144 Questions
Where is the junction of the ascending and transverse colon located?
Hepatic flexure
What is the distal 8–15 cm of the extraperitoneal large bowel that lies within the pelvis?
Rectum
Which region of the colon forms the junction of the transverse and descending colon?
Hepatic flexure
What is the characteristic feature of absorptive cells in the large intestine mucosa?
Apical striated borders
Which cells in the large intestine mucosa synthesize, store, and secrete mucin granules?
Goblet cells
What is the shape of the crypts in the large intestine mucosa?
Tubular
Which type of cells are found in the crypt epithelium of the large intestine mucosa?
Mature absorptive cells, goblet cells, endocrine cells, and Paneth cells
What is the hallmark of Hirschsprung disease?
Absence of ganglion cells in the distal portion of the large bowel
Which gender is more commonly affected by Hirschsprung disease?
Males
What percentage of Hirschsprung disease patients have Down syndrome?
10%
In Hirschsprung disease, where should a biopsy be taken in infants?
3 cm above the anal valve
What is the most common complication associated with Hirschsprung disease?
Acute intestinal obstruction
Which segment of bowel is involved in the short-segment form of Hirschsprung disease?
Rectum and rectosigmoid
What causes Hirschsprung disease?
Absence of parasympathetic ganglion cells
How is Hirschsprung disease diagnosed?
Endoscopy with biopsy
Which form of Hirschsprung disease has a segment extending from the distal colorectum into the proximal dilated bowel?
Classic form
At what point should a biopsy be taken in older children suspected to have Hirschsprung disease?
3 cm above the anal valve
What are the main complications associated with diverticulosis?
Hemorrhage, perforation, diverticulitis
Where are diverticula located in the bowel in cases of diverticulosis?
Mesenteric and lateral aspects
How does diverticulitis manifest radiographically?
With sawtoothed serrations and a narrowed lumen
What is a key feature that distinguishes Irritable Bowel Syndrome from Inflammatory Bowel Disease?
Gender predominance
Which factor is NOT considered to be involved in the pathogenesis of Irritable Bowel Syndrome according to the text?
Genetic predisposition
What is the main diagnostic criterion for Irritable Bowel Syndrome?
Improvement with defecation and change in stool form
In Inflammatory Bowel Disease, what leads to inappropriate mucosal immune activation?
Complex interactions between microbiota and host immunity
Which aspect is NOT mentioned as contributing to the pathogenesis of Inflammatory Bowel Disease in the text?
Dietary factors
What characterizes the chronicity of Inflammatory Bowel Disease?
Pain-free episodes
Which condition shows a requirement for a specific frequency of abdominal pain as part of its diagnostic criteria?
Irritable Bowel Syndrome
What is the earliest lesion seen in Crohn Disease?
Aphthous ulcer
Which of the following contributes to the cobblestone appearance of the mucosa in Crohn Disease?
Sparing of interspersed mucosa
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?
Crypt abscesses
Which feature contributes to stricture formation in Crohn Disease?
Submucosal fibrosis
What is a common microscopic finding in Crohn Disease characterized by abundant neutrophils that infiltrate and damage crypt epithelium?
Crypt abscesses
What is a characteristic manifestation of extensive transmural disease in Crohn Disease?
Creeping fat
Which aspect contributes to the patchy distribution of Crohn Disease?
Ulceration with sparing of interspersed mucosa
What is a hallmark feature found in approximately 35% of Crohn Disease cases?
Crypt abscesses
Which feature seen in Crohn Disease leads to the abrupt transition between ulcerated and adjacent normal mucosa?
Crypt abscesses
Which factor contributes to the thickened and rubbery nature of the intestinal wall in Crohn Disease?
Submucosal fibrosis
What is a characteristic manifestation of ulcerative colitis involving the colon and rectum?
Stringy mucoid material in the stool
Which term describes the condition when the entire colon is involved in ulcerative colitis?
Pancolitis
What is a distinguishing feature of ulcerative colitis regarding the alignment of ulcers in the colon?
Ulcers aligned along the short axis of the colon
Which of the following is NOT a characteristic of severe ulcerative colitis cases?
Granulomas presence
What contributes to the creation of pseudopolyps in ulcerative colitis?
Islands of regenerating mucosa bulging into the lumen
What distinguishes primary sclerosis cholangitis-associated diarrhea from ulcerative colitis diarrhea?
Relief by defecation
What distinguishes pancolitis from ulcerative proctosigmoiditis?
Colon and proximal involvement
Which characteristic of adenomas is the most important in correlating with the risk of malignancy?
Size
Which type of adenomas tends to be small, composed of rounded or tubular glands, and are often pedunculated?
Tubular adenomas
What is the range of diameters for adenomas as mentioned in the text?
0.3 to 10 cm
In adenomas, what does a reduction in the number of goblet cells indicate?
Risk of developing adenocarcinoma
Which type of adenoma is covered by slender villi, often larger and sessile, and harbors cancers more frequently?
Villous adenoma
What is one feature that correlates with the larger size and higher frequency of cancer in villous adenomas?
- elongation and stratification
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?
- high-grade dysplasia
What is a distinguishing feature of tubulovillous adenomas?
- presence of mixed architecture
Which characteristic is most associated with sessile adenomas?
- slender villi covering
What percentage of lesions larger than 4 cm in diameter contain foci of invasive cancer?
~40%
Which gene is involved in the development of adenomas in patients with MUTYH-associated polyposis?
MYH
What is the hallmark extraintestinal manifestation in Familial Adenomatous Polyposis (FAP) that can be detected at birth?
Congenital hypertrophy of the retinal pigment epithelium
What is the minimum number of polyps necessary for a diagnosis of classic Familial Adenomatous Polyposis (FAP)?
At least 100
What percentage of untreated Familial Adenomatous Polyposis (FAP) patients develop colorectal adenocarcinoma before age 30?
100%
What type of polyps are morphologically indistinguishable from sporadic adenomas in Familial Adenomatous Polyposis (FAP)?
Tubular adenomas
Which type of polyposis is characterized by fewer than 100 polyps appearing at later ages, along with delayed colon cancer development?
MYH-associated polyposis (MAP)
At what age range does the incidence of adenocarcinoma of the GI tract peak?
60 to 70 years
Which genetic pathway is activated in the classic adenoma-carcinoma sequence of adenocarcinoma?
APC/β-catenin pathway
What is the histological appearance of adenocarcinomas in the distal colon?
Annular lesions with luminal narrowing
What are the characteristic microscopic findings in adenocarcinomas?
Few glands with abundant mucin production
What is the most common symptom that leads to clinical attention for cecal and right-sided colon cancers?
Fatigue and weakness due to iron deficiency anemia
Which dietary factor is most closely associated with an increased risk of colorectal cancer?
Low intake of unabsorbable vegetable fiber
What contributes to the characteristic firm consistency of adenocarcinomas?
'Strong stromal desmoplastic response'
'Napkin-ring' constrictions are seen in which part of the colon affected by adenocarcinomas?
Distal colon
'Polypoid, exophytic masses' are characteristic appearance of adenocarcinomas in which part of the colon?
Proximal colon
What type of genetic pathway is associated with defects in DNA mismatch repair and accumulation of mutations in microsatellite repeat regions?
MSI pathway
What histological feature characterizes poorly differentiated adenocarcinomas?
Few glands
What is the characteristic manifestation of HNPCC regarding the tumor-infiltrating lymphocytes?
Presence of T cells
Which feature is NOT commonly associated with Hereditary Non-polyposis Colorectal Cancer (HNPCC)?
Left-sided location
In addition to colorectal cancer, individuals with HNPCC are at an increased risk for malignancies in which other organ?
Kidney
What general histological feature is typically observed in HNPCC tumors?
Medullary appearance
What defines the squamous zone in the anal canal?
It extends from the perianal skin to the lower end of the rectum
What is unique about the transition zone in some individuals?
It lacks squamous mucosa entirely
What characterizes the colorectal zone in the anal canal?
Proximal aspect demarcated by internal sphincter muscle
Which condition is characterized by abnormal inflammatory tracts with two or more internal openings within the anal canal?
Anal fistulas
What is the typical lining of the fistulous tract in anal fistulas?
Granulation tissue
What is a common predisposing factor for the development of hemorrhoids?
Venous stasis of pregnancy
Which condition is characterized by ectasia of the hemorrhoidal vascular plexus?
Hemorrhoids
What is the distinguishing feature of internal hemorrhoids compared to external hemorrhoids?
Derived from the superior hemorrhoidal plexus
Which condition may develop secondary to portal hypertension?
Hemorrhoids
What is a common microscopic feature of fibroepithelial polyps?
Edematous core
Which condition may be confused clinically with squamous cell carcinoma due to its necrotizing ulcers that progressively enlarge in the anus?
Granuloma inguinale
What is pathognomonic for Granuloma inguinale if found in biopsies?
Donovan bodies
What can be a manifestation of Lymphogranuloma venereum that distinguishes it from other conditions mentioned?
Fever
In what percentage of Granuloma inguinale cases does the anus become involved?
7%
What is a characteristic symptom associated with Lymphogranuloma venereum?
Anal pain
Which type of squamous cell carcinoma of the anus is characterized by polypoid tumors that resemble condylomas and have a well-differentiated appearance?
Verrucous SCC
In anal squamous cell carcinomas, poorly differentiated tumors are associated with shorter survival, representing which type of microscopic grade?
Grade 3
What is the primary cause of poor prognosis in patients with HPV-negative squamous cell carcinomas of the anus?
HPV infection status
What is the pattern of lymph node metastasis seen in squamous cell carcinomas arising above the dentate line in the anus?
Paravertebral nodes
What distinguishes basaloid (non-keratinizing) squamous cell carcinomas from verrucous SCC in anal cancers?
Angulated or trabecular nests of cells
Which factor is NOT mentioned as influencing the prognosis of squamous cell carcinomas of the anus?
Microscopic grade
What is the most common symptom seen in squamous cell carcinoma of the anus compared to colorectal cancer?
Anal pain
Which HPV-associated anorectal lesion is characterized by fleshy, pink/white papillary or 'cauliflower-like' masses?
Condyloma acuminatum
What is a characteristic microscopic finding in High-Grade Squamous Intraepithelial Lesions (HGSIL)?
Nuclear membrane irregularity and hyperchromasia
What is a common symptom associated with Squamous Intraepithelial Neoplasia?
Anal itching
What is the main marker of HPV infection associated with Squamous Intraepithelial Neoplasia?
p16
Which anal canal lesion primarily affects the anal canal mucosa itself?
Anal Intraepithelial Neoplasia
Which type of lesion is included in the category of Low-Grade Squamous Intraepithelial Lesions (LGSIL)?
Anal Intraepithelial Neoplasia (AIN)
Which microscopic finding is NOT associated with High-Grade Squamous Intraepithelial Lesions (HGSIL)?
"Cauliflower-like" masses
"Sharply demarcated perinuclear clearing or halo" is a microscopic finding associated with which condition?
Squamous Intraepithelial Neoplasia
What is the characteristic microscopic feature of Squamous Intraepithelial Neoplasia?
Perinuclear clearing
Which anal intraepithelial lesion features fleshy, pink/white papillary masses?
Condyloma acuminatum
What is the best-known HPV-associated anorectal lesion?
Condyloma acuminatum
What feature is NOT associated with Low-Grade Squamous Intraepithelial Lesions (AIN 1)?
Enlarged nuclei
What is the main marker associated with HPV infection in Squamous Intraepithelial Neoplasia?
p16 overexpression
Which microscopic finding is characteristic of High-Grade Squamous Intraepithelial Lesions (HGSIL)?
Nuclear membrane irregularity
What is a common gross feature of Condyloma acuminatum?
"Cauliflower-like" masses
Which neoplasia shows hyperchromatic nuclei and pleomorphism under microscopic examination?
Squamous Intraepithelial Neoplasia
Which clinical symptom is commonly seen in patients with Squamous Intraepithelial Neoplasia?
Anal bleeding
What microscopic finding is typically NOT associated with Squamous Intraepithelial Neoplasia?
Atypical parakeratosis
What is the primary manifestation of squamous cell carcinoma of the anus, distinguishing it from colorectal cancer?
Anal pain
Which type of squamous cell carcinoma of the anus is associated with a worse prognosis due to shorter disease-free survival?
HPV-negative SCC
Where do conventional squamous cell carcinomas of the anal canal most commonly arise in relation to the dentate line?
Distal to the dentate line
What is a characteristic gross finding of early lesions of squamous cell carcinoma of the anus?
Verrucoid appearance
In which group of patients is the prognosis for squamous cell carcinomas of the anus typically worse?
African-American patients
For which tumors of the anal margin is local excision sometimes considered adequate treatment?
< 2.0 cm in size
'Peripheral palisading' and 'lack of keratinization' are features seen in which type of squamous cell carcinoma of the anus?
Basaloid (non-keratinizing) SCC
Which nodes do tumors distal to the dentate line in the anal canal typically metastasize to?
Inguinal nodes
What is a key factor that correlates with shorter survival in squamous cell carcinomas of the anus?
Poorly differentiated grade only
What is the average length of the appendix?
9 cm
What is the typical diameter of the appendix?
0.7 cm
At what age does the appendix reach its maximum diameter?
4 years
What could be a cause of increased intraluminal pressure in the appendix?
Lymphoid hyperplasia
What symptom is characteristic of acute appendicitis?
Pain that starts in the right lower quadrant and migrates
Which theory suggests that low-fiber diets make individuals more susceptible to infection in the appendix?
Retention of stool
Which marker is typically elevated in acute appendicitis?
Erythrocyte sedimentation rate
What is a common cause of obstruction in the appendix leading to acute appendicitis?
Fecalith
'Tenderness to palpation, nausea and vomiting, fever, leukocytosis', and which other symptom are indicative of acute appendicitis?
'Elevated temperature'
Which type of appendiceal tumor is most commonly identified among adults?
Neuroendocrine Tumor (NET/Carcinoid tumor)
Which type of Appendiceal Mucinous Neoplasm has features indicating an increased risk of peritoneal dissemination?
Low grade Appendiceal Mucinous Neoplasm (LAMN)
Which age group typically experiences the presentation of Low grade Appendiceal Mucinous Neoplasm (LAMN)?
Middle-aged adults
What is the characteristic gross finding associated with High grade Appendiceal Mucinous Neoplasm (HAMN)?
Absence of infiltrative growth
What is a common presenting symptom in patients with Low grade Appendiceal Mucinous Neoplasm (LAMN) restricted to the appendix?
Acute appendicitis-like symptoms
Which Appendiceal tumor may acquire a characteristic yellow color after formalin fixation?
Neuroendocrine Tumor (NET/Carcinoid tumor)
In which part of the appendix do Neuroendocrine Tumors (NET/Carcinoid tumors) typically occur?
Tip
Which type of adenoma is typically small, composed of rounded or tubular glands, and often pedunculated?
Tubular adenoma
What is the characteristic microscopic finding associated with Neuroendocrine Tumors (NET/Carcinoid tumors)?
Argentaffin and argyrophil positive cytoplasm
Which gender has a higher incidence of Low grade Appendiceal Mucinous Neoplasm (LAMN)?
Female
What is a rare lesion that can arise in the appendix with high-grade epithelial features?
High grade Appendiceal Mucinous Neoplasm (HAMN)
This quiz covers the complications associated with Ulcerative Colitis, focusing on carcinoma and dysplasia. Topics include incidence rates, risk factors, and microscopic findings in patients with Ulcerative Colitis.
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