Systems Pathology II - Exam 1 (Part 3)

What is a common feature/symptom of disorders of the small/large intestine?

Malabsorption & Diarrhea

What is the lack of movement of intestinal contents through the intestine with pain, distention, constipation, vomiting, which can develop acutely or gradually, and MC occurs in the small intestine?

Intestinal Obstructions

Which of the 4 types of Intestinal obstructions is an abdominal wall defect, allowing a segment of intestine to protrude, leading to inflammation?

Hernia

What is the MC type of hernia (70%)? Who does this occur MC in?

Inguinal

-- 90% of those in MALES

What are the 4 locations for hernias?

1) Epigastric

2) Umbilical

3) Inguinal

4) Femoral

Which of the 4 types of Intestinal obstructions is chronic inflammation (post surgery) with adherent segments?

Adhesions

Which of the 4 types of Intestinal obstructions is when a proximal segment telescopes into a distal segment leading to retention of intestinal content in distended bowel, leading to abdominal pain, red currant jelly stool, and occurs in children, with treatment being barium or air enema or surgery? What is the MC location for this to occur?

Intussusception

MC - Ileocecal area (Ileum & Cecum)

Which of the 4 types of Intestinal obstructions is the twisting of a loop of bowel, leading to abdominal pain and requiring surgery? What is the MC location for this to occur?

Volvulus

MC = sigmoid colon

What is a congenital small pouch in the wall of the intestine that is MC asymptomatic near the junction of the small and large intestines, with the pouch being a remnant of tissue from the prenatal development of the digestive system, but it is not made up of the same tissue as the small intestine but instead a type of tissue found int he stomach or pancreas (can produce acid)?

Meckel Diverticulum

When Meckel Diverticulum is symptomatic, it can lead to what symptom's?

Inflammation

1) Diverticulitis (pain)

2) Perforation/Hemorrhage

Who is most at risk for Meckel Diverticulum? What percent of the population has this? What percent of individuals who have this is symptomatic? How long is the outpouch?

2x Males

2% population

2% symptomatic

2 inches

NOTE: Rule of 2s

What is the onset of abdominal pain that is sudden and severe, with a non-specific cause?

Acute abdomen

What is the MC cause of acute abdomen, occurs in 7% of the population, with pain early on beginning in the periumbilical/epigastric discomfort, then later the pain becomes a deep/sharp/constant pain in the right lower quadrant, anorexia, nausea/vomiting, low-grade fever, and leukocytosis?

Acute Appendicitis

Who is MC affected by acute appendicitis?

Adolescents & Young adults

Males

What is a common cause of Acute Appendicitis (50-80%)?

Obstruction! (ischemia --> inflammation)

- fecaliths, gallstones, tumor, worms, undigested food, foreign object

If the appendix perforates (ruptures), what can this lead to? What is the prognosis?

Peritonitis & Sepsis

-- high morbidity & mortality

T/F: Tumors of the appendix are fairly common and a common cause of acute appendicitis?

FALSE

-- tumors of appendix RARE

What is the MC tumor of the appendix? What is the appendix also a possible site for?

Carcinoid

NOTE: rarely adenocarcinoma

Possible site for mucocele

What is an acquired condition often in the sigmoid colon (95%) with numerous diverticula that may become larger & more numerous with infection being possible and perforation can lead to hemorrhage due to risks such as age, refined food, constipation, decreased fiber and increased straining/pressure, and is diagnosed via colonoscopy, barium enema, CT, MRI, or capsule endoscopy?

Sigmoid Diverticulitis (colonic diverticulosis)

50% of people with sigmoid diverticulitis are >____ years old, with ____% symptomatic (diverticulitis) with diarrhea, cramping, and localized pain in the lower left quadrant?

>60 years old

20% symptomatic

What is the sensation of inadequate bowel movement (gone to bathroom, but feels as if not everything is getting out)?

Tenesmus

How is Sigmoid Diverticulitis treated?

Reduce intraluminal pressure through lifelong dietary modification

-- increase fiber (decreases exaggerated peristalsis)

-- Antibiotics can also combat infection

What condition affects the superior mesenteric and inferior mesenteric arteries, with ischemia leading to hypotension or occlusion or mucosal infarction, and severity is based on the onset (acute/chronic) and extent of ischemia with risks such as elderly and history of cardiovascular disease?

Ischemic Bowel Disease (Ischemic Colitis)

What are 3 major causes of Ischemic Bowel Disease?

1) Thrombosis

2) Arterial Embolism

3) Non-occlusive Ischemia

What is a common and complex disorder combining hypertension and obesity, with high serum triglycerides, low serum HDL, and insulin resistance (3/5)?

Metabolic Syndrome (MetS)

Which type of ischemic bowel disease is insidious with episodic bloody diarrhea, mimicking IBD (inflammatory bowel disease)?

Chronic Ischemic Bowel Disease

Which type of ischemic bowel disease is severe abdominal pain (rigidity), nausea, vomiting, frank blood in stool with a risk for septic/hypovolemic shock, and 50% are lethal?

Acute Ischemic Bowel Disease

What are some treatments of Ischemic Bowel Disease?

Prophylactic antibiotics, clot prevention/dissolving meds, IV fluids, treat underlying medical conditions

-- avoid vasoconstrict medications

-- surgery to remove dead tissue or repair bowel in serious cases

What is a vascular lesion in the submucosal & mucosal vessels which are tortuous/dilated, located in the cecum (MC) or ascending colon, with 20% of the lower intestinal bleeds (melena or fecal occult blood),

Angiodysplasia

What are dilated hemorrhoidal venous plexus thin walled varices which are swollen and tortuous, and is the MC GI vascular disorder in 5% of adults, can range from asymptomatic to very painful to irritate surrounding tissues wit perianal itching (pruritus) or frank blood in stool?

Hemorrhoids

Which type of hemorrhoids increases the anorectal line? Which decreases the anorectal line?

Internal Hemorrhoids

External Hemorrhoids

What are some risks of Hemorroids?

Diagnosed by a colonoscopy, affects 1% of adults (increasing w age), and is hypothesized to develop due to mechanical stress (constipation)

What is the MC complication of Hemorrhoids? What is the MC treatment?

Rectal bleeding

Most self-limiting

Hemorrhoids recur from a range of ___-___%

5-50%

What condition is intestinal inflammation to diarrhea, and is a common symptom of other conditions such as infection, inflammation, ischemia, and malabsorption?

Diarrheal Diseases (Enterocolitis, Coloenteritis)

What are the 4 Malabsorption conditions in the US?

1) Celiac Disease

2) Crohn Disease

3) Lactose intolerance

4) Pancreatic insufficiency

What is a condition which occurs when the pancreas does not make enough of a specific enzyme (pancreatic elastase) that the body uses to digest food int he small intestine?

Exocrine Pancreatic Insufficiency (EPI)

What is the concern with chronic diarrhea?

Decreased absorption (fats, carbs, proteins, vitamins, minerals, electrolytes, H2O)

What is excessive fat in feces (bulky, frothy, greasy, yellow/gray diarrhea)?

Steatorrhea

What is bloody diarrhea following infection (painful, may be small volume, mucus)?

Dysentery

What are some features of malabsorption?

Weight loss/muscle wasting

Borborygmus & flatulence

Abdominal distension

Anorexia

What is an immune-mediated non-infectious malabsorption reaction to gliadin (gluten) where Lymphocytes (T & B cells) have villous atrophy in the duodenum & jejunum which is treated by a gluten-free diet?

Celiac Disease (Celiac sprue, gluten-sensitive enteropathy)

What two genes are involved in the familial risk of Celiac Disease? How much of a risk is there with just one copy of the gene?

HLA-DQ2 or -DQ8

1 copy = 3-10x

2 copies increases more

Also 1% of US/European Caucasians (30-60 years old)

NOTE: this human leukocyte antigen does not mean you HAVE celiac, but it does increase risk; genetic test CAN rule out, but CANNOT confirm

What is when the grooves are elongated compared to a normal intestinal linin which has short crypts, which is blunted or atrophic villi and shrinking/flattening of villi due to repeated gluten exposure?

Crypt Hyperplasia (Villous atrophy)

What are some features of Celiac Disease?

Diarrhea, steatorrhea, bloating, abdomianl distention/bloating, failure to gain weight

Anemia/fatigue

Possibly asymptomatic

What does Celiac Disease increase the risk of?

Intestinal Adenocarcinoma

How is Celiac Disease diagnosed?

Duodenal biopsy

IgA to tissue transglutaminase

IgG deaminated gliadin

Additional tests = bone density, nutritional deficiencies, if no response to gluten free diet more evaluation required

What condition is itchy (pruritic) small blisters on the arms, elbows, legs, and buttocks, and occurs in 10% of celiac disease patients?

Dermatitis Herpetiformis

What is a disease of the small intestine characterized by mucosal injury, malnutrition, & inflammation (chronic enteritis) with fever/malaise, diarrhea/steatorrhea leading to weight loss, and nutritional deficiencies leading to stunted growth, and is idiopathic but may be autoimmune (villus atrophy) or infectious since it can respond to antibiotics?

Environmental Enteropathy (Whipple's (Tropical Sprue) Disease)

Who is Environmental Enteropathy (Whipple's (Tropical Sprue) Disease) MC seen in?

CHILDREN (2-3) living in tropical areas (30 degrees of the equator) or recently visited

What condition is reduced/absent lactase, so lactose cannot be digested by the brush boarder enzymes leading to bloating, cramps, gas, and diarrhea (30 mins postprandial), is MC acquired in young adulthood and is rarely congenital (autosomal recessive), diagnosed via a breath hydrogen test and treated via avoiding lactose (lactase supplements)?

Lactose Intolerance (Lactase deficiency, disaccharidase deficiency)

What condition is a microbial infection leading to inflammation and diarrhea with abdominal pain, urgency/incontinence, perianal discomfort, hemorrhage, and is a major global health problem duet o bacteria, virus, or protozoan?

Infectious Enterocolitis

T/F: Everyone has 1.5 episodes of diarrhea annually

TRUE

Which condition is due to a gram (-) bacteria and is found in contaminated H2O (fecal-oral) in India/Africa due to a toxin that opens the CFTR, leading to massive chloride ion secretion (water follows, losing 1L per hour; minimal tissue damage) and often has acute onset with vomiting & "rice water" diarrhea, cramping, dehydration, and hypovolemic shock?

Cholera

What pathogen causes Cholera?

Vibrio cholerae

(gram (-) bacteria)

Cholera is treated by fluids, electrolytes, antibiotics, and zinc, but in ____% of cases its lethal if no treatment received in 24 hours.

70%

What is 3 or more unformed or "loose" stools within 24 hours when traveling to a new place, due to consumption of contaminated food or water (fecal-oral), acute onset, recovery within a few days, watery diarrhea, cramps, nausea, vomiting?

Traveler's Diarrhea

What is the #1 bacteria associated with Traveler's Diarrhea?

Enterotoxigenic E. coli

(symptoms 3-4 days after exposure)

What is the MC bacterial enteric pathogen in the US from contaminated H2O, Raw Chicken, unpasteurized milk, with symptoms beginning 2-5 days after exposure due to enterotoxins leading to dysentery & fever (10+/day, 7-10 days/week)?

Campylobacter Enterocolitis

What conditions can be triggered/initiated by Campylobacter Enterocolitis if an individual is already susceptible or prone to it?

Reactive arthritis or GBS

What is abdominal pain, watery or bloody diarrhea with sudden onset, early fever, and 6+ BM/day that can be caused by many different pathogens (campylobacter, shigella, E. coli, Salmonella) where the first 4 days si bloody diarrhea, mucosal edema, cryptitis, crypt ulcers, abscesses, and for 6-9 days we see resolution and regenerative features?

Acute Self-limited Colitis

How is Acute Self-limited Colitis diagnosed? Treated?

Diagnosis: Stool culture, colonoscopy w/ mucosal bipsy, lab work = high WBC

Treated: supportive therapy w/ rehydration, rarely antibiotics/steroids

What are 2 differential diagnosis for Acute self-limited colitis?

Inflammatory bowel disease (IBD), Crohn, Ulcerative Collitis

What are histological characteristics of Campylobacter jejuni in acute self-limited colitis? E. coli?

Neutrophils, crypt abscess

Neutrophils, normal crypt architecture

What is the MC bacterial cause of food poisoning and is a non-bloody diarrhea, N/V, fever, myalgia, headache, abdominal cramps due to contaminated eggs, poultry, inadequately pasteurized milk, and lizards/snakes?

Salmonella food poisoning (acute bacterial gastroenteritis, Salmonellosis)

What is swelling/inflammation of the large intestine due to over-growth of Chloridoids difficile bacteria PSEUDOMEMBRANES due to cellular debris and WBCs and is the MC post hospital infection and a common cause of diarrhea after antibiotic use?

Pseudomembranous colitis (Clostridium difficile colitis, C. Diff. colitis)

What makes up 1/2 of all gastroenteritis (stomach flu) conditions from infection to inflammation to diarrhea and symptoms of nausea, vomiting, diarrhea, cramps, and malabsorption int he stomach or SI that occurs during contaminated food/water and is self limiting, treated via palliative care & fluid replacement?

Viral gastroenteritis

Which viral gastroenteritis occurs in children (6 months - 2 years) 1-2 days after exposure?

Rotavirus

Which viral gastroenteritis occurs in adults and is the Norwalk-like virus which occurs 1-2 days after exposure?

Norovirus

What pathogen is the most common waterborne disease in the US and is a flagellated protozoa resistant to cold and chlorine, transmitted via fecal-oral route with a 1-2 week latency and it alters SI enzymes (noninvasive)?

Giardia intestinalis

What is severe watery diarrhea with abdominal pain, bloating, N/V, malabsorption, low grade fever, and "rotten egg" smelling stool?

Giardiasis (Beaver fever)

What is a functional GI disorder with altered bowel habits with NO inflammation, often with chronic and relapsing abdominal pain, altered BM habits, bloating, diarrhea, or constipation (C), but is idiopathic (no cellular abnormalities/pathogen) and is treated w/ fiber, decreased carbs, and stress management?

Irritable Bowel Syndrome (IBS)

What percent of the population is affected by IBS? Who is it MC in?

10-20%

MC between 20-40 years (females, psychological stress)

What condition is a category of conditions with abnormal host immune response (hypersensitivity), genetic predisposition, intestinal epithelial dysfunciton and lack of microbiota diversity, relapsing episodes of inflammation, abdominal pian, diarrhea, blood in stool, and weight loss?

Inflammatory Bowel Disease (IBD)

Inflammatory Bowel Disease (IBD) is an abnormal GI immune response that can be idiopathic/hypersensitivity/autoimmune that is _________ & ________ in nature, and is more common in what population?

Chronic & Relapsing

Females, adolescence, Caucasians, hygeine hypothesis

What type of inflammatory bowel disease (IBD) is in the entire GI tract (gum to bum) and transmural (deep) regional inflammation and fissures/strictures, is a T cell-mediated reaction (pathogen trigger) with melena, mild diarrhea, fever, abdominal pain, skip lesions, granulomas, ulcerations, strictures, skin reaction, arthritis, AS, eye irritation, and fatigue, but no cure?

Crohn's Disease (regional enteritis)

Crohn's Disease occurs more commonly in young adults (19-40), is treated by probiotics and immunosuppressive meds, but can increase the risk of what?

GI adenocarcinoma (8-10 years after diagnosis)

Where are Crohn's Disease Lesions MC?

Ileum

What type of inflammatory bowel disease (IBD) always begins in the rectum/distal colon and moves proximally, and is in the mucosa & submucosa with superficial inflammation leading to mucosal ulcerations, and pseudopolyps, has an insidious onset (tenemus, fever, abdominal pain) with relapsing episodes, and grossly bloody/mucoid (stringy) stool lasting days to months with lower abdominal cramping?

Ulcerative Colitis (UC)

Ulcerative Colitis (UC) affects young adults, adults, and seniors, is associated with toxic megacolon (polyarthritis, sacroiliitis, AS, eye irritation), is diagnosed via colonoscopy & biopsy, and smoking is __________.

Inhibitory

Ulcerative Colitis increases the risk of what condition?

Adenocarcinoma risk (8-10 years after diagnosis)

What is a characteristic feature(s) of Crohn's Disease? Ulcerative Colitis?

Crohn's = Skip Lesions

(Strictures, fissures/fibrosis, creeping fat, cobblestone appearance)

UC = Pseuodoplyps

SUMMARY: Crohn's vs Ulcerative Collitis

Crohn's Disease

- malabsorptive

- fissures/strictures/granulomas/skip lesions

- entire GI tract

- fibrosis

Ulcerative Colitis

- NOT malabsorptive

- Pseudopolyps/diffuse ulcerations

- Non-granulomatous/little-to-no fibrosis

- Rectum/distal colon

BOTH

- IBD

- Familial, females

- adenocarcinoma risk

- EXTRAINTESTINAL manifestations (ex: oral ulcers, arthritis, spondylitis)

What type of colon polyp & tumor can arise form IBD and is low risk, removed during colonoscopy?

Inflammatory

What type of colon polyp & tumor is removed during colonoscopy, and when small in the lower colon its rarely malignant, but when larger in the upper colon is precancerous?

Hyperplastic

What type of colon polyp & tumor is a benign neoplasm that is removed during colonoscopy, with dysplasia can become a adenocarcinoma and is in 50% of people over 50, a family history increases the risk by 4x, and a regular follow-up needed to screen for/remove new polyps, with symptoms such as occult blood (FOB) and possible anemia?

Adenomatous (Tubular Adenoma; Colonic Adenomas)

What type of colon polyp & tumor when small is low risk, when larger its a higher risk, and when flat they're harder to remove?

Villous Adenoma (Tubulovillous Adenoma)

What type of colon polyp & tumor makes up 20-30% of colon cancers and is hard to detect during colonoscopy?

Serrated adenoma

What is the MC colon polyp (70%)?

Adenomatous (Tubular adenoma)

What type of GI polyp & tumor is rare compared to other types of GI polyps, but are the most commons type of polyp in children?

Hamartomata's polyps (HPs)

Cancer is rare in adenomas if ____cm, but occurs in 50% of cases if ____cm

<1cm

>2cm

What condition is an autosomal dominant cancer syndrome due to an APC mutation on chromosome 5, or autosomal recessive on the MUTYH-associated polyposis gene on chromosome 1, with teenaged onset of numerous adenomas and fundic gland polyps, fecal occult blood, anemia, and has a diagnostic criteria of >100 adenomas, MC 500-2500 polyps?

Familial Adenomatous Polyposis

Familial Adenomatous Polyposis has a 100% rate of developing what condition, MC before the age of 30, which is why many get a prophylactic colectomy to preserve their life?

Colon cancer

What condition is a hereditary cancer syndrome where inherited mutations alter DNA mismatch repair, increasing the risk of various cancers at a younger onset (ex: colorectal/small intestine, gastric, brain, endometrial (MC), skin, ovarian, uterine)?

Lynch Syndrome (Hereditary nonpolyposis colorectal cancer; HNPCC)

Tumors of the colon can be benign or malignant, and a major source of morbidity & mortality worldwide, with 5% of US population developing colorectal cancer, making up 10% of cancer related deaths, and 40% of cases lethal. What are the 2 types of tumors of the colon?

1) Adenocarcinomas (MC)

2) Carcinoid tumors

What is the MC malignancy of GI tract? What is the MC age of diagnosis? Who has the highest rates due to highly processed diet (30x increased risk)?

Colorectal adenocarcinoma

50-70 years old

USA highest rates (age, males, IBD, dietary risk factors, decreased fiber)

What is the most common location for colon cancer?

Ascending colon

What is the most common location of metastasis for colorectal adenocarcinoma?

Liver

What are the 6 ways to reduce your risk of colorectal cancer?

1) Eat less processed foods

2) Healthy weight

3) Eat more fiber

4) Consume less alcohol

5) Don't smoke

6) Stay active

What type of cancer are 1/2 adenocarcinomas and 1/2 carcinoids and is rare, asymptomatic early with features such as abdominal pain/cramping, nausea, vomiting, and weight loss?

Small intestine cancer