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Questions and Answers
What is a characteristic gross appearance of Crohn's disease?
What is a characteristic gross appearance of Crohn's disease?
Which of the following clinical features is NOT typically associated with Crohn's disease?
Which of the following clinical features is NOT typically associated with Crohn's disease?
What type of cells are primarily involved in the microscopic characteristic lesions of Crohn's disease?
What type of cells are primarily involved in the microscopic characteristic lesions of Crohn's disease?
Which complication is most associated with Crohn's disease due to intestinal narrowing?
Which complication is most associated with Crohn's disease due to intestinal narrowing?
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The primary site typically affected by Crohn's disease is which of the following?
The primary site typically affected by Crohn's disease is which of the following?
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In ulcerative colitis, which feature is characteristic of its gross appearance?
In ulcerative colitis, which feature is characteristic of its gross appearance?
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What is a common precipitating factor for the clinical manifestations of recurrent diarrhea in Crohn's disease?
What is a common precipitating factor for the clinical manifestations of recurrent diarrhea in Crohn's disease?
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In the context of intestinal diseases, what is the significance of 'fistula formation' in Crohn's disease?
In the context of intestinal diseases, what is the significance of 'fistula formation' in Crohn's disease?
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Which clinical feature is commonly associated with acute appendicitis?
Which clinical feature is commonly associated with acute appendicitis?
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What complication is NOT typically associated with acute appendicitis?
What complication is NOT typically associated with acute appendicitis?
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Meckel's diverticulum is characterized by which of the following features?
Meckel's diverticulum is characterized by which of the following features?
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Which statement is true regarding colonic diverticula?
Which statement is true regarding colonic diverticula?
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Which of the following is NOT a complication of colonic diverticula?
Which of the following is NOT a complication of colonic diverticula?
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What is a common clinical feature of congenital megacolon (Hirschsprung disease)?
What is a common clinical feature of congenital megacolon (Hirschsprung disease)?
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Which of the following statements is correct regarding the features of Meckel's diverticulum?
Which of the following statements is correct regarding the features of Meckel's diverticulum?
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What histological feature is characteristic of congenital megacolon?
What histological feature is characteristic of congenital megacolon?
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What is a characteristic finding of ulcerative colitis in the microscopic examination during the acute phase?
What is a characteristic finding of ulcerative colitis in the microscopic examination during the acute phase?
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Which of the following complications is NOT typically associated with ulcerative colitis?
Which of the following complications is NOT typically associated with ulcerative colitis?
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What symptom is commonly observed in patients with ulcerative colitis?
What symptom is commonly observed in patients with ulcerative colitis?
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In the chronic phase of ulcerative colitis, which of the following changes occurs?
In the chronic phase of ulcerative colitis, which of the following changes occurs?
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What gross appearance is typical of the colon in a patient with ulcerative colitis?
What gross appearance is typical of the colon in a patient with ulcerative colitis?
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What is the most common cause of acute appendicitis?
What is the most common cause of acute appendicitis?
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What type of necrosis can occur in severe cases of acute appendicitis?
What type of necrosis can occur in severe cases of acute appendicitis?
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Which of the following statements correctly describes Crohn's disease in comparison to ulcerative colitis?
Which of the following statements correctly describes Crohn's disease in comparison to ulcerative colitis?
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Study Notes
Intestinal Diseases - Overview
- Intestinal diseases encompass a range of conditions affecting the intestines
- Key types discussed include idiopathic intestinal inflammations, appendicitis, intestinal diverticula, and congenital megacolon.
Idiopathic Intestinal Inflammations
- Included diseases are Crohn's disease (regional enteritis) and ulcerative colitis.
- Crohn's disease: A chronic, non-specific granulomatous disease.
- Cause unknown
- Typically affects the terminal ileum, but may affect other parts of the intestines.
- Gross appearance includes segmental (skip) lesions, cobblestone appearance of mucosa, deep ulcers, thickened intestinal wall, and narrowed lumen (string sign on X-ray).
- Microscopic features include diffuse infiltration of all intestinal layers by mononuclear cells, presence of submucosal tubercles composed of epithelioid and giant cells, no caseation necrosis and fibrosis in late stages.
- Clinical features often include recurrent diarrhea, abdominal cramps, and fever lasting from days to weeks. Age peaks in two ranges: 10-30 and 50-70.
- Complications include intestinal obstruction, perforation with peritonitis or fistula formation, malabsorption syndrome, bleeding and anemia, mucosal dysplasia (increased risk of malignancy).
- Ulcerative colitis: An inflammatory condition of colon and rectum, initially acute, but progressing to chronic with periods of remission.
- Cause unknown
- Inflammation is limited to the mucosa and submucosa (except in severe cases).
- Gross appearance includes continuous lesions throughout the affected colon, congested velvety mucosa, shallow ulcers, and pseudopolyps (intact mucosa).
- Microscopic features include severe mucosal congestion during acute phase, presence of crypt abscesses and giant mucosal ulcers, and destruction of glandular epithelium during chronic phase, infiltration by mainly plasma cells, and epithelial hyperplasia and dysplasia in late stages.
- Clinical features include diarrhea with mucus and blood in the stool, lasting from days to months, that subsides and recurs at varying intervals. Age peak is typically around 20-30.
- Complications include rectal hemorrhage, anemia, diarrhea, weight loss, perforation, malignant change(after 10 years of pancolitis), secondary amyloidosis, and toxic megacolon (massive colon dilatation due to loss of motility.
Appendicitis
- The most frequent cause of acute abdomen in younger adults and children of both sexes.
- Cause: usually due to obstruction of the appendix lumen, leading to ischemia and secondary bacterial infection (E. coli).
- Gross appearance: swollen, congested appendix; fibrin may be visible on the serosal surface.
- Microscopic appearance: inflammatory exudate in the lumen, infiltration of the wall by acute inflammatory cells (especially in the muscle layer), ulceration and necrosis of mucosa, congestion of blood vessels, and edema of the wall, potentially gangrenous necrosis in severe cases.
- Clinical features include periumbilical pain migrating to the right lower quadrant, anorexia, vomiting, mild fever, and leukocytosis (WBC count >15000/cmm).
- Complications include perforation with peritonitis; toxemia, and death (2%), and portal pyemia, chronic appendicitis.
Diverticula of the Intestine
- Outpouching of the intestinal wall.
- Can be congenital (e.g., Meckel's diverticulum) or acquired (e.g., colonic diverticulosis).
- Meckel's diverticulum: Remnant of the vitelline duct. Occurs in 2% of the population, usually identified at 2 years of age. Typically located 2 feet from the ileocecal valve and 2 cm in length. Carcinoid tumors occur in 2% of cases.
- Colonic diverticula: Arise in the sigmoid colon due to chronic constipation. Characterized by multiple pouches formed of mucosa and submucosa protruding through weak spots in the colon wall at the mesenteric attachment points.
- Complications include inflammation (diverticulitis), peptic ulcers (if gastric mucosa is present), carcinoid tumors, and intestinal obstruction.
Congenital Megacolon (Hirschsprung's Disease)
- Genetic disorder leading to the absence of ganglion cells in a segment of the colon.
- Gross appearance includes dilation above the affected segment, with the affected segment or portion (e.g., rectum or sigmoid colon) being narrow.
- Microscopic: Absence of ganglion cells in the Auerbach's and Meissner's plexuses in the submucosa.
- Clinical features typically appear in infancy, are more common in females (4:1 ratio), and are characterized by constipation, abdominal distention, and vomiting.
- Complications include enterocolitis (life-threatening) and perforations (rare).
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Description
Test your knowledge on gastrointestinal disorders, focusing primarily on Crohn's disease and its distinguishing features. This quiz covers gross appearances, clinical manifestations, complications, and related conditions, allowing you to explore the subject in depth.
