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138 Cards in this Set
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a recurrent granulomatous inflammatory disorder that usually affects the entire wall of the terminal ileum or colon
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Crohn's disease
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inflammatory bowl disease associated with discontinuous patchy skip areas and narrowed lumen
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Crohn's disease
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Gross description of Crohn's disease
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skip areas
thickened wall narrowed lumen fistulous mesenteric fat creep over the bowel |
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inflammatory bowel disease associated with transmural involvement by chronic inflammation and non-caseating granulomas
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Crohn's disease
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usually presents with chronic diarrhea and right lower quadrant pain - may have blood in stool
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Crohn's disease
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Are crohn's and ulcerative colitis systemic diseases
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Yes
arthritis, ocular lesions, skin lesions, liver, vascular |
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systemic disease with primary manifestation being recurrent episodes of inflammation and ulceration of the colon mucosa
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Chronic ulcerative colitis
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inflammatory bowel disease associated with ulcerations beginning in the rectum and spreading proximally without skip areas
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ulcerative colitis
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presents with recurrent intermittent attacks of mucoid bloody diarrhea and crampy abdominal pain
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ulcerative colitis
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complication of ulcerative colitis
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toxic megacolon
adenocarcinoma of colon and rectum |
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differentiate crohn's vs. ulcerative colitis:
location lesions microscopic complications |
location - C (ileum, right colon), UC (rectum distal colon)
lesions - C (discontinuous), UC (continuous) microscopic - C (granulomas), UC (crypt abscesses, pseudopolyps) complications - C (fistulas), UC (toxic megacolon) |
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which has a higher risk of developing adenocarcinoma, crohn's vs. ulcerative colitis
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ulcerative colitis
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Is there inflammation associated with irritable bowel syndrome
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No inflammation
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disorder of altered bowel habits, abdominal pain, and abnormal bowel motility in the absence of identifiable morphologic abnormalities
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irritable bowel syndrome
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what are key symptoms that are absent in irritable bowel syndrome
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nocturnal diarrhea
fever rectal bleeding |
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4 causes of acute intestinal infarction
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hypoperfusion
arterial occlusion venous occlusion extraluminal obstruction of arteries or veins |
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type of intestinal infarction that involves the small bowel more often than the colon
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transmural infarction
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is transmural infarction does occur in the colon, where and why
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splenic flexure - border zone between superior and inferior mesenteric arteries
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why is the mucosa only affected in partial thickness infarctions
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because the mucosa is at the end of the arterial supply
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associated with compromised vascular supply (usually artherosclerosis), more common in the colon than the small intestine
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chronic intestinal ischemia
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abnormal dilations of mucosal and submucosal vessels in the cecum and right colon
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angiodysplasia (vascular ectasia)
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most frequently seen in older patients and associated with aortic valvular disease or abnormalities in von Willibrand Factor
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angiodysplasia (vascular ectasia)
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varices of the anal and perianal venous plexuses
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hemorrhoids
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patients associated with hemorrhoids
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pregnancy
straining to defecate portal hypertension |
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associated with bright red rectal bleeding
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hemorrhoids
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small herniations of mucosa and submucosa through the muscular wall of the intestine
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diverticula
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most common sight of acquired diverticula
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distal colon
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why would diverticula cause lower GI bleeding
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because it an outpoutching of mucosa at the point where nutrient artery penetrates the muscularis
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is lower GI bleeding more common in diverticulosis or diverticulitis
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diverticulosis - no inflammation
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steatorrhea
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greater than 6g/dL in 24 hours of dietary fat intake
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3 mechanisms of diarrhea
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1. secretory - toxins
2. osmotic - decreased absorption 3. increased intestinal motility |
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4 causes of malabsorption
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1. disturbance in intraluminal digestion - pancreatic insufficiency or bile salt deficiency
2. mucosal abnormalities - lactase deficiency, celiac disease, crohn's disease 3. decreased transit time 4. decreased transport of nutrients |
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malabsorption syndrome associated with villus abnormalities which responds to removal of gluten from the diet
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celiac disease
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associated with IgA antigliadin and antiendomysial antibodies
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celiac disease
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associated with a slight risk of developing GI tract T-cell lymphoma
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celiac disease
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an infection by an actinobacterium species
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Whipple's disease
tropheryma whippelii |
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malabsorption due to lymphatic blockage by engorged macrophages
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Whipple's disease
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system disease with migratory arthritis and vague CNS changes, villie are distended and blunted by histiocytes
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Whipple's disease
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3 most common causes of mechanical ileus
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adhesions
hernias neoplasms |
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failure of peristalsis
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functional obstruction
-adynamic ileus -Hirschsprung's disease -bowel infarction |
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causes of adynamic ileus
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peritonitis
electrolyte imbalance bowel infarction |
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strangulation of the herniated bowel
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blood supply is obstructed causing infarction
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invagination of a segment of intestine into an adjacent segment of intestine
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intussusception
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in who is intussusception more common
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children
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rotation of the gut around its mesenteric axis
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volvulus
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which part of the bowel is volvulus most common
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sigmoid colon
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most common sights of intestinal atresia
associations |
duodenum - down syndrome
jejunum - cystic fibrosis |
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why does polyhydramnios develop in some motheres
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babies cannot swallow amniotic fluid due to intestinal obstruction and it builds up
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persistent patency of the vitelline duct
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mecekl's diverticulum
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where is meckel's diverticulum located
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distal ileum on the antimesenteric border
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why is meckel's diverticulum and "true" diverticulum
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because it contains all the layers of the bowell wall unlike an acquired diverticula (mucosa and submucosa only)
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most common problem associated with meckel's diverticulum
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bleeding from peptic ulcers due to ectopic gastric mucosa
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most common congeintal anomaly of the small intestine
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meckel's diverticulum
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failure of development of submucous and myenteric neural plexuses
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Hirchsprung's disease
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association of Hirschsprung's disease
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limited to rectum or rectum and sigmoid
more frequent in down syndrome and males |
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morphology of Hirschsprung's disease
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1. distal abnormal area has constricted diameter
2. proximal normal area is dilated 3. absent ganglion cells in submucosa and muscularis |
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bowel necrosis occurring in the neonate
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neonatal necrotizing enterocolitis
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associated with prematurity, ischemia (respiratory distress) and infection
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neonatal necrotizing enterocolitis
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pockets of gas within the wall of the GI tract surrounded by histiocytes and giant cells
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pneumatosis cystoides intestinalis
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associated with neonatal necrotizing entercolitis in about 1/3 of cases
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pneumatosis cystoides intestinalis
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brown colored mucosa due to laxative abuse
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melanosis coli
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why is mucosa brown in melanosis coli
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macrophages in lamina proprio filled with lipofuscin
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dilated appendix filled with mucus
common cause |
mucocele
mucus-producing tumor |
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pseuomyxoma peritonei
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rupture of wall by mucus-secreting tumor in appendix producing diffuse peritoneal seeding
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most common site of carcinoid tumor
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appendix
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most common cause of hospital-acquired diarrhea
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pseudomembranous entercolitis
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commonly associated antibiotics with pseumembranous enterocolitis
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clindamycin
lincomycin ampicillin |
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bacterial diarrhea that is not invading
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enterotoxigenic E. coli (ETEC)
V. cholerae |
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most common cause of traveler's diarrhea
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ETEC
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bacterial diarrhea due to organism that invades mucosa causing crypt abscesses especially in the distal colon
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Shigellosis
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associated with bloody, mucus-containing diarrhea
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Shigella
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toxin that activates adenylate cyclase (cAMP) leading to secretion of large amounts of electrolytes and fluid
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cholera toxin
*no bloody stools because does not invade |
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bacterial diarrhea due to organism that invades the mucosa and multiplies in lymphoid tissue (especially Peyer's patches) causing longitudenal ulcers of the ileum
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S. typhi
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bacterial organism that invade intestinal mucosa
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C. jejuni
Shigella Salmonella |
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differentiate longitudenal and circumferential ileal ulcers
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longitudenal - S. typhi due to invasion of lymphoid tissue
circumferential - TB due to invasion of lymphoid drainage |
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two organisms associated with viral gastroenteritis
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rotavirus - children
norwalk virus (calciviridae) - adults |
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characteristics of amebiasis
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diarrhea with blood and mucus
flasked-shaped ulcers of colon dissemination to liver toxic megacolon |
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characteristic of giardiasis
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most common intestinal protozoal parasite
ingested cysts release trophozoites in the duodenum does not invade teardrop-shaped flagellate with two nuclei |
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ends at the ligament of Treitz
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duodenum
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supports the crypts and villi
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lamina propria
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separates the mucosa from submucosa
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muscularis mucosa
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what does the submucosa contains
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vascular CT
Meissner's neural plexus (P fibers) |
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what contains Aerbach's plexus (S and P fibers)
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muscularis propria
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controls secretions
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meissner's plexus
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controls peristalsis
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auerbach's plexus
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associated with crypt abscesses filled with neutrophils
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ulcerative colitis
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this type of intestinal infarction is usually limited to one long segment rather than multiple separate areas
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transmural infarct
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most common heterotropic tissues associated with Meckel's diverticulum
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gastric mucosa
pancreatic |
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Are found in abscess and occasionally contain ingested red cells and disseminte to the liver, lungs, and/or brain
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Entamoeba histolytica
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associated with flattening of villi as well as chronic inflammation
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celiac disease
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histiocytes contain PAS positive material
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Whipple's disease
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usually the result of obstruction of the mucosal lumen by a fecalith
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diverticulitis
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associated with multiple hemangiomas, inherted vascular abnormality
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rendu-osler-weber syndrome
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dysplastic process that results in a benign neoplasm of glandular epithelium
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adenoma
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can adenomas develop into carcinomas
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Yes
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two different types of adenomas
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tubular adenomas - usually pedunculated (on a stalk)
villous adenomas - usually sessile (broad, flat base) Tubulovillous adenomas - pedunculated |
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at which size diameter does the adenoma have increased risk of developing into carcinoma
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greater than 2 cm in diameter
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these types of polyps are usually found in multiple
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tubular and tubulovillous adenomas
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these types of polyps are usually solitary
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villous adenomas
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where are tubular/tubulovillous adenomas usually found
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sigmoid colon
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where are villous adenomas found
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rectum and distal colon - most common
ampulla of vater (in duodenum where bile duct) |
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which types of polyps has greater risk of malignancy
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villous adenoma
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Characteristics of familial adenomatous polyposis
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at least 100 polyps (tubular/tubulovillous)
autosomal dominant defect on chromosome 5q21 100% risk of malignancy if not treated |
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multiple colonic polyps found along with osteomas of face and abdominal desmoids
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gardner syndrome
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multiple colonic polyps found along with CNS neoplasms
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turcot syndrome
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risk of malignant potential in gardner and turcot syndromes
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100% risk like FAP
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one of the most common types of polyps that presents with serrated infolding of lining cells that has NO pre-malignant potential
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hyperplastic polyps
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solitary, pedunculated polyp with dilated glands and inflammatory cells in the lamina propria
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Juvenile polyposis (retention polyp)
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this solitary polyp found in children is considered hamartomatous
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juvenile polyposis (retention polyp)
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hamartoma found in the small bowel with disorganized appearing glands with smooth muscle between them
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Peutz-Jegher syndrome
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Peutz-Jegher Syndrome
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multiple PJ type polyps
mucocutaneous pigmentation (buccal, lips, digits) AD chromosome 19 presents between 10 and 30 years old |
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Does peutz-jegher syndrome have increased risk of carcinoma
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Yes, however the cancer does not arise from peutz-jegher polyps
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sessile or ulcerated mass that can encircle the colon lumen causing an apple-core appearance on radiographs
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adenocarcinoma
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clinical presentation of adenocarcinoma of colon or rectum
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bleeding
anemia obstruction - usually on left-side of colon |
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risk factors for developing adenocarcinoma of colon
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increased number and size of polyps
family history ulcerative colitis strep bovis |
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what drug can decrease risk of colorectal cancer
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aspirin or NSAIDs
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genetic mutation seen in most adenocarcinomas of colon
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APC gene at 5q21
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Adenocarcinoma of small intestine
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most occur in duodenum (villous adenoma near ampulla)
can have regional lymph node metastases crohn's disease increases risk |
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neuroendocrine cells tumor that produces serotonin
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carcinoid tumor
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submucosal mass with central depression and regular, relatively uniform cuboidal epithelial cells with secretory granules
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carcinoid tumor
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stain for carcinoid tumor
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chromogranin
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most common location for carcinoid tumor
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appendix
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Carcinoid syndrome
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flushing, diarrhea, wheezing, endocardial fibrosis with valvular deformity (right side)
occurs when metastatic to liver because the liver usually detoxifies serotonin |
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why is the endocardial fibrosis on the right side of the heart in carcinoid syndrome
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because lungs detoxify serotonin prevent left side involvement
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intestinal B-cell MALT lymphoma
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usually in the stomach associated with long-term H. pylori infection
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Mediterranean type intestinal lymphomas
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usually in the proximal small bowel with IgA producing plasma cells with only heavy chains
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tumor associated with interstitial cells of cajal, CD34, and c-Kit
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GI stromal tumor
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treatment of GIST
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Gleevec - inhibitor of c-Kit tyrosine kinase
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cancers of anal canal
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squamous cell carcinomas associated with HPV infection
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lymphoma associated with long term malabsorption, especially celiac disease
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enteropathy associated T-cell lymphoma
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two non-neoplastic polyps (hamartomas)
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Peutz-Jegher
Juvenile (retention) polyp |
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when does carcinoid syndrome occur
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when tumor has metastasized to the liver
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heart abnormality associated with carcinoid tumor
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tricuspid insufficiency
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most common non-neoplastic polyp
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hyperplastic polyp - serrated lumen
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which type of polyp is not associated with malignant potential
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hyperplastic polyp
*peutz-jegher polyp itself has no malignant potential but it is associated with increased carcinoma is other mucosa |
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what does the APC gene do
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tumor suppressor gene
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which intestinal polyp is most likely to be associated with gastric carcinoma
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Peutz-Jegher
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most adenocarcinomas of the colon arise from which type of polyp
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tubar adenoma - just much more common with more in number than villous
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