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</p> Signup and view all the answers

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

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

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

    <p>Tubular</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</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</p> Signup and view all the answers

    Which gender is more commonly affected by Hirschsprung disease?

    <p>Males</p> Signup and view all the answers

    What percentage of Hirschsprung disease patients have Down syndrome?

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

    What is the most common complication associated with Hirschsprung disease?

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

    What causes Hirschsprung disease?

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

    How is Hirschsprung disease diagnosed?

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

    What are the main complications associated with diverticulosis?

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

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

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

    How does diverticulitis manifest radiographically?

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

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

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

    What characterizes the chronicity of Inflammatory Bowel Disease?

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

    What is the earliest lesion seen in Crohn Disease?

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

    Which feature contributes to stricture formation in Crohn Disease?

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

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

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

    Which aspect contributes to the patchy distribution of Crohn Disease?

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

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

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

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

    <p>Pancolitis</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</p> Signup and view all the answers

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

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

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

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

    What distinguishes pancolitis from ulcerative proctosigmoiditis?

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

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

    <p>Size</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</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</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</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</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</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</li> </ul> Signup and view all the answers

    What is a distinguishing feature of tubulovillous adenomas?

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

    Which characteristic is most associated with sessile adenomas?

    <ul> <li>slender villi covering</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%</p> Signup and view all the answers

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

    <p>MYH</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</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</p> Signup and view all the answers

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

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

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

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

    What are the characteristic microscopic findings in adenocarcinomas?

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

    What contributes to the characteristic firm consistency of adenocarcinomas?

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

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

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

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

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

    What histological feature characterizes poorly differentiated adenocarcinomas?

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

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

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

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

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

    What general histological feature is typically observed in HNPCC tumors?

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

    What is unique about the transition zone in some individuals?

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

    What characterizes the colorectal zone in the anal canal?

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

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

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

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

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

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

    <p>Hemorrhoids</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</p> Signup and view all the answers

    Which condition may develop secondary to portal hypertension?

    <p>Hemorrhoids</p> Signup and view all the answers

    What is a common microscopic feature of fibroepithelial polyps?

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

    What is pathognomonic for Granuloma inguinale if found in biopsies?

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

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

    <p>Fever</p> Signup and view all the answers

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

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

    What is a characteristic symptom associated with Lymphogranuloma venereum?

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

    What is a common symptom associated with Squamous Intraepithelial Neoplasia?

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

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

    <p>p16</p> Signup and view all the answers

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

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

    What is the characteristic microscopic feature of Squamous Intraepithelial Neoplasia?

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

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

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

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

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

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

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

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

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

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

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

    What is a common gross feature of Condyloma acuminatum?

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

    Which neoplasia shows hyperchromatic nuclei and pleomorphism under microscopic examination?

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

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

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

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

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

    What is the average length of the appendix?

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

    What is the typical diameter of the appendix?

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

    At what age does the appendix reach its maximum diameter?

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

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

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

    Which marker is typically elevated in acute appendicitis?

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

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

    <p>Fecalith</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'</p> Signup and view all the answers

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

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

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

    <p>Tip</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></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</p> Signup and view all the answers

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

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

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