Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
pathoma
colon
| Question | Answer |
|---|---|
| defective relaxation and peristalsis of rectum and distal sigmoid colon is associated w what congenital disease? what is this disorder/ | this is hirschsprung disease, associated with downs syndrome |
| hirschsprungs is a congenital failure of what? | ganglion cells to descend into the myenteric (auerbach) and submucosal (meissners) plexus |
| where are these plexi located in the bowel wall? | meissners plexus (submucosal) are located in the submucosa to regulate blood flow, secretions and absorptions. myenteric (auerbach) plexus is btw IC and OL in muscularis propria to regulate motility |
| what are the clinical features of hirschsprungs disease? | failure to pass meconium, empty rectal vault on DRE, and massive dilatation (megacolon) of bowel prox to the obstruction w risk of rupture |
| what type of biopsy should you do for suspicion of hirschsprungs disease? what do you expect to find? | rectal suction biopsy to find a lack of ganglion cells |
| tx of hirschsprungs? | resection of the involved bowel; ganglion cells are present in bowel proximal to the diseased segment |
| what are the bowel wall layers affected in chrons disease vs ulcerative colitis? | chrons disease you have knife like fissures involving full thickness of bowel wall. ulcerative colitis have ulcers on the mucosa and submucosa |
| what areas of bowel are affected in chrons disease vs ulcerative colitis? | chrons: anywhere from the mouth to anus can be affected w the fissures, MC is terminal ileum, least is rectum.(have skip lesions) UC: ulcers start in rectum and extend proximally to the cecum (continuous) |
| what are the sxs of chrons disease vs ulcerative colitis? | chrons disease you have pain in RLQ (where the ileum is) w non-bloody diarrhea and UC you have pain in the LLQ (where the rectum is) with bloody diarrhea |
| what type of inflammation do you see in UC vs CD? | chrons you have lymphoid aggregates w granulomas and UC: you have crypt abscesses w neutrophils |
| what is the gross appearance of chrons vs ulcerative colitis? | gross appearance of chrons: cobblestone mucosa, creeping fat, and strictures (string sign). ulcerative colitis: pseudopolpys, loss of haustra (lead pipe sign on imaging) |
| what are the complications of UC vs CD? | CD complications: malabsorption w nutritional deficiency, Ca oxalate kidney stones, fistula formation, CA. UC: toxic megacolon, and CA (usually not a concern until 10 YR of involvement) |
| associations w CD and UC? | CD: ankylosing spondylitis, sacroilitis, migratory polyarthritis, erythema nodosum, uveitis. UC: primary sclerosing cholangitis and pANCA+ |
| smoking in association to CD vs UC? | smoking increases risk of chrons disease and protects against UC |
| colonic diverticula are true or false diverticulum? | they are false diverticulum with outpouchings of mucosa and submucosa through the muscularis propria. |
| what are colonic diverticula associated with? | wall stress- constipation, straining and low-fiber diet. seen in odler adults (risk increases with age) |
| where is the weak point in the colonic wall that increases change of colonic diverticula? | where the vasa recta traverse the muscularis propria. esp seen in the sigmoid colon |
| although colonic diverticula are asxs what are some complications? | rectal bleeding (hematochezia), diverticulitis- dt obstructing fecal material (presents w appendicitis-like sxs in LLQ) and fistula- inflamed diverticulum ruptures and attaches to local structure. colovesicular fistula presents w air (or stool) in urine |
| angiodysplasia is a congenital malformation of the capillary beds in the _____ and ______ | mucosa and submucosa. arises in the cecum and R colon from high wall stress. |
| AD disorder with thin walled blood vessels in the mouth and GI tract is known as what disease? | hereditary hemorrhagic telangiectasia |
| ischemic colitis is ischemic damage to what area of the colon? what is the most common cuase of ischemic colitis? | the splenic flexure- (watershed area of the SMA). MC cause is atherosclerosis of SMA. |
| how does ischemic colitis present? | post-prandial pain, weight loss. an infarction= pain and bloody diarrhea |
| relapsing abdominal pain w bloating, flatulence, and change in bowel habits (constipation or diarrhea) is what disease? what population is it seen in? | IBS, in middle aged females. |
| what can help IBS sxs? | increasing fiber in your diet. |
| what are the 2 most common types of colonic polyps? | hyperplastic and adenomatous. |
| hyperplastic polyps are dt hyperplasia of what? what will you see on microscopy of hyperplastic polyps? and where does it normally occur in the GI tract? | hyperplastic colonic polyps are hypertrophy of the glands. you see serrated appearance on microscopy and its arises in the LEFT colon |
| are hyperplastic polyps benign or malignant? | benign. they have NO malignant potential |
| how are adenomatous polyps different from the hyperplastic? | adenomatous are neoplastic proliferation of the glands, theyre PRE-malignant so they can progress to adenocarcinoma |
| please explain the adenoma-carcinoma sequence of molecular progression from normal colonic mucosa to adenomatous polyp to carcinoma. | APC gene mutations increase the risk for formation of a polyp. k-ras mutation leads to the formation of a polyp. and p53 mutation and increased expression of COX allow for progression to CA. |
| what can you give your pt to inhibit the progression of adenoma to carcinoma? | aspirin** |
| how do we screen for polyps? | colonoscopy and fecal occult blood test. goal is remove adenomatous polyps before progression to carcinoma |
| why do we remove ALL polyps upon colonoscopy? | bc both adenomatous (premalignant) and hyperplastic (benign with no malignant potential) look the same. |
| what is the greatest risk for progression from adenoma to carcinoma? | size >2cm, sessile growth and villous histology |
| APC mutation on ch 5 that increases risk to develop adenomatous polyps in colon and rectum is known as what disease? | familial adenomatous polyposis (FAP) |
| tx for FAP? | removal of rectum and colon |
| what is the difference btw gardners and FAP? | gardners is FAP but with fibromatosis (non-neoplastic proliferation of fibroblasts in retroperitoneum and locally destroys tissue) and osteomas- benign tumor of bone in the skull |
| what is the difference btw turcot syndrome and FAP? | turcot has CNS tumors (medulloblastoma and glial tumors) |
| 4 YO pt presents with a single rectal polyp (hamartomatous, benign) that prolapses and bleeds. dx? | juvenile polyp |
| what if there were multiple of these polyps in the stomach and colon? whats this called? | juvenile polyposis= increased risk of carcinoma progression |
| peutz jeghers syndrome presents with hamartomatous polyps throughout GI and hyperpigmentation of what areas? | lips, oral mucosa and genital skin. |
| peutz jeghers syndrome has an increased risk of what CA? | breast, colon and gynecological |
| peak incidence of colorectal CA? | 60-70YO |
| colorectal CA MC arises from what sequence? | adenoma-carcinoma, but can also airse from microsatellite instability (MSI) |
| what are microsatellites? | are repeating sequences of noncoding DNA, the integrity of sequence is maintained during cell division. instability= defective DNA copy mechanisms- DNA mismatch repair enzymes.. |
| what disease is dt an inherited mutation in the DNA mismatch repair enzymes? | HNPCC- hereditary nonpolyposis colorectal carcinoma |
| you have increased risk of what CA in HNPCC? | ovarian, endometrial and colorectal carcinoma(arises de novo- not from adenomatous polyps, at early age. R sided) |
| whata re the screenings for colorectal carcinoma? | colonoscopy and fecal occult blood test. goal is to remove adenomatous polyps before carcinoma develops or to detect carcinoma early |
| L sided colon CA grows as what classic lesion? whats the pt presentation? | L sided colon CA= napkin ring lesion w decreased stool caliber. pt has LLQ pain and blood streaked stool |
| R sided CA pt presentation/ | iron deficiency anemia (dt occult bleeding) and vague pain. (older woman w IDA has colorectal CA until proven otherwise) |
| colon CA= increased risk for what other condition? | strep bovis endocarditis** |
| where does colon CA like to mets to/ | liver |
| what serum marker is useful in determining pt response to tx for colorectal CA? | CEA. NOT useful for screening |
Created by:
afrank1