CP21 - GI Disease 2

Question 1

what are the 2 types of diverticular of the large bowel?

Answer 1

true congenital diverticulum

acquired pseudodiverticulum

Question 2

what are the 3 major types of diverticular disease of the large bowel

Answer 2

Sigmoid diverticulosis ( acquired diverticula )

Diverticulosis of the colon ( acquired and congenital diverticula )

Giant diverticulum

Question 3

features for diverticulosis of the colon

Answer 3

• Protrusions of mucosa and submucosa through the bowel wall

- Commonly sigmoid colon

Question 4

pathogenesis of diverticulosis of the colon

Answer 4

Increased intra-luminal pressure - irregular/uncoordinated peristalsis

Points of relative weakness in the bowel wall - Age related changes in connective tissue

Question 5

what is the pathology of diverticulosis

Answer 5

Thickening of muscularis propria, Elastosis of taeniae coli ( leading to shortening of colon )

Question 6

what is the clinical feature of diverticular disease?

Answer 6

Asymptomatic ( 90 – 99 % )
Cramping abdominal pain
Alternating constipation and diarrhoea

Acute and chronic complications ( 10 – 30 % )

Question 7

what are some of the acute complication for diverticular disease?

Answer 7

Diverticulitis /
Perforation
Haemorrhage ( 5 % )

Question 8

what are some of the chronic complication for diverticular disease?

Answer 8

Intestinal obstruction ( strictures : 5 – 10 % )
Fistula ( urinary bladder, vagina )
Diverticular colitis ( segmental and granulomatous )
Polypoid prolapsing mucosal folds

Question 9

what are the 2 subtypes of chronic idiopathic inflammatory bowel disease

Answer 9

ulcerative colitis, crohn’s disease, indeterminate colitis ( symptoms between crohn’s and uc)

Question 10

what are the clinical presentation of UC

Answer 10

Diarrhoea ( > 66 % ) with urgency/tenesmus
Constipation ( 2 % )
Rectal bleeding ( > 90 % )
Abdominal pain ( 30 – 60 % 
Anorexia
Weight loss ( 15 – 40 % )
Anaemia (blood loss in stool)

Question 11

what are some of the complication for UC

Answer 11

Toxic megacolon (inflammed diluted transverse colon as gas and fluid accumulate in the colon and eventually perforate and leak into the abdomen) and perforation
sticture (rare)
Haemorrhage
Carcinoma

Question 12

what are the clinical features of crohn’s disease

Answer 12

Chronic relapsing disease
Affects all levels of GIT from mouth to anus
Diarrhoea ( may be bloody )
Colicky abdominal pain 
Palpable abdominal mass
Weight loss / failure to thrive
Anorexia
Fever
Oral ulcers
Peri – anal disease
anaemia

Question 13

what are some of the complication for Crohn’s Disease

Answer 13

Toxic megacolon
Perforation
Fistula
Stricture ( common )
Haemorrhage
Carcinoma
Short bowel syndrome ( repeated resection – removal of too mach small bowel and so not enough for sufficient intake of nutrients

Question 14

what are the difference in pathology of UC and Crohns

Answer 14

UC - affect colon, appendix, terminal ileum, continuous disease, rectum always involved,

Crohns - affects all parts of GIT, skip lesions, rectum involved in 50% of the time.

Question 15

what are histological difference between UC and Crohns

Answer 15

UC - Granular red mucosa with flat ,undermining ulcers, strictures rare, no fistulae

Crohn’s - Cobblestone appearance with apthoid and fissuring ulcers, serositis, stricture common, fistulae common

Question 16

what are some of the extra-intestinal manifestations of IBD

Answer 16

Hepatic - Fatty change, Granulomas, Bile duct carcinoma

Skeletal
Polyarthritis
Sacro-ileitis
Ankylosing spondylitis

Ocular- iritis, uveitis
Renal - kidnet & bladder stones

Question 17

what is the progression of UC into colorectal cancer

Answer 17

inflamed mucosa, low-grade dysplasia, high grade dysplasia, colorectal cancer

Question 18

what are the different subtype of colorectal polyps?

Answer 18

Neoplastic , hamartomatous , inflammatory or reactive, Benign or Malignant, Epithelial or Mesenchymal

Question 19

what are some of the non-neoplastic polyps in colo-rectum

Answer 19

Hyperplastic polyps, hamartomatous polyps (Peutz-jeghers polyps, Juvenile polyps), polyps related to mucosal prolapse, psot-inflammatory polyps, inflammatory fibroid polyp, benign lymphoid polyp

Question 20

what are the different subtypes of polyps

Answer 20

see lecture from slides 52

Question 21

what is peutz-jeghers syndrome

Answer 21

autosomal dominant condition, multiple GIT polyps

Question 22

what are some of the neoplastic polyps

Answer 22

see lecture slide 57

Question 23

is there a risk for adenoma from neoplastic polyps of the GIT become malignant

Answer 23

a small % of adenomas progress to adenocarcinoma over an average of 10 – 15 years

Question 24

what is FAP?

Answer 24

Familial adenomatous polyposis - 100 % lifetime risk of large bowel cancer ( classical ) ;

Question 25

What is HNPCC

Answer 25

Hereditary nonpolyposis colorectal cancer

50 - 70 % lifetime risk of large bowel cancer
Increased risk of many cancer around the body

Question 26

what are some of the spreading of colorectal cancer

Answer 26

Direct invasion of adjacent tissues
Lymphatic metastasis ( lymph nodes )
Haematogenous metastasis ( liver & lung )
Transcoelomic ( peritoneal ) metastasis

Question 27

what is the duke staging for colorectal cancer?

Answer 27

Stage A : adenocarcinoma confined to the bowel wall with no lymph node metastasis
Stage B : adenocarcinoma invading through the bowel wall with no lymph node metastasis
Stage C : adenocarcinoma with regional lymph node metastasis regardless of depth of invasion
Stage D : distant metastasis present