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Clinical Pathology > CP11-3 Lower GI Pathology > Flashcards

CP11-3 Lower GI Pathology Flashcards

1
Q

What are the two subtypes of IBD?

A

Ulcerative colitis and Crohn’s disease

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2
Q

What is the epidemiology of IBD?

A

Ulcerative colitis = 5-15 cases per 100,000 - increased in urban areas

Crohn’s disease = 5-10 cases per 100,000

Peak age incidence = 20-40 year olds

More common in western countries like UK, Scandinavia, Northern Europe and USA

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3
Q

who is more likely to have chronic disease? Men or women?

A

Women

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4
Q

what are risk factors for IBD?

A

Smoking for Crohn’s (not UC)
Oral contraceptive pill
Childhood infections
Domestic hygiene

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5
Q

What are two protective factors for UC?

A

Smoking
Appendectomy in childhood

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6
Q

How do patients present with UC?

A

Diarrhoea with urgency and increased frequency - sometimes constipation but less common
Rectal bleeding
Abdominal pain
Associated weight loss - potentially anorexia
Anaemia

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7
Q

What are complications of UC?

A

Toxic megacolon and perforation
Haemorrhage
Stricture (rare)
Carcinoma in chronic uncontrolled disease

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8
Q

What is the pathology of UC?

A

Continuous superficial inflammation, mainly of the mucosa, which usually starts distally in the rectum and extends proximally. Can show confluence ulceration. Never transmembrane inflammation and granulomas uncommon.

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9
Q

What are symptoms of Crohn’s disease?

A

Chronic relapsing disease
Diarrhoea (can contain blood)
Colicky abdominal pain
Palpable abdominal mass
Weight loss
Fever
Oral ulcers
Anaemia

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10
Q

What is the pathology of Crohn’s disease?

A

Affects GI tract from mouth to anus with majority patients affected in the ileocolic area. It has skin lesions of deep, transmural inflammation and fistulation. Granulomas are common.

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11
Q

What are some complications of Crohn’s disease?

A

Toxic megacolon
Perforation
Fistulation
Strictures (common)
Haemorrhage
Carcinoma
Short bowel syndrome due to repeated resections

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12
Q

What are some extra-intestinal manifestations of IBD?

A

Fatty change and granuloma formation in the liver
Polyarthitis
Oral ulcers
Uveitis and retinitis
Amyloidosis
Thrombosis-embolic disease

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13
Q

What is ischaemic bowel disease?

A

Acute, intermittent or chronic reduction of blood flow in the colon due to occlusion or non-occlusive causes, majority due to an arterial embolism (40-50%). It is usually multifactorial and associated with other vascular diseases.

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14
Q

What are the main types of ischaemic colitis?

A

Transient (>80%)
Chronic segmental ulcerating with ischaemic stricture
Acute fulminant and gangrenous

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15
Q

How do patients with ischaemic colitis present?

A

Acute onset cramping abdominal pains
Urgent need to poo
Blood diarrhoea
Rectal bleeding
Symotom improvement within 48 hours and recovery takes 1-2 weeks

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16
Q

What percentage of patients with ischaemic colitis require surgery for colonic infarction?

A

20%

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17
Q

where is ischaemic colitis most common?

A

Left colon especially round the splenic flecture

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18
Q

What is diverticular disease?

A

When there are protrusions of mucosa and submucosa through the bowel wall.

19
Q

Where are protrusions form diverticular disease most commonly found?

A

In the sigmoid colon - less commonly in proximal colon

20
Q

What are the two types of diverticular disease?

A

True congenital diverticulum
Acquired false pseudo diverticulum

21
Q

What is the epidemiology of diverticular disease?

A

Common in western world, rare elsewhere
Urban > rural areas
Male = females
Less common in vegetarians
More common in those with a low fibre diet
Increases with age

22
Q

What is the pathogenesis of diverticular disease?

A

Increased intra-luminal pressure causes irregular, uncoordinated peristalsis causing overlapping semi circular arcs of the bowel wall. This causes areas of relative weakness in the bowel wall.

23
Q

How do patients with diverticular disease present?

A

Asymptomatic for most part
But can present with cramping abdominal pain and alternating diarrhoea and constipation

24
Q

What are acute complications of diverticular disease?

A

Diverticulitis
Peri-diverticular abscesses
Perforation
Haemorrhage

25
Q

What are chronic complications of diverticular disease?

A

Intestinal obstructions (5-10% of which are due to strictures)
Fistulas e.g. with bladder or vagina
Diverticular colitis -(segmental and Granulomatous)
Polypoid prolapsing mucosal folds

26
Q

What are colorectal polyps?

A

Mucosal protrusions of the lower GI tract due to mucosal or sub mucosal pathology or a lesion deeper in the bowel. They can be solitary of multiple, small or large and appear pedunculated, sessile or flat.

27
Q

How are polyps classified?

A

If neoplastic, haemartomatous, inflammatory or reactive
If benign or malignant
If epithelial or mesenchymal

28
Q

What are the two subtypes of haemartomatous polyps?

A

Peutz-jeghers
Juvenile

29
Q

What are characteristics of hyper plastic polyps?

A

Common
1-5 mm
Often multiple
Located in rectum and sigmoid colon
No distal potential

30
Q

What is Peutz-Jeghers syndrome?

A

An autosomal dominant disease characterised by multiple polyps predominantly in the small bowel with have muco-cutaneous pigmentation. They cause abdominal pain, GI bleeding and anemia, presenting in teens and early 20s. It increases risk of cancer.

31
Q

What are adenomas of the large bowel?

A

Benign tumours of the epithelium of the colon which are commonly polypod and evenly distributed around the colon They are pre cursers to colorectal cancer.

32
Q

What is the epidemiology of large bowel adenomas?

A

25-35% of > 50s

33
Q

How do adenomas in the large bowel appear macroscopically?

A

Pedunculated
Sessile
Flat

34
Q

What different architectural types of colon adenomas are there?

A

Villous, tubulo-villous or tubular

35
Q

What is the epidemiology of colorectal cancer?

A

3rd most common cancer globally

36
Q

What are 3 hereditary causes of colorectal cancer?

A

FAP
Lynch syndrome

37
Q

What factors are protective against colorectal cancer?

A

Fibre/folate
Aspirin (NSAIDs)
Oral contraceptives

38
Q

What are some risk factors of colorectal cancer?

A

Diet (high in fat and red meat)
Obesity
Low physical activity
Alcohol
Pelvic radiation
UC and Crohn’s

39
Q

What is FAP?

A

Familial adenomatous polposis, an autosomal dominant condition with mutation of the APC tumour suppressor genes which is associated with multiple benign adenomatous polyps which give you a 100% lifetime risk of large bowel cancer (unless attenuated FAP).

40
Q

What is Lynch syndrome?

A

An autosomal dominant genetic condition causing mutations in DNA mismatch repair genes. This causes increased risk of various cancers in abdominal organs e.g. endometrium, small bowel and urinary tract. Causes a 50-70% of lifetime risk for cancer.

41
Q

Where are most colorectal cancers found?

A

In rectum - followed by sigmoid colon then caecum

42
Q

What is the most common subtype of bowel cancer?

A

Adenocarcinomas

43
Q

What is an example of a common neoplastic colorectal polyp?

A

Tubular adenoma.

Clinical Pathology (65 decks)

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