Path Block 3 (GIe)

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  1. Why do Hemorroids develope?
    Who are at high risk?
    what is the MCC?
    They develope because of persistant elevation of venous pressure in the hemorrhoidal plexus

    • Pregnant females
    • 30years old
    • Straining at stool
  2. What is Diverticular disease?
    What side? what location in bowel?
    What is the pathogenesis?
    • -It is an Aquired Diverticulum
    • -left side of colon and particularly in the sigmoid colon

    • 1-Weekness in the Colonic wall
    • 2-Increase in the intraluminal pressure
  3. Image Upload 1What is this?
    This is Diverticulitus.

    Recall that a true diverticulum has to have all three layer?
  4. Image Upload 2
    Diverticular Disease
  5. Image Upload 3What do you see? What is it?
    See Multiple Air/fluid filled levels (Stair step pattern)

    Intestinal Obstruction
  6. Image Upload 4
    • Herniation
    • Adhesion
    • Intussusception
    • Volvulus
  7. Hernia, Inguinal
    What side?
    If it cannot be reduced it is called? If this is prolonged it could lead to?
    • -Right sided
    • -Boys
    • -Incarceration
    • -Can lead to Ischemia and an obstruction
  8. Name the rare malignant tumors of the small bowel and their locations.
    • Adenocarinomas --- in the duodenum
    • note?: Adenoma is also here (benign)
    • Carcinoids-- in the ileum
  9. What does Sessile mean?
    What does Pedunculated mean?
    • No stalk
    • Has a stalk
  10. Name the Pedunculated polyps? Which are neoplastic and non-neoplastic?
    • Hamaromatous (Non-neoplastic)
    • -Juvenile
    • -Peutz-Jeghers

    Tubular Adenoma (Neoplastic)
  11. Name the Sessile polyps and which are neoplastic and which are not.
    • Non-Neoplastic
    • Hyperplastic
    • Inflammatory
    • Lymphoid
    • Neoplastic
    • Villous Adenoma
  12. Image Upload 5
    What is this?
    Hyperplastic polyp

    90% Colon polyps>50% over 50
  13. Patient comes in with Hyperpigmentation around the lips. What do they have?
    • Hamartomatous polyps
    • - Peutz-Jeghers Type
  14. Image Upload 6
    What its it? What age?
    • This is a Peutz Jeghers polyp.
    • See Splying so Smooth muscle

    Seen in the Children in their Teens
  15. Image Upload 7
    What is this? What age? malignant?
    This is a Juvenile "retention" polyp

    Seen in Children

    no malignancy
  16. Image Upload 8
    Inflammatory (Pseud) Polyp
  17. Image Upload 9
    Lymphoid Polyp
  18. What are the Three Types of adenomatous polyps?

    Which is most common?
    • 1.Tubular adenoma
    • Most common Small and Pedunculated
    • 2.Tubulovillous adenoma

    • 3.Villous Adenoma
    • large and Sessile
  19. What is Serrated Adenoma
    • Considered a varient of Hyperplastic polyp.
    • has some premalignent potential
  20. Image Upload 10
    • This is a Villous Adenoma
    • Broad Bassed Sessile
  21. What gene is associated 100% with colon cancer?
    APC gene------Famillial Adenomatous Polyposis
  22. Hereditary Non-Polyposis colorectal carcinomas.
    What is it called?
    What is its inheritance?
    What is its mutation?
    Lynch or Warthin-Lynch syndrome


    DNA mismatch
  23. What is the genetic Sequence of mutation of adenoma-carcinoma?
    APC--> K Ras--> p53
  24. Adenomatous Polyp

    Malignant Risk increase with?
    • polyp size
    • Severity of the epithelial dysplasia
    • Hystologic architecture
  25. Colorectal Carcinoma
    What is it?
    Risk factors?
    • A common Malignant tumor
    • Seen slightly more in men
    • 70% on the Left side

    • Risk Factors:
    • Advancing age (50)
    • History of CIBD
    • Obesity, Smoking, Alcohol use, diet
  26. Colorectal Carcinoma

    How do they grow?
    Right sided, Grows into the tintestinal lumen as a polypoid Bulky mass

    When Left sided, Grows as an infiltrative-ulcerative type. This leads to Obstruction,
  27. Colorectal Carcinoma

    • Survival: All Patients
    • –1 year: 80-90% (stage 1 &2)
    • –5 year: 60%

    #2 cancer killer in U.S.
  28. Colorectal cancer Staging
  29. Tumor Node Metastasis
    • •Stage I T1 or T2 N0 M0
    • •Stage II T3 or T4 N0 M0
    • Stage III Any T N1 or N2 M0
    • Stage IV Any T Any N M1
  30. Screening starting at 50
    • -A fecal occult blood test (FOBT) every year
    • -A flexible sigmoidoscopy (FSIG) every five years
    • -Annual fecal occult blood test and flexible sigmoidoscopy every five years*
    • -A double-contrast barium enema every five years
    • -A colonoscopy every ten years
  31. Cacinoid tumor
    What do they look like?

    At what size is it considered malignant?
    • Apendix 90%
    • Distal Ileum next MC

    - They are small and rarely metastasis

    - Greater than 2 cm
  32. Image Upload 11
    Carcinoid Tumor
  33. Image Upload 12
    Multiple Carcinoid Tumors
  34. If the Carcinoid tumor is in the

    - Single and Benign

    - Multiple and malignant
  35. What are the Clinical Symptoms of Carcinmoid Syndrome?
    • Severe episodic skin flushing
    • Diarrhea, Abdominal cramping
    • Asthma, Bronchoconstriction
    • Carcinoid heart disease (tricuspid valve insufficiency).
  36. Vermiform Appendix
    arises from
    rich in?
  37. no known specific function
    • Cecum
    • Lymphoid rich
  38. Acute Appendicitis
    Clinical Findings
    Seen in Males more

    • –Initial peri-umbilical pain, localizing to RLQ
    • –Nausea and/or vomiting
    • Abdominal tenderness, particularly in bernies point
    • –Mild fever
    • –Leukocytosis; 15,000 – 20,000
  39. Image Upload 13
    Mucocele, secondary to a mucinous Cystadenoma
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Path Block 3 (GIe)
Path Block 3 (GIe)
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