Gastrointestinal Diseases Overview

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Questions and Answers

What characteristic of the mucosa is described as having a cobblestone appearance?

Ulcers

Chronic Active Inflammation

Fissures (correct)

Creeping mesenteric fat

What type of inflammation features deep ulcers and neutrophils?

Chronic Active Inflammation (correct)

Superficial Inflammation

Fibrosis

Epithelial dysplasia

Which of the following is a complication typically associated with chronic inflammation of the mucosa?

Regeneration of epithelium

Formation of fistulas (correct)

Presence of granulomas

Narrowing of the lumen

How does chronic active inflammation affect the layers of the wall?

Affects all wall layers (transmural) Signup and view all the answers

What type of abscess is associated with chronic inflammation?

Crypt abscesses Signup and view all the answers

What is a key feature of granulomas observed in chronic inflammation?

Non-caseating granulomas Signup and view all the answers

What is indicated by the presence of pseudo-polyps in long-standing chronic inflammation?

Epithelial regeneration Signup and view all the answers

What does the chronic phase of inflammation NOT demonstrate?

Dysplasia Signup and view all the answers

What clinical feature is likely to be present in a patient with mesenteric artery thrombosis or embolism?

Persistent vomiting Signup and view all the answers

Which complication is associated with gangrene in the context of mesenteric artery obstruction?

Ischemic necrosis Signup and view all the answers

Which condition is NOT a functional cause of chronic intestinal obstruction?

Endophytic tumor Signup and view all the answers

What is a potential complication of diverticular disease of the colon?

Diverticulitis or abscess Signup and view all the answers

Which organism is commonly associated with acute diffuse suppurative appendicitis?

Staphylococcus aureus Signup and view all the answers

Which of the following is a characteristic of celiac disease?

Partial to total villous atrophy Signup and view all the answers

Which of the following is a common predisposing factor for acute appendicitis in adults?

Carcinoid tumor Signup and view all the answers

What is a defining characteristic of malabsorption syndromes?

Defective absorption of nutrients Signup and view all the answers

What is the primary characteristic of giardiasis?

Partial villous atrophy of the small intestine Signup and view all the answers

Which of the following conditions can lead to secondary malabsorption?

Inflammation Signup and view all the answers

What type of organism causes typhoid fever?

Salmonella typhi Signup and view all the answers

Which of the following is NOT a complication of typhoid fever?

Steatorrhea Signup and view all the answers

How is primary intestinal tuberculosis primarily contracted?

Swallowing human or bovine tubercle bacilli Signup and view all the answers

What feature is common in the pathology of typhoid fever?

Longitudinal ulcers in the intestinal mucosa Signup and view all the answers

Which symptom is commonly associated with secondary malabsorption?

Chronic diarrhea with weight loss Signup and view all the answers

Which method is required for secondary intestinal tuberculosis infection?

Ingestion of infected sputum Signup and view all the answers

What is a feature of ulcers found in tuberculous lymphadenitis?

Undermined edges with a caseous floor Signup and view all the answers

What generally characterizes the fate of tuberculous infections in individuals with low body resistance?

Infections lead to systemic spread. Signup and view all the answers

What type of necrosis is typically associated with Bacilli reaching Peyer’s patches?

Caseous necrosis Signup and view all the answers

In the case of tuberculous girdle ulcers, which of the following features is noted?

A caseous floor Signup and view all the answers

What is a common outcome of tuberculous lymphangitis?

Localized lesions in mesenteric lymph nodes Signup and view all the answers

What type of ulcers are commonly seen in the context of terminal ileal involvement?

Multiple terminal ileal ulcers Signup and view all the answers

What is a direct complication of tuberculosis according to the discussed information?

TB peritonitis Signup and view all the answers

How does good body resistance affect tuberculous infections?

Improved localization of lesions Signup and view all the answers

What is the primary characteristic of tubular adenomas?

They are pedunculated and small. Signup and view all the answers

Which of the following is NOT a type of neoplastic polyp?

Pseudopolyps Signup and view all the answers

Which of the following conditions is related to Peutz-Jeghers polyps?

Mucocutaneous hyperpigmentation and extraintestinal malignancies. Signup and view all the answers

What is the risk factor for malignancy correlated with adenomas?

Size of the adenoma and degree of dysplasia. Signup and view all the answers

What percentage of patients with familial adenomatous polyposis (FAP) will develop colorectal carcinoma by the age of 30?

100% Signup and view all the answers

Which type of polyp is most likely to present with rectal bleeding in children?

Juvenile polyp Signup and view all the answers

The term 'adenomas' encompasses which characteristic?

They are pre-cancerous with variable cancer risk. Signup and view all the answers

What is the initial treatment option for patients discovered to have APC mutations?

Prophylactic colectomy Signup and view all the answers

Study Notes

Crohn's Disease

Gross Appearance: Cobblestone appearance of the mucosa, adherent creeping mesenteric fat, deep fissures, fistula tracts and fibrosis
Microscopic Features: Chronic active inflammation with deep ulcers, fissures, & neutrophils. All wall layers are affected (transmural) with fibrosis, granulomas (35% non-caseating), and no dysplasia.
Complications: Thrombosis or embolism of mesenteric artery leading to infarction of a segment, septic peritonitis, and gangrene.

Chronic Intestinal Obstruction

Definition: Gradual incomplete obstruction of the intestinal lumen.
Causes: Functional (Hirschsprung disease) or organic (adhesions, endophytic tumor, fibrous stricture)
Gross Appearance: Proximal segment markedly dilated and hypertrophic, distal segment collapsed.

Diverticular Disease of The Colon

Definition: Acquired herniations of mucosa and submucosa into the intestinal wall.
Complications: Diverticulitis or abscess, bleeding, perforation & septic peritonitis, fibrosis & stricture.

Acute Diffuse Suppurative Appendicitis

Etiology: Obstruction with fecolith & seeds (adults), lymphoid hyperplasia (children), or carcinoid tumor. Organisms include Staphylococci and E. coli.
Complications: Perforation & septic peritonitis, peri-appendicular inflammatory mass/ abscess, gangrene, portal pyemia, mucocele (mucus-filled bag), empyema (pus-filled bag), and chronic appendicitis.

Malabsorption

Definition: Defective absorption of fats, proteins, carbohydrates, water, electrolytes, minerals, and vitamins.
Etiology: Celiac disease (gluten-induced enteropathy), tropical sprue, Giardiasis, secondary malabsorption due to various factors (inflammation, tumors, post-surgical resections). Patients generally present with chronic diarrhea, steatorrhea, and weight loss.

Typhoid Fever

Definition: Systemic infective disease of the small intestine and other organs caused by Salmonella typhi, predominantly affecting children and adolescents.
Route of infection: Ingestion of contaminated water or food.
Pathogenesis: Pathological features include enlarged and swollen Peyer's patches, oval longitudinal ulcers in the intestinal mucosa, and enlarged spleen.
Complications: Hemorrhage, perforation, secondary amyloidosis, and dysplasia/adenocarcinoma.

Primary Intestinal Tuberculosis

Mode of infection: Swallowing of human or bovine tubercle bacilli.
Pathology: Primary complex includes an initial lesion with a group of tubercles in Peyer's patches forming a small nodule and minimal ulceration of the covering mucosa, tuberculous lymphangitis, and tuberculous lymphadenitis (Tabes Mesenterica).
Fate and Complications: With good body resistance, the disease localizes. With low body resistance, the disease spreads. Direct spread leads to TB peritonitis, while lymphatic spread leads to TB lymphadenitis. Other complications include hemorrhage, fissures, fistulae, fibrosis with strictures, secondary amyloidosis, and malabsorption.

Secondary Intestinal Tuberculosis

Mode of infection: Ingestion of infected sputum from patients with pulmonary TB.
Pathology: Lesions typically occur in the terminal ileum and caecum, with bacilli reaching Peyer's patches and solitary follicles, leading to caseous necrosis and erosion of the covering mucosa. Multiple tuberculous ulcers result, located in the terminal ileum, transversely (girdle), and undermined edges with a caseous floor. Mesenteric lymph nodes show minimal lesions.
Fate and Complications: Spread can occur directly, leading to TB peritonitis, or lymphatically, leading to TB lymphadenitis. Other complications include hemorrhage, perforation, secondary amyloidosis, dysplasia/adenocarcinoma, and liver damage (associated with primary sclerosing cholangitis).

Intestinal Polyps and Tumors

Non Neoplastic Polyps: Bilharzial polyps, pseudopolyps (in ulcerative colitis), hyperplastic polyps, and hamartomatous polyps (including juvenile polyps and Peutz-Jeghers polyps).
Neoplastic Polyps (Adenomas): Tubular adenoma (pedunculated, small), villous adenoma (sessile, large), tubulo-villous adenoma (combined). Adenomas are very common, their incidence increases with age, and they are considered precursors to colorectal cancers. The risk of malignancy is correlated to the size of the adenoma and the degree of dysplasia.
Familial Adenomatous Polyposis (FAP): Autosomal dominant hereditary disease characterized by numerous colorectal adenomas during teenage years, caused by mutations in the APC gene. Diagnosis requires at least 100 polyps. Colorectal carcinoma develops in 100% of patients before age 30. Prophylactic colectomy is standard therapy for patients carrying APC mutations.

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Description

Explore the essential characteristics and complications of Crohn's disease, chronic intestinal obstruction, and diverticular disease of the colon. This quiz will test your understanding of their gross and microscopic features along with their clinical implications. Perfect for students of gastroenterology or medical professionals.