CP21 - GI Disease 2 Flashcards
what are the 2 types of diverticular of the large bowel?
true congenital diverticulum
acquired pseudodiverticulum
what are the 3 major types of diverticular disease of the large bowel
Sigmoid diverticulosis ( acquired diverticula )
Diverticulosis of the colon ( acquired and congenital diverticula )
Giant diverticulum
features for diverticulosis of the colon
- Protrusions of mucosa and submucosa through the bowel wall
- Commonly sigmoid colon
pathogenesis of diverticulosis of the colon
Increased intra-luminal pressure - irregular/uncoordinated peristalsis
Points of relative weakness in the bowel wall - Age related changes in connective tissue
what is the pathology of diverticulosis
Thickening of muscularis propria, Elastosis of taeniae coli ( leading to shortening of colon )
what is the clinical feature of diverticular disease?
Asymptomatic ( 90 – 99 % )
Cramping abdominal pain
Alternating constipation and diarrhoea
Acute and chronic complications ( 10 – 30 % )
what are some of the acute complication for diverticular disease?
Diverticulitis /
Perforation
Haemorrhage ( 5 % )
what are some of the chronic complication for diverticular disease?
Intestinal obstruction ( strictures : 5 – 10 % )
Fistula ( urinary bladder, vagina )
Diverticular colitis ( segmental and granulomatous )
Polypoid prolapsing mucosal folds
what are the 2 subtypes of chronic idiopathic inflammatory bowel disease
ulcerative colitis, crohn’s disease, indeterminate colitis ( symptoms between crohn’s and uc)
what are the clinical presentation of UC
Diarrhoea ( > 66 % ) with urgency/tenesmus Constipation ( 2 % ) Rectal bleeding ( > 90 % ) Abdominal pain ( 30 – 60 % Anorexia Weight loss ( 15 – 40 % ) Anaemia (blood loss in stool)
what are some of the complication for UC
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
what are the clinical features of crohn’s disease
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
what are some of the complication for Crohn’s Disease
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
what are the difference in pathology of UC and Crohns
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.
what are histological difference between UC and Crohns
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
what are some of the extra-intestinal manifestations of IBD
Hepatic - Fatty change, Granulomas, Bile duct carcinoma
Skeletal
Polyarthritis
Sacro-ileitis
Ankylosing spondylitis
Ocular- iritis, uveitis
Renal - kidnet & bladder stones
what is the progression of UC into colorectal cancer
inflamed mucosa, low-grade dysplasia, high grade dysplasia, colorectal cancer
what are the different subtype of colorectal polyps?
Neoplastic , hamartomatous , inflammatory or reactive, Benign or Malignant, Epithelial or Mesenchymal
what are some of the non-neoplastic polyps in colo-rectum
Hyperplastic polyps, hamartomatous polyps (Peutz-jeghers polyps, Juvenile polyps), polyps related to mucosal prolapse, psot-inflammatory polyps, inflammatory fibroid polyp, benign lymphoid polyp
what are the different subtypes of polyps
see lecture from slides 52
what is peutz-jeghers syndrome
autosomal dominant condition, multiple GIT polyps
what are some of the neoplastic polyps
see lecture slide 57
is there a risk for adenoma from neoplastic polyps of the GIT become malignant
a small % of adenomas progress to adenocarcinoma over an average of 10 – 15 years
what is FAP?
Familial adenomatous polyposis - 100 % lifetime risk of large bowel cancer ( classical ) ;
What is HNPCC
Hereditary nonpolyposis colorectal cancer
50 - 70 % lifetime risk of large bowel cancer
Increased risk of many cancer around the body
what are some of the spreading of colorectal cancer
Direct invasion of adjacent tissues
Lymphatic metastasis ( lymph nodes )
Haematogenous metastasis ( liver & lung )
Transcoelomic ( peritoneal ) metastasis
what is the duke staging for colorectal cancer?
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
