Alimentary Tract pathology

Question 1

What are the different sections of the large bowel?

Answer 1

Caecum 
Ascending colon 
Transverse colon 
Descending colon 
Sigmoid 
Rectum

Question 2

What 3 cell types are found in the mucosa of the small bowel?

Answer 2

Goblet cells
Columnar absorptive cells
Endocrine cells

Question 3

What are the main histological features of the large bowel?

Answer 3

No villi 
Tubular crypts 
Columnar absorptive cells 
Goblet cells 
Endocrine cells

Question 4

What constitutes the myenteric plexus?

Answer 4

Meissener’s plexus (base of submucosa)

Auerbach’s plexus (between inner and outer muscle layers)

Question 5

What type of control are the extrinsic muscles of the bowel under?

Answer 5

Autonomic innervation

Question 6

What is the pathogenesis of inflammatory bowel disease?

Answer 6

Strong immune response against normal flora with defects in the epithelial barrier function in genetically susceptible people

Question 7

What are the pathological features of ulcerative colitis?

Answer 7

Limited to the colon

Continuous pattern of inflammation

Question 8

What are the histological features of ulcerative colitis?

Answer 8

Inflammation of mucosa 
Crypt abscesses 
Disarray of crypts 
Mucosal atrophy 
Ulceration into submucosa- pseudopolyps 
Submucosal fibrosis

Question 9

What are the complications of ulcerative colitis?

Answer 9

Haemorrhage
Perforation
Toxic dilatation
Increased risk of cancer

Question 10

What are the pathological features of Crohn’s disease?

Answer 10

Thickened, oedematous and fibrotic mesentery
Can effect any level of tract from mouth to anus
Narrowing of lumen
Can present as skip lesions
Ulceration

Question 11

What are the histology features of Crohn’s disease?

Answer 11

Cryptitis and crypt abscesses 
Atrophy 
Deep ulceration 
Transmural inflammation 
Non caseating granulomas 
Fibrosis 
Hypertrophy of mural nerves

Question 12

What are the complications of Crohn’s disease?

Answer 12

Malabsorption 
Strictures
Fistulas and abscesses 
Perforation 
Increased risk of cancer

Question 13

What is ischaemic enteritis?

Answer 13

Acute occlusion of 1 of the 3 major supply vessels leading to infarction (coeliac, sup mesenteric and inf mesenteric arteries)

Question 14

What are the predisposing conditions of ischaemia?

Answer 14

Arterial thrombosis (atherosclerosis, aneurysm, hypercoagulable states, oral contraceptives)
Arterial embolism
Cardiac failure

Question 15

What are the histologic features of acute ischaemia?

Answer 15

Oedema 
Intestinal haemorrhages 
Initial absence of inflammation 
Sloughing necrosis of mucosa 
Vascular dilatation

Question 16

What are the pathological features of chronic ischaemia?

Answer 16

Mucosal inflammation 
Ulceration 
Submucosal inflammation 
Fibrosis 
Strictures

Question 17

What are the symptoms of radiation colitis?

Answer 17

Abdominal cramps
Diarrhoea
Malabsorption
Weight loss

Question 18

What are the histological features of radiation colitis?

Answer 18

Bizarre cellular changes 
Crypt abscesses
Arterial stenosis 
Ulceration 
Necrosis
Haemorrhage 
Perforation

Question 19

What are the histological features of appendicitis?

Answer 19

Fibrinopurulent exudate
Perforation
Abscess
Acute inflammation in wall and pus in lumen

Question 20

What are the features of low grade adenoma?

Answer 20

Increased nuclear size
Increased nuclear number
Reduced mucin

Question 21

What are the features of high grade adenoma?

Answer 21

Crowded
Very irregular
Carcinoma in situ

Question 22

What are the symptoms of a right sided colorectal adenocarcinoma?

Answer 22

Anaemia
Vague pain
Weakness
Exophytic/polypoid

Question 23

What are the symptoms of a left sided colorectal adenocarcinoma?

Answer 23

Annular (similar to apple core)
Bleeding
Altered bowel habit