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Lecture 10
Non-neoplastic Gastrointestinal Tract
| Question | Answer |
|---|---|
| A remnant of the omphalomesenteric duct and located near the ileocecal valve. It usually contains heterotopic gastric or pancreatic tissue, or both. | Meckel's diverticulum |
| What percentage of the population have a Meckel's diverticulum? | 2% |
| What is the typical location of a Meckel's diverticulum? | Found on the antimesenteric side of the ileum usually within 2 feet of the ileocecal valve. The diverticulum is typically 2-3 inches long. |
| Common invasive bacteria resulting in diarrhea | Campylobacter jejuni, E. coli, Salmonella, Shigella, Tuberculosis, Yersinia enterocolitica |
| Common toxigenic bacteria causing diarrhea | Vibrio cholerae, E. coli |
| A disease characterized by hypersensitivity to gliadin. A gluten-free diet leads to clinical improvement. | Celiac sprue |
| Microscopic findings of Celiac sprue | (1) villous atrophy (2) increase in lymphocytes and plasma cells (3) crypt elongation |
| A malabsorption syndrome similar to Celiac sprue, but is likely due to an infectious agent. The findings are more severe in the distal small bowel than Celiac sprue. | Tropical sprue |
| Treatment of tropical sprue | Broad spectrum antibiotics |
| Microscopic findings of Whipple's disease | The lamina propria of the small bowel is filled with PAS-positive foamy macrophages. Rod-shaped bacilli are seen in macrophages or free in the lamina propria. |
| A malabsorption condition caused by the colonization of the small bowel with organisms that usually reside in the colon. | Bacterial Overgrowth Syndrome |
| Pathogenesis of disaccharidase deficiency | Villous absorptive cells lack sufficient quantities of lactase; therefore cannot break down lactose. This results in osmotic pull causing watery diarrhea and malabsorption. |
| Common causes of bowel obstruction | (1) adhesions (2) hernias (3) intussusception (4) volvulus |
| Definition of volvulus | Twisting of the bowel about its mesenteric base resulting in bowel obstruction, strangulation, and eventual infarction of involved bowel. |
| Pathogenesis of gallstone ileus | Gallstone erodes through the gallbladder wall into an adherent portion of the small bowel and eventual impaction of the gallstone in the terminal ileum. |
| Cause of intussusception in children | Enlarged Peyer's patches in reaction to viral infection act as lead points. |
| Cause of intussusception in adults | Intraluminal neoplasm |
| A chronic, idiopathic, ulcerative and fibrosing inflammatory bowel disease that can affect any portion of the GI tract. | Crohn's Disease |
| (T or F) Crohn's disease commonly affect the retum. | False. Rectal involvement is infrequent, but the anal/perianal area is often involved. |
| Morphology of Crohn's Disease | (1) Transmural involvement (2) skip lesions (3) non-caseating granulomas (4) cobblestone appearance of intestinal mucosa |
| A disease characterized by mucosal inflammation and ulceration limited to the colon | Ulcerative colitis |
| What layers of the intestine does ulcerative colitis involve? | Ulcerative colitis only involves the mucosa and submucosa |
| (T or F) Fistulas are common in ulcerative colitis. | False. Fistulas are more common in Crohn's disease due to the transmural involvement of the inflammation. |
| A severe complication of ulcerative colitis characterized by marked dilation of the colon. | Toxic megacolon |
| Morphologic characteristics of ulcerative colitis | (1) inflammatory changes involving only the mucosa and submucosa (2) continuous lesions (3) crypt abscesses (4) hemorrhage (5) pseudopolyps |
| Why is prophylatic total colectomy indicated in chronic ulcerative pancolitis? | More than 30% of patients who have pancolitis for at least 3 decades develop adenocarcinoma. The tumors tend to be poorly differentiated and presnt at a high stage. |
| Treatment of pseudomembranous colitis | Vancomycin |
| Antibiotics commonly associated with pseudomembranous colitis | (1) clindamycin (2) Lincomycin |
| Antibiotic associated colitis characterized by C. difficle infection and the formation of gray/yellowish membrane on top of the intestinal epithelium | Pseudomembrane colitis (C.difficle colitis) |
| A transmural colitis that affects premature or low birth weight infants. | Necrotizing enterocolitis |
| What portions of the GI tract are commonly affected in Necrotizing Enterocolitis? | (1) Terminal ileum (2) Cecum (3) Ascending colon |
| What is "backwash ileitis"? | Involvement of the terminal ileum by the inflammatory and ulcerative changes seen in chronic ulcerative colitis; distinguished from involvement of ileum and proximal colon by Crohn's disease |
| Inflammatory disease characterized by patchy bands of collagen deposited just beneath the epithelial surface and a mild increase in lymphocytes and eosinophils. Typically affects elderly women. | Collagenous colitis |
| Treatment of diversion colitis | (1) instillation of short chain fatty acids (2) Reestablishment of colonic continuity |
| A congential condition suspected when the infant fails to pass meconium stool | Hirschsprung's disease |
| Condition resulting in dilation of the colon proximal to the segment of agangliosis | Hirschsprung's disase |
| How do you diagnose Hirschsprung's disease? | Biopsy of the anorectal junction. Biospy tissue will reavel absence of ganglion cells. |
| A condition common in the Western population. Found commonly in the elderly. Characterized by the herniation ofhte mucosa and the submucosa into the muscularis propria. | Diverticulosis |
| What portion of the GI tract is most frequently involved in diverticulosis? | The sigmnoid colon is involved in 90% of cases. |
| Inflammation of colonic diverticula, which can be complicated by abscess formation and peritonitis. | Diverticulitis |
| Most common cause of severe lower GI bleeding characterized by a focus of small, dilated capillaries inthe mucosa of the cecum or right colon The submucosa also contain tortuous, abnormal, and dilated veins. | Angiodysplasia |
| A shallow ulcer found on the anterior rectal wall in young adults | Mucosal prolapse (solitary rectal ulcer) |
| Common location of stercoral uclers | Recto-sigmoid colon |
| Colonic ulcers that arise due to pressure necrosis of the mucosa by hard, impacted feces | Stercoral ulcers |
| Causes of penumatosis cystoides intestinalis | (1) dissection of air around great vessesls and their abdominal branches in COPD patients (2) presence of invasive, gas-forming bacteria in damaged bowel wall |
| A condition characterized by localized or diffuse air-filled spaces in the colon | Pneumatosis cystoides intestinalis |
| A condition characterized by black colonic mucosa from frequent anthraquinone cathartic ingestion | Melanosis coli |
| Appearance of the colon with frequent laxative use | Black colonic mucosa |
| Causes of hemorrhoids | (1) constipation (2) venous stasis in pregnancy (3) protal hypertension |
| Location of internal hemorrhoids | Internal hemorrhoids are found above the anorectal line |
| Longitudinal ulcers found in the posterior and distal portion of the anal canal resulting from trauma during passage of hard, bulky feces. | Anal fissures |
| Pathogenesis of acute appendicitis | Obstruction of the appendical lumen(most often with fecalith), resulting in bacterial proliferation and inflammation, which range from mild to gangreous. |
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