gastrointestinal_week_4_20190518174147 Flashcards by raniya robb

what is a polyp

protrusion above an epithelial surface - it is a tumour (swelling)

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what is malignant epithelial polyps (majority of polyps)

polypod - adenocarcinomas carcinoid polyps

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what is majority of benign epithelial polyps

neoplastic - adenoma (do not metastasise)

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what is different macroscopic views of polyps

pedunculated (hanging)sessile (slightly raised)flat (completely flat)

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why would pedunculated be the polyp youd want

its easier to remove

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what does the actual polyp look like under macroscope

irregular surface, long stalk

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what does polyp look like histopathologically

dysplastic epithelial lining

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what is the different architecture variables of adenoma polyps

tubullovillous, tubular or villousBUT all are dysplastic

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what is the consequence of adenomas

they are precursors of cororectal carcinomas

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why must all adenomas be removed

because they are all premalignant, either done endoscopically or surgically

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what is the pathology of a large bowel tumour

moderately differentiated dirty necrosis patterntumour is invasive through muscularis propia

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what is the staging of colorectal carcinoma

dukes A - confined by muscularis propia dukes B - through muscularis propia dukes C - metastatic to lymph nodes

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how do patients present with left sided (rectum, sigmoid, descending) colorectal carcinoma - 75%

blood PR, altered bowel habit, obstruction

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how do patients present with right sided (caecum, ascending) colorectal carcinoma - 25%

anaemia, weight loss

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what is pathology of cororectal carcinoma

varied gross appearance (polypoid, stricturing, ulcerating)typical histopathological appearance (adenocarcinomas)clinical stuff in other lecture

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what are the three ways colorectal carcinoma can kill you

local invasion (mesorectum, peritoneum, other organs)lymphatic spread (mesenteric nodes)haematogenous (liver via portal venous system, distant sites)

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what are the different kinds of inherited cancer syndromes

heriditary non polyposis coli (HNPCC) - <100 polypsfamilial adenomatous polyposis (FAP) - >100 polypsonly 10% is inherited

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what is characteristics of HNPCC

late onset, autosomal dominant, defect in DNA mismatch repair, inherited mutation in MLH-1, MSH-2, PMS-1, MSH-6

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what is characteristics of FAP

early onset, autosomal dominant, defect in tumour supression, inherited mutation in FAP gene

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how does HNPCC present

right sided tumours, mucinous tumours, crohns like inflammatory response, associated with gastric and endometrial carcinoma

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how does FAP present

throughout colon, adenocarcinoma, no specific inflammatory response, associated with desmoid tumours and thyroid carcinoma

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the longitudinal smooth muscle layer in caecum and colon is dividd into three strands - what is this called

taeniae coli - it encircles rectum and anal canal smooth muscle is thickened at internal anal sphincter which is surrounded by skeletal muscle of external anal sphincter

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the activity of taeniae coli and circular muscle layers in colon causes sac like budges - what is this called

haustra

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caecum normally receives material (undigestible residues etc) from terminal ileum - what permits the entry of this

Study These Flashcards

gastroileal reflex in response to gastrin and CKK through one way ileocaecal valve

how does the ileocaecal valve work

maintain positive resting pressurerelaxing in response to distension of duodenum contracting in response to distension of ascending colon

what causes appendicitis

when appendiceal office that connects lymphoid tissue to distal caecum being obstructed by faecalith

what are common benign condition

crohns colitis and ulcerative colitis, diverticular disease, functional disorders

what are less common benign conditions

colonic volvulus, colonic andiodysplasia, ischaemic colitis, pseudo-obstruction

what is diverticular disease

mucosal herniation through muscle coat effects sigmoid colon, low fibre intake, incidental finding is it diverticulosis or diverticulitis?

how is diverticulosis diagnosed

clinical barium enema sigmoidoscopy

what is the clinical features of diverticulitis

LIF pain/tendernessseptic altered bowel habit

what are the complications of diverticular disease

pericolic abscess, perforation, haemorrhage, fistula (abnormal connection between 2 epithelial surfaces), stricture

what is treatment of uncomplicated diverticulitis

some IV oral antibiotics

what is treatment of complex diverticulitis

percutaneous drainage hartmanns procedure laparoscopic lavage and drainage primary resection/anastomosis

what are causes of acute and chronic colitis

infective colitis, ulcerative colitis, crohns colitis, ischaemic colitis

what is symptoms of acute and chronic colitis

diarrhoea +/- blood abdominal cramps dehydration sepsis weight loss, anaemia (chronic)

how can colitis be diagnosed

plain X-ray sigmoidoscopy + biopsy stool culturesbarium enema (dont really do this anymore)

what is treatment of ulcerative colitis / crohns colitis

IV fluids IV steroids - once infective/ischaemic colitis ruled out GI rest

what happens if patient doesnt settle after treatment

rescue medial therapy surgery

what is characteristics of ischaemic colitis

in elderly - effects arteriescan be acute or chronic occlusion of inferior mesenteric artery

what is characteristics of colonic angiodysplasia

submucosal lakes of blood obscure cause of rectal bleeding usually right side of colon

how is colonic angiodysplasia diagnosed

angiographycolonoscopy injection or surgical resection

how is colonic angiodysplasia treated

embolisationendoscopic ablationsurgical resection

what are causes of large bowel obstruction

colorectal cancer, benign stricture, volvulus

what is the usual treatment of large bowel obstruction

resuscitate, operate, stenting

signs of large bowel obstruction

constipation, vomiting, abdominal distension, pain

what causes sigmoid volvulus

bowel twists on mesentery may become gangrenous

how can sigmoid volvulus be diagnosed

plain X-ray abdo rectal contrast

what is treatment of sigmoid volvulus

flatus tube, surgical resection

what is pseudo-obstruction

no real mechanical obstructionin elderly/debilitated hypoxia

what are functional bowel disorders

chronic constipation - if young check thyroid

gastrointestinal_week_4_20190518174147 Flashcards

(59 cards)