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diverticula of the bowel Flashcards

1
Q

what are the 2 types of diverticulum.

A

1- True “congenital” diverticulum e.g. merkels lined by all layers of the GI wall.
2-acquired “false” pseudo diverticulum.

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2
Q

Is diverticulosis of the colon acquired or congenital

A

acquired

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3
Q

define diverticulosis of the colon.

A

protrusions of the mucosa and submucosa through the bowel wall.

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4
Q

what layers of the gut wall does diverticulosis of the colon involve

A

mucosa and submucosa

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5
Q

in which part of the colon does diverticulosis of the colon typically occur

A

sigmoid colon

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6
Q

where are divertculi in the colon located

A

between the mesenteric and antimesentrtic taneia coli

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7
Q

what type of diet protects you from developing diverticula

A

high fibre diets

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8
Q

what is the pathogenesis of diverticulosis formation

A

increased intra-luminal pressure- ➢ Irregular , uncoordinated peristalsis.

mucosal outpouches at points of relative weakness occur in the bowel.
weakness are due to penetration by nutrient arteries between the mesenteric and anti mesenteric taneia coli and age related elastosis in the taenea coli

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9
Q

what change occurs in the bowel bowel in prediverticular disease

A

the muscularis propria thickens.

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10
Q

what are the clinical features of diverticular disease

A

most commonly asymptomatic
cramping and abdominal pain
alternating constipation and diarrhoea
acute and chronic complications

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11
Q

what are acute complications of diverticula disease

A

diverticultitis- inflammation
peridiverticular abcess- ulceration caused by bacteria resulting in an abcess.
perforation
haemorrage- ulceration in an artery or vein.

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12
Q

what are the chronic complications of diverticula disease

A

intestinal obstruction
fistula- urinary, bladder, vagina.
diverticular colitis- inflammation of the lining
polypoid prolapsing mucosal folds.

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13
Q

common pathogens which cause acute colitis

A

campylobacter, salmonella, CMV.

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14
Q

what can cause acute colitis

A

infection, immunosuppressed people, antibiotics, drugs, ischameia, radiation, neutropenia.

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15
Q

what causes chronic colitis

A

ischemia, diverticular, chronic infections (TB), eosiniphils, radiation, collagen and lymphocytes

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16
Q

what 3 conditions fall under the category of idiopathic inflammatory disease

A

ulcerative colitis
crohns
intermediate colitis-( mix of crowns and UC)

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17
Q

crohns of ulcerative colitis- which one is more common in children and females

A

Crohns

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18
Q

risk factors for UC and crohns.

A

Oral contraceptives
Childhood infections
domestic hygiene
familial clustering

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19
Q

what 2 substances are protective against UC but are risk factors of crohns

A

smoking, appendicectomy.

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20
Q

clinical presentation of ulcerative colitis

A 
diarrhoea
constipation
rectal bleeding
abdominal pain
anorexia
weight loss
anaemia.
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21
Q

complications of ulcerative colitis

A 
toxic mega colon- –	Bowel wall dilates and thins, gas and fluid accumulate and can perforate release it.
treatment is steroids and cephlasporin
haemorrhage
stricture
carcinoma
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22
Q

features macroscopically for ulcerative colitis

A

rectum and extends to rest of colon

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23
Q

define proctosigmoditus

A

sigmoid and rectum

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24
Q

define pan colitis

A

rectum to caecum

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25
is ulcerative colitis continous throughout the affected region
YES.
26
freatures microscopically of ulcerative coltiis
inflammation of restrict mucosa | Crypt abscess typical of UC- contains neutrophils.
27
clinical features of crohns disease
``` chronic relapsing and flare ups. mout to anus diarrhoaea colicky abdominal pain palpable abdominal mass weight loss/failure to thrive anorexia fever oral ulcers perinanal disease- strictures and fistulas anaemia ```
28
which part of the colon does crowns disease typically affects
iliocolic region
29
features of a macroscopic crohns colon
illiocolic- thickened and inflamed bowel lumen cobblestone appearance due to longitudinal and transverse strictures. pathcy appearance- skip lesions apthoid ulcer
30
features of a microscopic crohns colon
compact epitheliod cell granuloma- all layers of the bowel wall, found in liver and regional lymph nodes.
31
complications of crowns
``` toxic mega colon perforation fistula stricture haemorrhage carcinoma short bowel syndrome- from numerous resections ```
32
which condition is transmural crohn or ulcerative colitis
crohns
33
which condition only affect the mucosal layer
ulcerative colitis
34
which condition are granulomas present crohn or ulcerative colitis
crohns
35
which condition are crypt abcesseses common
ulcerative colitis.
36
what hepatic manifestations occur in IBD
Fatty chnage granulomas primary scleroising colongitis-inflammation and fibrosis scarring of the bile ducts. bile duct carcinoma
37
what skeletal changes occur in IBD
polyarthritis sacro-iletis ankolysing spondylitis
38
what mucocutaneous changes occur in IBD
Oral apthoid ulcers Pyoderma gangrenosum- ulcers Erythema nodosum- skin inflammation
39
what ocular changes occur in IBD
* Iritis/uveitis * Episcleritis * Retinitis- inflammation of the retina.
40
what renal changes occur in IBD
• Kidney and bladder stones
41
what haematological changes occur in IBD
* Anaemia * Leucocytosis * Thrombocytosis * Thrombo-embolic disease- DVT
42
what systemic changes occur in IBD
* Amyloid deposition. | * vasculitis
43
what are the risk factors for developing colorectal cancer
* Early age of onset * Duration of disease * Total or extensive colitis- how much colon is affecting. * PSC * Family History of cancer. * Severity of inflammation (pseudopolyps) * Presence of dysplasia (pre- malignant neoplasm).
44
how is colitis surveillance performed
* After 10 years UC colonscipic is offered to all patients every few years. * Take a biopsy and use it to see if any dysplasia is present. * The more active the disease the increased frequency of colonscopy.
45
what layer of the colon forms colorectal polyps
mucosal protrusion
46
3 types of colorectal polyps
sensile- no stalk pedunculated- stalk flat
47
How are polyps classified
* Neoplastic, harmartomatous (disorganised proliferation of normal bowel), inflammatory and reactive. * Benign or malignant * Epithelial or mesenchymal
48
the most common type of non-neoplastic polyp
hyperplastic polyp
49
is Harmartomtous polyp begin or malignant
beingin
50
2 conditions which result in harmartomtous polyps
Peutz-jeghers polyps | Juvenile polyps
51
most common site for hyper plastic polyp
rectum and sigmoid
52
are hyperplactic polyps malignant or benign
Small distal HP’s have NO malignant potential. Large right sided hyperplastic (caecum) polyps sessile serrated (broad-based polypoid lesion without a clear stalk.) may give rise to microsatellite unstable carcinoma
53
commoest polyp in children
juvenille polyp
54
what shape is a juvenile polyp
spherical
55
most common site for juvenile polyps
rectum and distal colon
56
are juvenile polyps malignant or benign
Juvenile polyposis (lots of them) associated with increased risk of colorectal and gastric cancer- FH Sporadic polyps have no malignant potential
57
what type of genetic condition is PEUTZ-JEGHERS SYNDROME
autosomal dominat
58
clinical presentation of PEUTZ-JEGHERS SYNDROME
``` abdominal pain (intussusception), gastro-intestinal bleeding and anaemia. Muco-cutaneous pigmentation- brown patches lips, fingers toes and lining of cheeks. ```
59
where are PEUTZ-JEGHERS SYNDROME polyps found.
small bowel and stomach. | can form in the gallbladder, urinary bladder and nasopharynx.
60
what cancer do PEUTZ-JEGHERS SYNDROME predispose you to
colon, stomach and breast.
61
what are the different types of benign neoplastic polyps
* Adenoma * Lipoma * Leiomyoma * Haemangioma * Neurofibroma
62
what are the different types of malignant neoplastic polyps
* Carcinoma * Carcinoid * Leiomyoscarcoma * GIST * Lymphoma * Metastatic tumour.
63
what type of tumours are adenomas
benign | epitheliod tumour
64
what shape are adenomas
polyp shape
65
what typeof cancer are adenomas precursors to
colorectal cancer.
66
which part of the colon has lager adenomas
recto-sigmoid and caecum
67
features of macroscopic adenomas
pedunculated(stalk), sessile(broad base) or flat. Architectural Type : villous, Tubulo-villous or tubular- villi or smooth surface with tubules.
68
what types of adenoma are more likely to form cancer | think about size and architecture
larger Flat adenomas- only raised above the mucosa and higher risk of dysplasia. villious
69
risk factors for colorectal cancer.
sporadic- most common FH- single gene, HNPCC, FAP IBD,diet, obesity, alcohol, • Hormone replacement therapy and oral contraceptives, Schistosomiasis, Pelvic radiation
70
what form of medication id protective for colorectal cancer
NSAIDS
71
which inherited codlins predisposes 100% to colorectal cancer
FAP
72
what types of polyps does FAP cause
multiple benign adenomatous polyps
73
HNPPC an FAP are both what type of genetic condition
autosomal dominat
74
what condition does a mutation in a APC tumour suppressor gene cause
FAP
75
what condition does a mutation in a DNA mismatch repair gene cause
HNPCC
76
what cancers other than colorectal does HNPCC predispose to
endometrial, ovarian, gastric, small bowel, urinary tract and billary tract cancer.
77
where are most colorectal cancers located
2/3 of cancer’s are distal to the splenic flexure.
78
what are the different types of colorectal cancer in terms of different tumours
``` Adenocarcinoma-most common Adenosquamous carcinoma Squamous cell carcinoma Neuroendocrine carcinoma undiffrentaited carcinome medually carcinoma ```
79
how are tumours graded
Well differentiated Moderately well differentiated Poorly differentiated - bad prognosis
80
how does colorectal cancer spread
* Direct invasion of adjacent tissues * Lymphatic metastasis (lymph nodes) * Haematogenous metastasis (liver and lung) * Transoelomic (peritoneal) metasis * Iatrogenic spread eg. Needle track recurrence, port site recurrence.
81
what 2 forms of staging are used for colorectal cancer
TNM | Duke's staging
82
what does the T part of TNM determine
tumour- what layers has the tumour crossed. • T1-mucosa and some submucosa. • T2- muscularis propria • T3-connective tissue • T4-ulcertive peritoneal lining perforation or invades another organ e.g. vagina etc.
83
what does the N part of TNM determine
nodes ➢ N0 no nodes involved ➢ N1 1 – 3 nodes involved ➢ N2 4 or more nodes involved
84
what does the M part of TNM determine
metastases ➢ M= distal metastases. ➢ M0= NO metastases ➢ M1=METASESES.
85
how many stages are there in duke's staging | and what defines in each stage
4 • 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 stage D worst.

Clinical Pathology (45 decks)

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