5: Pathology of the large intestine

Question 1

Out-pouching found in the large bowel via endoscopy indicate ____ disease.

Answer 1

diverticular

Question 2

What is a diverticulum?

Answer 2

Herniation of the mucosa through the muscle coat

Question 3

What can happen to diverticula to produce disease?

Answer 3

Inflammation

Perforation

Bleeding

Blockage

Question 4

What collects in diverticula?

Answer 4

Faeces

Bacteria

Question 5

Why do diverticulae become inflamed?

What does the initial diverticulosis progress to?

Answer 5

Blockage (e.g with seeds, food products)

Diverticulitis

Question 6

What dietary factor is associated with diverticular disease?

Answer 6

Low fibre diet

Question 7

Symptoms only occur if the diverticular disease is ___.

Answer 7

complicated

Question 8

What name is given to inflammation of diverticulae?

Answer 8

Diverticulitis

Question 9

If inflammation weakens the walls of diverticulae, what can happen?

Answer 9

Rupture

Question 10

If pus/faeces/bacteria leak from a ruptured diverticulum into the abdominal cavity, what can develop?

Answer 10

Peritonitis

Question 11

What can develop on the walls of the colon following diverticular rupture?

Answer 11

Abscesses

pain, fever

Question 12

What can develop between viscera following diverticular disease?

Answer 12

Fistula

Question 13

What organ, close to the large bowel, can develop a fistula following diverticular disease?

Answer 13

Bladder

Question 14

Why can diverticular disease cause blood in the stool?

Answer 14

Massive bleeding

Question 15

Why does low fibre intake cause diverticular disease?

Answer 15

Stool is more liquidy, harder to move along colon than solid

Greater pressure contractions, produces diverticular disease

Question 16

How are most cases of diverticular disease treated?

Answer 16

Surgery

Question 17

Who commonly develops ischaemia of the large bowel?

Answer 17

Elderly people

Those at risk of atherosclerosis

Question 18

What side of the large bowel tends to become ischaemic?

Answer 18

Left side

around the splenic flexure

Question 19

What disease process and which vessels are affected to produce large bowel ischaemia?

Answer 19

Atherosclerosis

S / I mesenteric arteries

Question 20

“withering of crypts”

“pink smudgy lamina propria”

“few chronic inflam. cells”

indicators of large bowel ischaemia

Question 21

What are some complications of ischaemic colitis?

Answer 21

Haemorrhage

Rupture

Stricture –> obstruction due to fibrosis following ischaemia

Question 22

What does a patient have if you find patchy membranes stuck to mucosa throughout the colonic wall?

Answer 22

Anti-biotic induced colitis

“Pseudomembranous” colitis

Question 23

“volcano like fibrinopurulent exudate lesions”

“flamethrower like”

antibiotic-induced pseudomembranous colitis

Question 24

What drugs cause the patchy membranous colitis seen all over the colonic wall?

Answer 24

Broad spectrum antibiotics

Question 25

Which bacteria produces toxins to kill the epithelium of the colon following broad spectrum antbiotic treatment?

Answer 25

***C. difficile***

Question 26

What drug can be used to treat infection following antibiotic-induced colitis?

Answer 26

**Oral vancomycin**

Question 27

What is wrong with a patient's large bowel if they have **watery diarrhoea**?

Answer 27

**Collagenous colitis** One of the **microscopic colitis** diseases - nothing can be seen grossly

Question 28

What becomes thicker and more prominent in the epithelial cells of patients with **collagenous colitis** (with watery diarrhoea)?

Answer 28

**Thickened basal lamina**

Question 29

What drugs can cause microscopic **collagenous colitis**?

Answer 29

**NSAIDs**

Question 30

Another patient has watery diarrhoea. Under the microscope they have increased numbers of IELs reminiscent of Coeliac disease. What disease do they actually have?

Answer 30

**Lymphocytic colitis** increased numbers of IELs

Question 31

What disease may someone have if they show microscopic **lymphocytic colitis**?

Answer 31

**Coeliac disease**

Question 32

What are the two types of microscopic colitis?

Answer 32

**Collagenous** **Lymphocytic**

Question 33

thick walled blood vessels inflammation disturbed crypts indicators of **radiation induced coltis**

Question 34

What is **radiation induced** **colitis** caused by?

Answer 34

**Cancer treatment** e.g chemo/radiotherapy

Question 35

What should be asked about in the history of someone with suspected radiation-induced colitis?

Answer 35

**Past medical history** | (previous history of cancer?)

Question 36

Acute colitis is commonly caused by \_\_\_.

Answer 36

**infection**