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Clinical Pathology > diverticula of the bowel > Flashcards

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
Q

is ulcerative colitis continous throughout the affected region

A

YES.

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26
Q

freatures microscopically of ulcerative coltiis

A

inflammation of restrict mucosa

Crypt abscess typical of UC- contains neutrophils.

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27
Q

clinical features of crohns disease

A 
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
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28
Q

which part of the colon does crowns disease typically affects

A

iliocolic region

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29
Q

features of a macroscopic crohns colon

A

illiocolic- thickened and inflamed bowel lumen
cobblestone appearance due to longitudinal and transverse strictures.
pathcy appearance- skip lesions
apthoid ulcer

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30
Q

features of a microscopic crohns colon

A

compact epitheliod cell granuloma- all layers of the bowel wall, found in liver and regional lymph nodes.

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31
Q

complications of crowns

A 
toxic mega colon
perforation
fistula
stricture
haemorrhage
carcinoma
short bowel syndrome- from numerous resections
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32
Q

which condition is transmural crohn or ulcerative colitis

A

crohns

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33
Q

which condition only affect the mucosal layer

A

ulcerative colitis

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34
Q

which condition are granulomas present crohn or ulcerative colitis

A

crohns

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35
Q

which condition are crypt abcesseses common

A

ulcerative colitis.

36
Q

what hepatic manifestations occur in IBD

A

Fatty chnage
granulomas
primary scleroising colongitis-inflammation and fibrosis scarring of the bile ducts.
bile duct carcinoma

37
Q

what skeletal changes occur in IBD

A

polyarthritis
sacro-iletis
ankolysing spondylitis

38
Q

what mucocutaneous changes occur in IBD

A

Oral apthoid ulcers
Pyoderma gangrenosum- ulcers
Erythema nodosum- skin inflammation

39
Q

what ocular changes occur in IBD

A
  • Iritis/uveitis
  • Episcleritis
  • Retinitis- inflammation of the retina.
40
Q

what renal changes occur in IBD

A

• Kidney and bladder stones

41
Q

what haematological changes occur in IBD

A
  • Anaemia
  • Leucocytosis
  • Thrombocytosis
  • Thrombo-embolic disease- DVT
42
Q

what systemic changes occur in IBD

A
  • Amyloid deposition.

* vasculitis

43
Q

what are the risk factors for developing colorectal cancer

A
  • 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
Q

how is colitis surveillance performed

A
  • 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
Q

what layer of the colon forms colorectal polyps

A

mucosal protrusion

46
Q

3 types of colorectal polyps

A

sensile- no stalk
pedunculated- stalk
flat

47
Q

How are polyps classified

A
  • Neoplastic, harmartomatous (disorganised proliferation of normal bowel), inflammatory and reactive.
  • Benign or malignant
  • Epithelial or mesenchymal
48
Q

the most common type of non-neoplastic polyp

A

hyperplastic polyp

49
Q

is Harmartomtous polyp begin or malignant

A

beingin

50
Q

2 conditions which result in harmartomtous polyps

A

Peutz-jeghers polyps

Juvenile polyps

51
Q

most common site for hyper plastic polyp

A

rectum and sigmoid

52
Q

are hyperplactic polyps malignant or benign

A

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
Q

commoest polyp in children

A

juvenille polyp

54
Q

what shape is a juvenile polyp

A

spherical

55
Q

most common site for juvenile polyps

A

rectum and distal colon

56
Q

are juvenile polyps malignant or benign

A

Juvenile polyposis (lots of them) associated with increased risk of colorectal and gastric cancer- FH

Sporadic polyps have no malignant potential

57
Q

what type of genetic condition is PEUTZ-JEGHERS SYNDROME

A

autosomal dominat

58
Q

clinical presentation of PEUTZ-JEGHERS SYNDROME

A 
abdominal pain (intussusception), gastro-intestinal bleeding and anaemia.
Muco-cutaneous pigmentation- brown patches lips, fingers toes and lining of cheeks.
59
Q

where are PEUTZ-JEGHERS SYNDROME polyps found.

A

small bowel and stomach.

can form in the gallbladder, urinary bladder and nasopharynx.

60
Q

what cancer do PEUTZ-JEGHERS SYNDROME predispose you to

A

colon, stomach and breast.

61
Q

what are the different types of benign neoplastic polyps

A
  • Adenoma
  • Lipoma
  • Leiomyoma
  • Haemangioma
  • Neurofibroma
62
Q

what are the different types of malignant neoplastic polyps

A
  • Carcinoma
  • Carcinoid
  • Leiomyoscarcoma
  • GIST
  • Lymphoma
  • Metastatic tumour.
63
Q

what type of tumours are adenomas

A

benign

epitheliod tumour

64
Q

what shape are adenomas

A

polyp shape

65
Q

what typeof cancer are adenomas precursors to

A

colorectal cancer.

66
Q

which part of the colon has lager adenomas

A

recto-sigmoid and caecum

67
Q

features of macroscopic adenomas

A

pedunculated(stalk), sessile(broad base) or flat.

Architectural Type : villous, Tubulo-villous or tubular- villi or smooth surface with tubules.

68
Q

what types of adenoma are more likely to form cancer

think about size and architecture

A

larger
Flat adenomas- only raised above the mucosa and higher risk of dysplasia.
villious

69
Q

risk factors for colorectal cancer.

A

sporadic- most common
FH- single gene, HNPCC, FAP
IBD,diet, obesity, alcohol, • Hormone replacement therapy and oral contraceptives, Schistosomiasis, Pelvic radiation

70
Q

what form of medication id protective for colorectal cancer

A

NSAIDS

71
Q

which inherited codlins predisposes 100% to colorectal cancer

A

FAP

72
Q

what types of polyps does FAP cause

A

multiple benign adenomatous polyps

73
Q

HNPPC an FAP are both what type of genetic condition

A

autosomal dominat

74
Q

what condition does a mutation in a APC tumour suppressor gene cause

A

FAP

75
Q

what condition does a mutation in a DNA mismatch repair gene cause

A

HNPCC

76
Q

what cancers other than colorectal does HNPCC predispose to

A

endometrial, ovarian, gastric, small bowel, urinary tract and billary tract cancer.

77
Q

where are most colorectal cancers located

A

2/3 of cancer’s are distal to the splenic flexure.

78
Q

what are the different types of colorectal cancer in terms of different tumours

A 
Adenocarcinoma-most common
Adenosquamous carcinoma
Squamous cell carcinoma
Neuroendocrine carcinoma
undiffrentaited carcinome
medually carcinoma
79
Q

how are tumours graded

A

Well differentiated
Moderately well differentiated
Poorly differentiated - bad prognosis

80
Q

how does colorectal cancer spread

A
  • 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
Q

what 2 forms of staging are used for colorectal cancer

A

TNM

Duke’s staging

82
Q

what does the T part of TNM determine

A

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
Q

what does the N part of TNM determine

A

nodes
➢ N0 no nodes involved
➢ N1 1 – 3 nodes involved
➢ N2 4 or more nodes involved

84
Q

what does the M part of TNM determine

A

metastases
➢ M= distal metastases.
➢ M0= NO metastases
➢ M1=METASESES.

85
Q

how many stages are there in duke’s staging

and what defines in each stage

A

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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