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Lecture 10

Non-neoplastic Gastrointestinal Tract

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.
Created by: UVAPATH2



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