Pathology of Intestines Overview
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Questions and Answers

What is one of the least likely complications of acute appendicitis?

  • Perforation and peritonitis
  • Chronic appendicitis
  • Toxemia
  • Peptic ulcer (correct)
  • Which of the following is true regarding Meckel’s diverticulum?

  • It can lead to carcinoid tumors. (correct)
  • It is always larger than 2 cm in length.
  • It is congenital only in 2% of the population.
  • It occurs usually in adults.
  • Which of the following describes colonic diverticula?

  • Result from chronic constipation. (correct)
  • Characterized by single protruding sacs.
  • Present predominantly in children.
  • More common in the cecum.
  • What is a significant clinical feature of Hirschsprung disease?

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

    What is the primary defect in Hirschsprung disease?

    <p>Absence of ganglion cells in certain colon segments (D)</p> Signup and view all the answers

    Which of the following is NOT a listed complication of acute appendicitis?

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

    Which factor is associated with the acquired form of diverticular disease?

    <p>Age-related changes (B)</p> Signup and view all the answers

    What condition might result from ectopic gastric mucosa in the context of diverticular disease?

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

    What is a characteristic microscopic feature seen during the acute phase of ulcerative colitis?

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

    Which of the following complications is associated with ulcerative colitis after 10 years of pancolitis?

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

    In acute appendicitis, which statement describes the gross appearance of the affected appendix?

    <p>It appears swollen and congested. (B)</p> Signup and view all the answers

    What symptom commonly precedes the pain associated with acute appendicitis?

    <p>Peri-umbilical pain (B)</p> Signup and view all the answers

    What type of cell predominates in the chronic inflammatory infiltration seen in ulcerative colitis?

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

    Which of the following features differentiates ulcerative colitis from Crohn’s disease?

    <p>Location limited to the colon (A)</p> Signup and view all the answers

    Which of these is NOT a cause of obstruction leading to acute appendicitis?

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

    What occurs in the chronic phase of ulcerative colitis regarding epithelial structure?

    <p>Destruction of glandular epithelium (A)</p> Signup and view all the answers

    What is the underlying immunologic process in celiac disease?

    <p>Reactivity to gliadin causing damage to epithelial cells. (B)</p> Signup and view all the answers

    Which clinical manifestation is common across malabsorption syndromes?

    <p>Weight loss due to nutrient deficiencies. (A)</p> Signup and view all the answers

    What is a characteristic feature of Whipple's disease?

    <p>Associated with Tropheryma whippelii bacteria. (A)</p> Signup and view all the answers

    What is a key difference between celiac disease and tropical sprue?

    <p>Tropical sprue is more common in tropical regions. (D)</p> Signup and view all the answers

    What condition is characterized by a deficiency of the lactase enzyme?

    <p>Lactose intolerance. (B)</p> Signup and view all the answers

    Which microscopic feature is indicative of celiac disease?

    <p>Increased plasma cells in the lamina propria. (B)</p> Signup and view all the answers

    Which symptom is specifically associated with lactose intolerance?

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

    What is the primary cause of diarrhea in patients with malabsorption syndromes?

    <p>Inadequate absorption of nutrients. (B)</p> Signup and view all the answers

    What is a distinct characteristic of Crohn's disease as observed in imaging studies?

    <p>Thickened wall of the intestine with a narrow lumen (B)</p> Signup and view all the answers

    Which of the following clinical features is NOT commonly associated with Crohn's disease?

    <p>Congested velvety mucosa (C)</p> Signup and view all the answers

    Which of the following is a characteristic lesion found microscopically in Crohn's disease?

    <p>Submucosal tubercles without caseation necrosis (C)</p> Signup and view all the answers

    What is a potential complication of Crohn's disease due to narrowing of the intestine?

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

    Which age groups are the primary peaks for the occurrence of Crohn's disease?

    <p>10-30 years and 50-70 years (C)</p> Signup and view all the answers

    What type of ulceration is commonly seen in Crohn's disease?

    <p>Deep linear or fissure ulcers (B)</p> Signup and view all the answers

    What is the nature of ulcerative colitis compared to Crohn's disease?

    <p>Limited to the mucosa and submucosa, initially acute (B)</p> Signup and view all the answers

    Which feature is commonly documented in the gross appearance of ulcerative colitis?

    <p>Continuous lesions with shallow ulcers (B)</p> Signup and view all the answers

    Flashcards

    Crohn's Disease (CD)

    A chronic, non-specific granulomatous inflammation of the intestines.

    Skip Lesions(CD)

    Uneven distribution of inflammation, affecting some sections of the intestine while others are spared.

    Submucosal tubercles (CD)

    Characteristic microscopic lesions in Crohn's Disease, featuring a collection of immune cells.

    Ulcerative colitis (UC)

    Chronic inflammation limited to the colon and rectum, characterized by continuous lesions.

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    Pseudopolyps (UC)

    Mounded areas of intact mucosa, resembling polyps, seen in chronic ulcerative colitis.

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    Congested mucosa (UC)

    Swollen and reddened lining of the colon and rectum in ulcerative colitis.

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    String sign

    A narrowing of the intestinal lumen as seen on an X-ray, often a sign of Crohn's disease

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    Inflammatory Bowel Disease (IBD)

    A group of chronic inflammatory disorders that affect the digestive system, including Crohn's disease and ulcerative colitis

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    Crypt Abscess (UC)

    Localized collection of pus within the crypts of the colon, a hallmark microscopic finding in the acute phase of UC.

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    Acute Appendicitis

    Inflammation of the appendix, a common cause of acute abdominal pain in young adults.

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    Appendicitis Cause

    Usually due to blockage of the appendix's opening, leading to tissue damage and infection (e.g., by fecal matter, infection, or tumors).

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    Acute Appendicitis Symptoms

    Starts with pain around the belly button, moving to the lower right side, loss of appetite (anorexia)

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    UC Complications

    Potential health problems arising from UC, including bleeding, weight loss, colon perforation and, possibly, cancer after a long period of UC.

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    UC Gross Appearance

    The appearance of the colon in UC, showing red ulcers and pink intact mucosa.

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    Chronic UC Features

    Long-term UC damage includes destruction of gland tissue, chronic inflammation (mostly plasma cell infiltration), and possible gland growth abnormalities (dysplasia).

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    Acute Appendicitis Complication

    Perforation and peritonitis, leading to potential toxemia and death, are serious.

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    Meckel's Diverticulum

    A congenital pouch in the small intestine, a vestige of the vitelline duct.

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    Meckel's Diverticulum Rule of 2s

    Occurs in 2% of people, often diagnosed at age 2, typically 2 feet from the ileocecal valve, and approximately 2 cm long.

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    Congenital Megacolon (Hirschsprung Disease)

    A genetic condition causing lacking ganglion cells in a section of the colon, leading to colon dilation.

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    Hirschsprung Disease Symptoms

    Infancy onset, more common in females, and constipation/abdominal distension are common signs.

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    Colonic Diverticula (acquired)

    Multiple pouches forming in the sigmoid colon due to chronic constipation, weakening the intestinal wall.

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    Diverticulitis

    Inflammation of the diverticula, resulting from infection.

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    Celiac disease

    An immune reaction to gluten, damaging the small intestine, causing malabsorption.

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    Malabsorption

    Inability of the small intestine to absorb nutrients properly.

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    Tropical Sprue

    Malabsorption in tropical areas, often due to bacterial infection.

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    Lactose intolerance

    Inability to digest lactose (milk sugar) due to a lack of the lactase enzyme.

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    Whipple disease

    Rare bacterial infection affecting many organs, including the small intestine, causing malabsorption.

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    Gluten

    A protein found in wheat, rye, and barley that triggers an immune response in celiac disease.

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    Villi atrophy

    Loss or shrinking of finger-like projections (villi) in the small intestine that reduces its surface area for absorption.

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    Anti-gliadin antibodies

    Antibodies produced in response to the gliadin protein, which are present in celiac patients.

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    Study Notes

    Pathology of Intestines

    • This presentation covers various pathologies of the intestines, including diverticula, congenital megacolon (Hirschsprung's disease), malabsorption syndromes, inflammatory bowel diseases (IBDs), acute appendicitis, and diverticular disease.

    Topics to be Covered

    • Diverticula of the intestine
    • Congenital megacolon (Hirschsprung's disease)
    • Malabsorption syndromes (Celiac disease, Tropical sprue, Lactose intolerance, Whipple's disease)
    • Inflammatory bowel diseases (IBD): Crohn's disease, Ulcerative colitis
    • Acute appendicitis
    • Diverticular disease (Meckel's diverticulum, Colonic diverticula)

    Inflammatory Bowel Diseases (IBD)

    • Also known as idiopathic intestinal inflammations.
    • Crohn's disease (CD): Chronic non-specific granulomatous disease
      • Cause: Unknown
      • Sites: Typically the terminal ileum, but can affect any part of the colon or intestines.
      • Gross appearance: Segmental (skip) lesions, cobblestone mucosa with deep linear or fissure ulcers along the bowel axis. Thickened intestinal wall, narrow lumen (string sign in x-ray), and serosal extension of mesenteric fat.
      • Microscopic: Diffuse infiltration of all intestinal wall layers by mononuclear cells; hyperemia and edema. Submucosal tubercles formed of epithelioid and giant cells without caseation necrosis. Fibrosis in late stages.
      • Clinical features: Recurrent diarrhea, abdominal cramps, fever (lasting days to weeks); two peaks in age: 10-30, 50-70.
      • Complications: Intestinal obstruction, perforation of fissuring ulcers (leading to peritonitis or fistula formation), malabsorption syndrome, bleeding, and anemia; increased risk of malignancy (five-fold to six-fold).
    • Ulcerative colitis (UC): Inflammatory condition of the colon and rectum; initially acute, then chronic with periods of remission.
      • Cause: Unknown
      • Inflammation is limited to the mucosa and submucosa, except in severe cases.
      • Gross appearance: Continuous lesions throughout the colon; congested velvety mucosa; shallow ulcers; pseudopolyps (intact mucosa).
      • Microscopic: Acute phase: severe mucosa congestion and crypt abscess formation; chronic phase: destruction of glandular epithelium, infiltration by chronic inflammatory cells (mainly plasma cells); epithelial hyperplasia, potentially dysplasia.
      • Clinical features: Diarrhea with mucus and blood in stool; may persist for days to weeks or months, and subside to recur; peaks in age 20-30.
      • Complications: Rectal hemorrhage, diarrhea and weight loss, perforation, malignant change (after 10 years of pancolitis), secondary amyloidosis, toxic megacolon.

    Acute Appendicitis

    • The most common cause of acute abdomen in children and young adults.
    • Cause: Obstruction of the lumen (e.g., fecoliths, hyperplastic lymphoid tissue, worms, or tumors) leading to ischemia of the wall and secondary bacterial infection (e.g., E. coli).
    • Gross appearance: Swollen, congested appendix; fibrin on the serosal surface.
    • Microscopic: Inflammatory exudate in the lumen; infiltration of the intestinal wall by acute inflammatory cells (primarily neutrophils), especially the muscular layer; ulceration and necrosis of the mucosa; congestion of blood vessels and edema of the wall; gangrenous necrosis (severe cases).
    • Clinical features: Peri-umbilical pain migrating to the right lower quadrant, anorexia, vomiting, mild fever, leucocytosis (>15000/cmm).
    • Complications: Perforation, peritonitis (with possible toxemia and death), portal pyemia, chronic appendicitis.

    Diverticular Disease

    • Diverticula: Outpouchings of the intestinal wall.
    • Types:
      • Meckel's diverticulum: Congenital; remnant of the vitelline duct; typically found 2 feet (60cm) from the ileocecal valve; 2cm in length; 2% risk of carcinoid tumor. Rule of 2's: occurs in 2% of population, usually diagnosed at 2 years of age.
      • Colonic diverticulosis: Acquired; multiple outpouchings in the sigmoid colon, mucosa and submucosa protruding through weak points in muscularis; due to chronic constipation.
    • Complication: Inflammation (diverticulitis), peptic ulcer (if ectopic gastric mucosa present), carcinoid tumor, intestinal obstruction.

    Hirschsprung's Disease

    • Genetic disorder causing lack of ganglion cells in a segment of the colon.
    • Results in dilatation of the colon above the affected segment and constriction of the affected colonic segment.
    • Microscopic: Absence of ganglion cells in Auerbach's and Meissner's plexuses in the submucosa.
    • Clinical features: Occurs in infancy, somewhat more frequent in females (4:1); constipation, abdominal distension, vomiting.
    • Complications: Enterocolitis (life-threatening), perforation.

    Malabsorption Syndromes

    • Maldigestion: Issues with digesting food due to pancreatic, biliary, or intestinal diseases, or overgrowth of bacteria.
    • Reduced absorptive capacity: Diseases like celiac disease, Crohn's disease, and surgical resection reduce the intestines' ability to absorb nutrients.
    • Transport abnormalities: Lymphoma, tuberculosis also can disrupt normal transportation of nutrients.
    • Clinical manifestations: Diarrhea, bulky stools, weight loss, evidence of vitamin deficiencies, fatigue.

    Celiac Disease

    • Gluten-sensitive enteropathy (non-tropical sprue)
    • Characterized by: Flat small bowel mucosa, prompt clinical improvement after withdrawal of gluten-containing foods.
    • Pathogenesis: Immunologic disorder; reactivity to gliadin (a gluten protein) damages epithelial cells lining the villi. Antibodies (anti-gliadin, anti-reticulin, and anti-endomysial) present in serum.
    • Gross appearance: Atrophic changes most severe in proximal small bowel.
    • Microscopic: Loss of villi; increased intra-epithelial lymphocytes; increased plasma cells in lamina propria.
    • Clinical manifestations: Presents in childhood, abdominal distention, flatulence, diarrhea, steatorrhea, weight loss. Treatment: Dietary gluten restriction.

    Tropical Sprue

    • Found in tropical climates; malabsorption, likely secondary to bacterial infection (E. coli).
    • Microscopic: Variable degrees of villous atrophy.
    • Patients respond well to broad-spectrum antibiotics.

    Lactose Intolerance

    • Lactase enzyme deficiency; the enzyme is located in the small intestinal brush border and digests lactose.
    • Absence of the enzyme results in sugar fermentation in the lumen.
    • Clinical manifestations: Abdominal cramps, diarrhea, flatulence, weight loss.

    Whipple's Disease

    • Rare infectious disease involving multiple organs (small intestine, joints, lungs, heart, liver, spleen, and CNS).
    • Occurs primarily in adult males (30-50 years).
    • Pathogenesis: Caused by the bacterium Tropheryma whipplei.
    • Microscopic: Macrophages in the lamina propria of the small intestine are filled with PAS-positive rod-shaped bacilli .
    • Treatment: Antibiotics.
    • Clinical manifestations: Malabsorption, weight loss, diarrhea.

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    Description

    This quiz covers key pathologies associated with the intestines, including diverticula, congenital megacolon, and various inflammatory bowel diseases such as Crohn's disease and ulcerative colitis. It also explores conditions like malabsorption syndromes and acute appendicitis. Test your understanding of these significant digestive health issues.

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