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Clinical Pathology > 21 - Pathology of the GI Tract - 2 > Flashcards

21 - Pathology of the GI Tract - 2 Flashcards

1
Q

Epidemiology of diverticulosis

A

Common in developed western world
Rare in Africa, Asia, S.America
Common in urban
Relationship with fibre content of diet

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2
Q

Pathogenesis of diverticulosis

A

Increased intra-luminal pressure -> irreguar, uncoordinated peristalsis.

Points of relative weakness in bowel wall

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3
Q

Pathology of diverticulosis

A

Thickening of muscularis propria
Elastosis of taeniae coli
Redundant mucosal folds and ridges
Sacculation and diverticula

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4
Q

Diverticular disease - clinical features

A

Asymptomatic (90%-99%)
Cramping abdominal pain
Alternating constipation and diarrhoea
Acute and chronic complications (10-30%)

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5
Q

Diverticular disease - complications

A

Acute - diverticulitis (20%), perforation, haemorrhage

Chronic - intestinal obstruction, fistula, diverticular colitis, polypoid prolapsing mucosal folds

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6
Q

Classification of colitis

A

inflammation of the colon
Usually mucosal inflammation but occasionally transmural or predominantly submucosal/muscular
Divided into acute / chronic

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7
Q

Causes of acute colitis

A 
Acute infective colitis
Antibiotic associate colitis
Drug induced colitis
Acute ischaemic colitis
Acute radiation colitis
Neutropenic colitis
Phlegmonous colitis
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8
Q

Causes of chronic colitis

A 
Chronic idiopathic inflammatory bowel disease
Microscopic colitis
Ischaemic colitis
Diverticular colitis
Chronic infective colitis
Diversion colitis
Eosinophilic colitis
Chronic radiation colitis
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9
Q

Idiopathic inflammatory bowel disease e.g.s

A

Ulcerative colitis
Crohn’s disease
Indeterminate colitis

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10
Q

Epidemiology of IBD - area

A

5-15 cases per 100,000 pa
Incidence highest in Scandinavia, UK, Northern Europe, USA
Lower in Japan, Southern Europe, Africa

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11
Q

Epidemiology of IBD - age

A

Peak age incidence 20-40 years of age
CD more common in females 1.3:1
UC equally common in males and females

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12
Q

Risk factors for IBD

A 
Cigarette smoking
Oral contraceptive
Childhood infections
MMR
Domestic hygiene
Appendicectomy
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13
Q

Ulcerative colitis - clinical presentation

A 
Diarrhoea (>66%)
Constipation
Rectal bleeding
Ab pain
Anorexia
Weight loss
Anaemia
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14
Q

Ulcerative colitis - complications

A

Toxic megacolon and perforation
Haemorrhage
Stricture
Carcinoma

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15
Q

Crohn’s Disease - clinical features

A 
Chronic relapsing disease
Affects all levels of GIT from mouth to anus
Diarrhoea
Colicky ab pain
Palpable ab mass
Weight loss / failure to thrive
Anorexia
Fever
Oral ulcers
Peri-anal disease
Anaemia
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16
Q

Crohn’s Disease - complications

A 
Toxic megacolon
Perforation
Fistula
Stricture
Haemorrhage
Carcinoma
Short bowel syndrome
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17
Q

UC vs Crohns - area of GIT

A

colon, appendix & terminal ileum vs all parts

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18
Q

UC vs Crohns - how it looks in colon

A

Continuous vs skip lesions

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19
Q

UC vs Crohns - involvement of rectum

A

Always involved vs rectum normal in 50%

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20
Q

UC vs Crohns - terminal ileum involvement

A

10% vs 30% chance

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21
Q

UC vs Crohns - pathology

A

Granular red mucosa with flat, undermining ulcers vs cobblestone appearance with apthoid and fissuring ulcers

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22
Q

UC vs Crohns - serosa

A

Normal vs serositis (fat wrapping)

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23
Q

UC vs Crohns - strictures present

A

Rare vs common

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24
Q

UC vs Crohns - fistulae

A

No spontaneous vs 10% presence

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25
UC vs Crohns - anal lesion presence chance
25% vs 75%
26
UC vs Crohns - pathology - invasion of mucosa
Mainly mucosal vs transmural
27
UC vs Crohns - pathology - crypt abscesses
Common vs less common
28
UC vs Crohns - pathology - crypt distortion
Severe vs less severe
29
UC vs Crohns - pathology - granulomas presence
Sarcoid like granulomas present in 60%
30
UC vs Crohns - pathology - polyps
Inflammatory polyps common vs uncommon
31
Extra-intestinal manifestations of IBD - hepatic
Fatty change Granulomas PSC Bile duct carcinoma
32
Extra-intestinal manifestations of IBD - skeletal
Polyarthritis Sacro-ileitis Ankylosing spondylitis
33
Extra-intestinal manifestations of IBD - muco-cutaneous
Oral apthoid ulcers Pyoderma gangrenosum Erythema nodoum
34
Extra-intestinal manifestations of IBD - ocular
Iritis/uveitis Episcleritis Retinitis
35
Extra-intestinal manifestations of IBD - renal
Kidney and bladder stones
36
Extra-intestinal manifestations of IBD - Haematological
Anaemia Leucocytosis Thrombocytosis Thrombo-embolic disease
37
Extra-intestinal manifestations of IBD - systemic
Amyloid | Vasculitis
38
Risk factors in UC
``` Early age of onset Duration of disease >8-10 years Total or extensive colitis PSC Family history CRC Severity of inflammation Presence of dysplasia ```
39
Colorectal polyps - what are they?
``` Mucosal protrusion Solitary or multiple polyposis Pedunculated, sessile or flat Small or large Due to mucosal or submucosal pathology or a lesion deeper in the bowel wall ```
40
Colorectal polyps - classifications
Neoplastic, hamartomatous, inflammatory or reactive Benign or malignant Epithelial or mesenchymal
41
Hamartomatous polyps types
Peutz-jeghers polyps | Juvenile polyps
42
Hyperplastic polyps
``` Common 1-5mm in size Often multiple Located in rectum & sigmoid colon Small distal hyperplastic polyps have no malignant potential ```
43
Juvenile polyp
Spherical and pedunculated 10-30mm Commonest type of polyp in children Typically occur in rectum & distal colon Sporadic polyps have no malignant potential
44
Peutz-jeghers syndrome
``` AD condition 1 in 50,000 - 1 in 120,000 Present clinically in teens or 20s with ab pain, gi bleeding & anaemia Multiple GI tract polyps Muco-cutaneous pigmentation ```
45
Benign polyp-types
``` Adenoma Lipoma Leiomyoma Haemangioma Neurofibroma ```
46
Malignant polyp-types
``` Carcinoma Carcinoid Leiomyosarcoma GIST Lymphoma Metastatic tumour ```
47
What is an adenoma?
Benign epithelial tumour
48
What do adenomas look like?
Pedunculated sessile or flat Villous, tubulo-villous or tubular Grade histologically by high grade vs low grade
49
What is progression of an adenoma?
To adenocarcinoma Usually over 10-15 years
50
What factors affect progression of an adenoma?
``` Flat adenomas = increase Size (>10mm is usually malignant) Villous & tubulo-villous High dysplasia HNPCC associated adenomas ```
51
Risk factors for colorectal cancer
``` Diet - fibre, fat, red meat, folate, calcium Obesity Alcohol NSAIDs HRT & oral contraceptives Schistomiasis Pelvic radiation Ulcerative colitis and crohn's ```
52
What 3 letter genetic condition makes you get colorectal cancer?
``` FAP AD 100% lifetime risk of large bowel cancer Multiple benign adenomatous polyps in colon Mutation in APC tumour suppressor gene ```
53
What 5 letter genetic condition makes you get colorectal cancer?
HNPCC 1-2% of colorectals Heriditary non-polyposis colorectal cancer AD 50-70% lifetime risk Increased chance of other GI and genitourinary cancers Due to mutations in DNA mismatch repair genes
54
Where are most colorectal cancers found?
Rectum | Sigmoid colon
55
What type of cancer is most common form of colorectal cancer?
Adenocarcinoma (95%)
56
Where can colorectal cancer spread?
Direct invasion of adjacent tissues Lymphatically to lymph nodes Via blood to liver and lung Transcoelomic mets through peritoneum
57
TNM staging
N0 - no nodes involved N1 - 1-3 nodes involved N2 - 4 or more nodes involved
58
Dukes staging
Stages A-D
59
Stage A (Duke's)
Adenocarcinoma confined to bowel wall with no lymph node mets
60
Stage B (Duke's)
Adenocarcinoma invading through bowel wall with no lymph node mets
61
Stage C (Duke's)
Adenocarcinoma with regional lymph node mets regardless of depth of invasion
62
Stage D (Duke's)
Distant mets present
63
Frequency of each Duke stage
A: 15% B: 35% C: 45% D: 20%
64
5 yr survival of each Duke stage
A: 90% B: 70% C: 45% D:

Clinical Pathology (65 decks)

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