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gastrointestinal_week_4_20190518174147 Flashcards

1
Q

what is a polyp

A

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

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2
Q

what is malignant epithelial polyps (majority of polyps)

A

polypod - adenocarcinomas carcinoid polyps

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3
Q

what is majority of benign epithelial polyps

A

neoplastic - adenoma (do not metastasise)

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4
Q

what is different macroscopic views of polyps

A

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

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5
Q

why would pedunculated be the polyp youd want

A

its easier to remove

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6
Q

what does the actual polyp look like under macroscope

A

irregular surface, long stalk

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7
Q

what does polyp look like histopathologically

A

dysplastic epithelial lining

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8
Q

what is the different architecture variables of adenoma polyps

A

tubullovillous, tubular or villousBUT all are dysplastic

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9
Q

what is the consequence of adenomas

A

they are precursors of cororectal carcinomas

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10
Q

why must all adenomas be removed

A

because they are all premalignant, either done endoscopically or surgically

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11
Q

what is the pathology of a large bowel tumour

A

moderately differentiated dirty necrosis patterntumour is invasive through muscularis propia

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12
Q

what is the staging of colorectal carcinoma

A

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

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13
Q

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

A

blood PR, altered bowel habit, obstruction

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14
Q

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

A

anaemia, weight loss

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15
Q

what is pathology of cororectal carcinoma

A

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

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16
Q

what are the three ways colorectal carcinoma can kill you

A

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

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17
Q

what are the different kinds of inherited cancer syndromes

A

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

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18
Q

what is characteristics of HNPCC

A

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

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19
Q

what is characteristics of FAP

A

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

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20
Q

how does HNPCC present

A

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

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21
Q

how does FAP present

A

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

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22
Q

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

A

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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23
Q

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

A

haustra

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24
Q

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

A

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

25
Q

how does the ileocaecal valve work

A

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

26
Q

what causes appendicitis

A

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

27
Q

what are common benign condition

A

crohns colitis and ulcerative colitis, diverticular disease, functional disorders

28
Q

what are less common benign conditions

A

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

29
Q

what is diverticular disease

A

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

30
Q

how is diverticulosis diagnosed

A

clinical barium enema sigmoidoscopy

31
Q

what is the clinical features of diverticulitis

A

LIF pain/tendernessseptic altered bowel habit

32
Q

what are the complications of diverticular disease

A

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

33
Q

what is treatment of uncomplicated diverticulitis

A

some IV oral antibiotics

34
Q

what is treatment of complex diverticulitis

A

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

35
Q

what are causes of acute and chronic colitis

A

infective colitis, ulcerative colitis, crohns colitis, ischaemic colitis

36
Q

what is symptoms of acute and chronic colitis

A

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

37
Q

how can colitis be diagnosed

A

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

38
Q

what is treatment of ulcerative colitis / crohns colitis

A

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

39
Q

what happens if patient doesnt settle after treatment

A

rescue medial therapy surgery

40
Q

what is characteristics of ischaemic colitis

A

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

41
Q

what is characteristics of colonic angiodysplasia

A

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

42
Q

how is colonic angiodysplasia diagnosed

A

angiographycolonoscopy injection or surgical resection

43
Q

how is colonic angiodysplasia treated

A

embolisationendoscopic ablationsurgical resection

44
Q

what are causes of large bowel obstruction

A

colorectal cancer, benign stricture, volvulus

45
Q

what is the usual treatment of large bowel obstruction

A

resuscitate, operate, stenting

46
Q

signs of large bowel obstruction

A

constipation, vomiting, abdominal distension, pain

47
Q

what causes sigmoid volvulus

A

bowel twists on mesentery may become gangrenous

48
Q

how can sigmoid volvulus be diagnosed

A

plain X-ray abdo rectal contrast

49
Q

what is treatment of sigmoid volvulus

A

flatus tube, surgical resection

50
Q

what is pseudo-obstruction

A

no real mechanical obstructionin elderly/debilitated hypoxia

51
Q

what are functional bowel disorders

A

chronic constipation - if young check thyroid

52
Q

other notes on document

A

other notes on document

53
Q

what causes antibiotic induced pseudomembranous colitis

A

patients on broad spectrum - c.diff toxin A and B attack endothelium and epithelium massive diarrhoea and bleeding

54
Q

how to treat this

A

flagyl/vancomycin

55
Q

what is collagenous colitis

A

thickened basement membrane disease is patchy no chronic architectural changes

56
Q

what to look for in clinical history in collagenous colitis

A

watery diarrhoea, normal endoscopy, drug history etc

57
Q

what is lymphocytic colitis

A

no chronic architectural changes in crypts intraepithelial lymphocytes raised but no thickening of BM

58
Q

what is radiation colitis

A

telangectasia (widened venules)bizarre stromal cells

59
Q

what is infective colitis

A

infectionrarely drugs, ischaemia, endoscopy etc busy epithelial but no crypt irregularity

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