| obstruction (fecalith, gallstone, tumor) increases intraluminal pressure causing collapse of veins and ischemia allowing bacterial proliferation and inflammation |
|
|
Term
| acute appendicitis: signs |
|
Definition
McBurneys: LLQ pain (later)
periumbilical pain (earlier)
N/V
abd tenderness
fever
increased WBC
repture: peritonitis causes gaurding and rebound tenderness |
|
|
Term
| acute appendicitis: complications |
|
Definition
| periappendiceal abscess - common |
|
|
Term
| acute appendicitis: prognosis |
|
Definition
| 2% mortality if no laproscopic removal |
|
|
Term
| acute appendicitis: rate of false positive diagnosis |
|
Definition
|
|
Term
| 2 tumors of eppendix, which is most common |
|
Definition
carcinoid - most common
mucocele |
|
|
Term
| carcinoid tumor of appendix: symptoms, location, appearance, prognosis |
|
Definition
rarley symptomatic
distal tip
solid bulbous swelling 2-3cm
distant spread rare, local invasion common |
|
|
Term
| mucocele of appendix: morphology, cause |
|
Definition
dilated filled with mucin
obstruction or mucin secreting adenoma or adenocarcinoma |
|
|
Term
|
Definition
internal: above dentate line
external: below dentate line |
|
|
Term
| anal fissure: pathogenesis |
|
Definition
| longitudinal defect in mucosa extending down from dentate line |
|
|
Term
|
Definition
sharp rectal pain on defication
bleeding: blood coated stool, appears on paper
sentineal pile: fibroepithelial tag below fissure |
|
|
Term
| 2 anal canal tumors, which is more common |
|
Definition
basaloid (cloacogenic) carcinoma - more common
squamous cell carcinoma |
|
|
Term
| basloid/cloacogenic carcinoma: location, epidemology |
|
Definition
transitional zone above dentate line
F?M |
|
|
Term
| squamous cell carcinma of the anal canal: cause |
|
Definition
| HPV 16 and 18 most common in MSM |
|
|
