Inflammatory Bowel Disease: Ulcerative Colitis Complications

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Questions and Answers

Where is the junction of the ascending and transverse colon located?

  • Hepatic flexure (correct)
  • Cecum
  • Descending colon
  • Splenic flexure

What is the distal 8–15 cm of the extraperitoneal large bowel that lies within the pelvis?

  • Descending (left) colon
  • Sigmoid colon
  • Rectum (correct)
  • Transverse colon

Which region of the colon forms the junction of the transverse and descending colon?

  • Ascending (right) colon
  • Hepatic flexure (correct)
  • Sigmoid colon
  • Transverse colon

What is the characteristic feature of absorptive cells in the large intestine mucosa?

<p>Apical striated borders (D)</p> Signup and view all the answers

Which cells in the large intestine mucosa synthesize, store, and secrete mucin granules?

<p>Goblet cells (A)</p> Signup and view all the answers

What is the shape of the crypts in the large intestine mucosa?

<p>Tubular (D)</p> Signup and view all the answers

Which type of cells are found in the crypt epithelium of the large intestine mucosa?

<p>Mature absorptive cells, goblet cells, endocrine cells, and Paneth cells (D)</p> Signup and view all the answers

What is the hallmark of Hirschsprung disease?

<p>Absence of ganglion cells in the distal portion of the large bowel (C)</p> Signup and view all the answers

Which gender is more commonly affected by Hirschsprung disease?

<p>Males (C)</p> Signup and view all the answers

What percentage of Hirschsprung disease patients have Down syndrome?

<p>10% (A)</p> Signup and view all the answers

In Hirschsprung disease, where should a biopsy be taken in infants?

<p>3 cm above the anal valve (A)</p> Signup and view all the answers

What is the most common complication associated with Hirschsprung disease?

<p>Acute intestinal obstruction (A)</p> Signup and view all the answers

Which segment of bowel is involved in the short-segment form of Hirschsprung disease?

<p>Rectum and rectosigmoid (C)</p> Signup and view all the answers

What causes Hirschsprung disease?

<p>Absence of parasympathetic ganglion cells (C)</p> Signup and view all the answers

How is Hirschsprung disease diagnosed?

<p>Endoscopy with biopsy (C)</p> Signup and view all the answers

Which form of Hirschsprung disease has a segment extending from the distal colorectum into the proximal dilated bowel?

<p>Classic form (C)</p> Signup and view all the answers

At what point should a biopsy be taken in older children suspected to have Hirschsprung disease?

<p>3 cm above the anal valve (C)</p> Signup and view all the answers

What are the main complications associated with diverticulosis?

<p>Hemorrhage, perforation, diverticulitis (B)</p> Signup and view all the answers

Where are diverticula located in the bowel in cases of diverticulosis?

<p>Mesenteric and lateral aspects (C)</p> Signup and view all the answers

How does diverticulitis manifest radiographically?

<p>With sawtoothed serrations and a narrowed lumen (A)</p> Signup and view all the answers

What is a key feature that distinguishes Irritable Bowel Syndrome from Inflammatory Bowel Disease?

<p>Gender predominance (B)</p> Signup and view all the answers

Which factor is NOT considered to be involved in the pathogenesis of Irritable Bowel Syndrome according to the text?

<p>Genetic predisposition (C)</p> Signup and view all the answers

What is the main diagnostic criterion for Irritable Bowel Syndrome?

<p>Improvement with defecation and change in stool form (C)</p> Signup and view all the answers

In Inflammatory Bowel Disease, what leads to inappropriate mucosal immune activation?

<p>Complex interactions between microbiota and host immunity (A)</p> Signup and view all the answers

Which aspect is NOT mentioned as contributing to the pathogenesis of Inflammatory Bowel Disease in the text?

<p>Dietary factors (B)</p> Signup and view all the answers

What characterizes the chronicity of Inflammatory Bowel Disease?

<p>Pain-free episodes (C)</p> Signup and view all the answers

Which condition shows a requirement for a specific frequency of abdominal pain as part of its diagnostic criteria?

<p><strong>Irritable Bowel Syndrome</strong> (A)</p> Signup and view all the answers

What is the earliest lesion seen in Crohn Disease?

<p>Aphthous ulcer (A)</p> Signup and view all the answers

Which of the following contributes to the cobblestone appearance of the mucosa in Crohn Disease?

<p>Sparing of interspersed mucosa (B)</p> Signup and view all the answers

What is found in approximately 35% of Crohn Disease cases and may occur in areas of active disease or uninvolved regions within any layer of the intestinal wall?

<p>Crypt abscesses (C)</p> Signup and view all the answers

Which feature contributes to stricture formation in Crohn Disease?

<p>Submucosal fibrosis (A)</p> Signup and view all the answers

What is a common microscopic finding in Crohn Disease characterized by abundant neutrophils that infiltrate and damage crypt epithelium?

<p>Crypt abscesses (D)</p> Signup and view all the answers

What is a characteristic manifestation of extensive transmural disease in Crohn Disease?

<p>Creeping fat (B)</p> Signup and view all the answers

Which aspect contributes to the patchy distribution of Crohn Disease?

<p>Ulceration with sparing of interspersed mucosa (B)</p> Signup and view all the answers

What is a hallmark feature found in approximately 35% of Crohn Disease cases?

<p>Crypt abscesses (C)</p> Signup and view all the answers

Which feature seen in Crohn Disease leads to the abrupt transition between ulcerated and adjacent normal mucosa?

<p>Crypt abscesses (B)</p> Signup and view all the answers

Which factor contributes to the thickened and rubbery nature of the intestinal wall in Crohn Disease?

<p>Submucosal fibrosis (B)</p> Signup and view all the answers

What is a characteristic manifestation of ulcerative colitis involving the colon and rectum?

<p>Stringy mucoid material in the stool (A)</p> Signup and view all the answers

Which term describes the condition when the entire colon is involved in ulcerative colitis?

<p>Pancolitis (B)</p> Signup and view all the answers

What is a distinguishing feature of ulcerative colitis regarding the alignment of ulcers in the colon?

<p>Ulcers aligned along the short axis of the colon (A)</p> Signup and view all the answers

Which of the following is NOT a characteristic of severe ulcerative colitis cases?

<p>Granulomas presence (B)</p> Signup and view all the answers

What contributes to the creation of pseudopolyps in ulcerative colitis?

<p>Islands of regenerating mucosa bulging into the lumen (D)</p> Signup and view all the answers

What distinguishes primary sclerosis cholangitis-associated diarrhea from ulcerative colitis diarrhea?

<p>Relief by defecation (D)</p> Signup and view all the answers

What distinguishes pancolitis from ulcerative proctosigmoiditis?

<p>Colon and proximal involvement (C)</p> Signup and view all the answers

Which characteristic of adenomas is the most important in correlating with the risk of malignancy?

<p>Size (C)</p> Signup and view all the answers

Which type of adenomas tends to be small, composed of rounded or tubular glands, and are often pedunculated?

<p>Tubular adenomas (B)</p> Signup and view all the answers

What is the range of diameters for adenomas as mentioned in the text?

<p>0.3 to 10 cm (A)</p> Signup and view all the answers

In adenomas, what does a reduction in the number of goblet cells indicate?

<p>Risk of developing adenocarcinoma (D)</p> Signup and view all the answers

Which type of adenoma is covered by slender villi, often larger and sessile, and harbors cancers more frequently?

<p>Villous adenoma (D)</p> Signup and view all the answers

What is one feature that correlates with the larger size and higher frequency of cancer in villous adenomas?

<ul> <li>elongation and stratification (B)</li> </ul> Signup and view all the answers

Which type of dysplasia is a risk factor for cancer in an individual polyp but does not increase the risk in other polyps within the same patient?

<ul> <li>high-grade dysplasia (D)</li> </ul> Signup and view all the answers

What is a distinguishing feature of tubulovillous adenomas?

<ul> <li>presence of mixed architecture (C)</li> </ul> Signup and view all the answers

Which characteristic is most associated with sessile adenomas?

<ul> <li>slender villi covering (B)</li> </ul> Signup and view all the answers

What percentage of lesions larger than 4 cm in diameter contain foci of invasive cancer?

<p>~40% (C)</p> Signup and view all the answers

Which gene is involved in the development of adenomas in patients with MUTYH-associated polyposis?

<p>MYH (B)</p> Signup and view all the answers

What is the hallmark extraintestinal manifestation in Familial Adenomatous Polyposis (FAP) that can be detected at birth?

<p>Congenital hypertrophy of the retinal pigment epithelium (B)</p> Signup and view all the answers

What is the minimum number of polyps necessary for a diagnosis of classic Familial Adenomatous Polyposis (FAP)?

<p>At least 100 (B)</p> Signup and view all the answers

What percentage of untreated Familial Adenomatous Polyposis (FAP) patients develop colorectal adenocarcinoma before age 30?

<p>100% (B)</p> Signup and view all the answers

What type of polyps are morphologically indistinguishable from sporadic adenomas in Familial Adenomatous Polyposis (FAP)?

<p>Tubular adenomas (C)</p> Signup and view all the answers

Which type of polyposis is characterized by fewer than 100 polyps appearing at later ages, along with delayed colon cancer development?

<p><strong>MYH</strong>-associated polyposis (MAP) (C)</p> Signup and view all the answers

At what age range does the incidence of adenocarcinoma of the GI tract peak?

<p>60 to 70 years (A)</p> Signup and view all the answers

Which genetic pathway is activated in the classic adenoma-carcinoma sequence of adenocarcinoma?

<p>APC/β-catenin pathway (D)</p> Signup and view all the answers

What is the histological appearance of adenocarcinomas in the distal colon?

<p>Annular lesions with luminal narrowing (B)</p> Signup and view all the answers

What are the characteristic microscopic findings in adenocarcinomas?

<p>Few glands with abundant mucin production (A)</p> Signup and view all the answers

What is the most common symptom that leads to clinical attention for cecal and right-sided colon cancers?

<p>Fatigue and weakness due to iron deficiency anemia (A)</p> Signup and view all the answers

Which dietary factor is most closely associated with an increased risk of colorectal cancer?

<p>Low intake of unabsorbable vegetable fiber (B)</p> Signup and view all the answers

What contributes to the characteristic firm consistency of adenocarcinomas?

<p>'Strong stromal desmoplastic response' (A)</p> Signup and view all the answers

'Napkin-ring' constrictions are seen in which part of the colon affected by adenocarcinomas?

<p>Distal colon (B)</p> Signup and view all the answers

'Polypoid, exophytic masses' are characteristic appearance of adenocarcinomas in which part of the colon?

<p>Proximal colon (C)</p> Signup and view all the answers

What type of genetic pathway is associated with defects in DNA mismatch repair and accumulation of mutations in microsatellite repeat regions?

<p>MSI pathway (A)</p> Signup and view all the answers

What histological feature characterizes poorly differentiated adenocarcinomas?

<p>Few glands (A)</p> Signup and view all the answers

What is the characteristic manifestation of HNPCC regarding the tumor-infiltrating lymphocytes?

<p>Presence of T cells (C)</p> Signup and view all the answers

Which feature is NOT commonly associated with Hereditary Non-polyposis Colorectal Cancer (HNPCC)?

<p>Left-sided location (D)</p> Signup and view all the answers

In addition to colorectal cancer, individuals with HNPCC are at an increased risk for malignancies in which other organ?

<p>Kidney (B)</p> Signup and view all the answers

What general histological feature is typically observed in HNPCC tumors?

<p>Medullary appearance (B)</p> Signup and view all the answers

What defines the squamous zone in the anal canal?

<p>It extends from the perianal skin to the lower end of the rectum (B)</p> Signup and view all the answers

What is unique about the transition zone in some individuals?

<p>It lacks squamous mucosa entirely (B)</p> Signup and view all the answers

What characterizes the colorectal zone in the anal canal?

<p>Proximal aspect demarcated by internal sphincter muscle (B)</p> Signup and view all the answers

Which condition is characterized by abnormal inflammatory tracts with two or more internal openings within the anal canal?

<p>Anal fistulas (C)</p> Signup and view all the answers

What is the typical lining of the fistulous tract in anal fistulas?

<p>Granulation tissue (B)</p> Signup and view all the answers

What is a common predisposing factor for the development of hemorrhoids?

<p>Venous stasis of pregnancy (D)</p> Signup and view all the answers

Which condition is characterized by ectasia of the hemorrhoidal vascular plexus?

<p>Hemorrhoids (A)</p> Signup and view all the answers

What is the distinguishing feature of internal hemorrhoids compared to external hemorrhoids?

<p>Derived from the superior hemorrhoidal plexus (B)</p> Signup and view all the answers

Which condition may develop secondary to portal hypertension?

<p>Hemorrhoids (D)</p> Signup and view all the answers

What is a common microscopic feature of fibroepithelial polyps?

<p>Edematous core (D)</p> Signup and view all the answers

Which condition may be confused clinically with squamous cell carcinoma due to its necrotizing ulcers that progressively enlarge in the anus?

<p>Granuloma inguinale (D)</p> Signup and view all the answers

What is pathognomonic for Granuloma inguinale if found in biopsies?

<p>Donovan bodies (D)</p> Signup and view all the answers

What can be a manifestation of Lymphogranuloma venereum that distinguishes it from other conditions mentioned?

<p>Fever (D)</p> Signup and view all the answers

In what percentage of Granuloma inguinale cases does the anus become involved?

<p>7% (C)</p> Signup and view all the answers

What is a characteristic symptom associated with Lymphogranuloma venereum?

<p>Anal pain (B)</p> Signup and view all the answers

Which type of squamous cell carcinoma of the anus is characterized by polypoid tumors that resemble condylomas and have a well-differentiated appearance?

<p>Verrucous SCC (D)</p> Signup and view all the answers

In anal squamous cell carcinomas, poorly differentiated tumors are associated with shorter survival, representing which type of microscopic grade?

<p>Grade 3 (B)</p> Signup and view all the answers

What is the primary cause of poor prognosis in patients with HPV-negative squamous cell carcinomas of the anus?

<p>HPV infection status (D)</p> Signup and view all the answers

What is the pattern of lymph node metastasis seen in squamous cell carcinomas arising above the dentate line in the anus?

<p>Paravertebral nodes (B)</p> Signup and view all the answers

What distinguishes basaloid (non-keratinizing) squamous cell carcinomas from verrucous SCC in anal cancers?

<p>Angulated or trabecular nests of cells (D)</p> Signup and view all the answers

Which factor is NOT mentioned as influencing the prognosis of squamous cell carcinomas of the anus?

<p>Microscopic grade (A)</p> Signup and view all the answers

What is the most common symptom seen in squamous cell carcinoma of the anus compared to colorectal cancer?

<p><strong>Anal pain</strong> (C)</p> Signup and view all the answers

Which HPV-associated anorectal lesion is characterized by fleshy, pink/white papillary or 'cauliflower-like' masses?

<p>Condyloma acuminatum (C)</p> Signup and view all the answers

What is a characteristic microscopic finding in High-Grade Squamous Intraepithelial Lesions (HGSIL)?

<p>Nuclear membrane irregularity and hyperchromasia (A)</p> Signup and view all the answers

What is a common symptom associated with Squamous Intraepithelial Neoplasia?

<p>Anal itching (A)</p> Signup and view all the answers

What is the main marker of HPV infection associated with Squamous Intraepithelial Neoplasia?

<p>p16 (A)</p> Signup and view all the answers

Which anal canal lesion primarily affects the anal canal mucosa itself?

<p>Anal Intraepithelial Neoplasia (B)</p> Signup and view all the answers

Which type of lesion is included in the category of Low-Grade Squamous Intraepithelial Lesions (LGSIL)?

<p>Anal Intraepithelial Neoplasia (AIN) (B)</p> Signup and view all the answers

Which microscopic finding is NOT associated with High-Grade Squamous Intraepithelial Lesions (HGSIL)?

<p>&quot;Cauliflower-like&quot; masses (D)</p> Signup and view all the answers

"Sharply demarcated perinuclear clearing or halo" is a microscopic finding associated with which condition?

<p>Squamous Intraepithelial Neoplasia (D)</p> Signup and view all the answers

What is the characteristic microscopic feature of Squamous Intraepithelial Neoplasia?

<p>Perinuclear clearing (A)</p> Signup and view all the answers

Which anal intraepithelial lesion features fleshy, pink/white papillary masses?

<p>Condyloma acuminatum (D)</p> Signup and view all the answers

What is the best-known HPV-associated anorectal lesion?

<p>Condyloma acuminatum (D)</p> Signup and view all the answers

What feature is NOT associated with Low-Grade Squamous Intraepithelial Lesions (AIN 1)?

<p>Enlarged nuclei (A)</p> Signup and view all the answers

What is the main marker associated with HPV infection in Squamous Intraepithelial Neoplasia?

<p>p16 overexpression (C)</p> Signup and view all the answers

Which microscopic finding is characteristic of High-Grade Squamous Intraepithelial Lesions (HGSIL)?

<p>Nuclear membrane irregularity (C)</p> Signup and view all the answers

What is a common gross feature of Condyloma acuminatum?

<p>&quot;Cauliflower-like&quot; masses (A)</p> Signup and view all the answers

Which neoplasia shows hyperchromatic nuclei and pleomorphism under microscopic examination?

<p>Squamous Intraepithelial Neoplasia (B)</p> Signup and view all the answers

Which clinical symptom is commonly seen in patients with Squamous Intraepithelial Neoplasia?

<p>Anal bleeding (D)</p> Signup and view all the answers

What microscopic finding is typically NOT associated with Squamous Intraepithelial Neoplasia?

<p>Atypical parakeratosis (A)</p> Signup and view all the answers

What is the primary manifestation of squamous cell carcinoma of the anus, distinguishing it from colorectal cancer?

<p>Anal pain (A)</p> Signup and view all the answers

Which type of squamous cell carcinoma of the anus is associated with a worse prognosis due to shorter disease-free survival?

<p>HPV-negative SCC (B)</p> Signup and view all the answers

Where do conventional squamous cell carcinomas of the anal canal most commonly arise in relation to the dentate line?

<p>Distal to the dentate line (C)</p> Signup and view all the answers

What is a characteristic gross finding of early lesions of squamous cell carcinoma of the anus?

<p>Verrucoid appearance (D)</p> Signup and view all the answers

In which group of patients is the prognosis for squamous cell carcinomas of the anus typically worse?

<p>African-American patients (D)</p> Signup and view all the answers

For which tumors of the anal margin is local excision sometimes considered adequate treatment?

<p>&lt; 2.0 cm in size (D)</p> Signup and view all the answers

'Peripheral palisading' and 'lack of keratinization' are features seen in which type of squamous cell carcinoma of the anus?

<p>Basaloid (non-keratinizing) SCC (C)</p> Signup and view all the answers

Which nodes do tumors distal to the dentate line in the anal canal typically metastasize to?

<p>Inguinal nodes (A)</p> Signup and view all the answers

What is a key factor that correlates with shorter survival in squamous cell carcinomas of the anus?

<p>Poorly differentiated grade only (D)</p> Signup and view all the answers

What is the average length of the appendix?

<p>9 cm (B)</p> Signup and view all the answers

What is the typical diameter of the appendix?

<p>0.7 cm (A)</p> Signup and view all the answers

At what age does the appendix reach its maximum diameter?

<p>4 years (A)</p> Signup and view all the answers

What could be a cause of increased intraluminal pressure in the appendix?

<p>Lymphoid hyperplasia (C)</p> Signup and view all the answers

What symptom is characteristic of acute appendicitis?

<p>Pain that starts in the right lower quadrant and migrates (C)</p> Signup and view all the answers

Which theory suggests that low-fiber diets make individuals more susceptible to infection in the appendix?

<p>Retention of stool (D)</p> Signup and view all the answers

Which marker is typically elevated in acute appendicitis?

<p>Erythrocyte sedimentation rate (B)</p> Signup and view all the answers

What is a common cause of obstruction in the appendix leading to acute appendicitis?

<p>Fecalith (C)</p> Signup and view all the answers

'Tenderness to palpation, nausea and vomiting, fever, leukocytosis', and which other symptom are indicative of acute appendicitis?

<p>'Elevated temperature' (A)</p> Signup and view all the answers

Which type of appendiceal tumor is most commonly identified among adults?

<p>Neuroendocrine Tumor (NET/Carcinoid tumor) (C)</p> Signup and view all the answers

Which type of Appendiceal Mucinous Neoplasm has features indicating an increased risk of peritoneal dissemination?

<p>Low grade Appendiceal Mucinous Neoplasm (LAMN) (A)</p> Signup and view all the answers

Which age group typically experiences the presentation of Low grade Appendiceal Mucinous Neoplasm (LAMN)?

<p>Middle-aged adults (C)</p> Signup and view all the answers

What is the characteristic gross finding associated with High grade Appendiceal Mucinous Neoplasm (HAMN)?

<p>Absence of infiltrative growth (C)</p> Signup and view all the answers

What is a common presenting symptom in patients with Low grade Appendiceal Mucinous Neoplasm (LAMN) restricted to the appendix?

<p>Acute appendicitis-like symptoms (B)</p> Signup and view all the answers

Which Appendiceal tumor may acquire a characteristic yellow color after formalin fixation?

<p>Neuroendocrine Tumor (NET/Carcinoid tumor) (A)</p> Signup and view all the answers

In which part of the appendix do Neuroendocrine Tumors (NET/Carcinoid tumors) typically occur?

<p>Tip (B)</p> Signup and view all the answers

Which type of adenoma is typically small, composed of rounded or tubular glands, and often pedunculated?

<p><strong>Tubular adenoma</strong> (C)</p> Signup and view all the answers

What is the characteristic microscopic finding associated with Neuroendocrine Tumors (NET/Carcinoid tumors)?

<p>Argentaffin and argyrophil positive cytoplasm (C)</p> Signup and view all the answers

Which gender has a higher incidence of Low grade Appendiceal Mucinous Neoplasm (LAMN)?

<p>Female (B)</p> Signup and view all the answers

What is a rare lesion that can arise in the appendix with high-grade epithelial features?

<p>High grade Appendiceal Mucinous Neoplasm (HAMN) (C)</p> Signup and view all the answers

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