GI Pathology 2 Flashcards
Bling ended out pouchings of bowel
Diverticular disease
give an example of aquired diverticular disease
Meckle’s
Where are diverticula commonly found?
Sigmoid colon, between mesenteric and anti-mesenteric taenia coli
What is the cause of diverticular disease
Uncoordinated peristalsis- increase in intraluminal pressure
Points of relative weakness in the bowel wall
Where in the bowel wall do penetrations occur?
At the arteries, where they enter the mucosa of the wall
Clinical presentation of diverticula disease
Cramping abdominal pain
Alternating diarrhoea and constipation
3 acute complications of diverticular disease
Diverticulitis/peridiverticular abscess
Perforation
Haemorrhage
4 chronic complicatioons of diverticular disease
Intestinal obstruction
Fistula
Diverticular colitis
Polypoind prolapsing mucosal fold
Which part of the bowel wall is colitis usually confined to?
Mucosa
Give 3 causes of acute colitis
Acute infection (camplylocbacter, salmonella, CMV)
Antibiotics
Drugs
Give a cause of chronic colitis
Chronic idiopathic inflammatory bowel disease
What 2 diseases come under idiopathic inflammatory bowel disease
Crohns and UC
Smoking is a) a risk factor, b)protective of which diseases
a) Crohns b)UC
Which part of the colon do you find UC
Starts in the rectum, spreads to a variable extent along colon
Crypt abscesses in crohn’s or UC?
UC
Complications of UC
Toxic megacolon and perforation
Haemorrhage
Stricture
Carcinoma
What part of the GI tract does Crohn’s affect?
Mouth to anus (most common form is ileocolic)
Skip lesions- discontinuous cobblestoning, and granulomas in UC or Crohn’s
Crohn’s
Mainly mucosal inflammation
UC
transmural inflammation
Crohn’s
Anal lesions more common
Crohn’s
Fistulae more common
Crohn’s
Strictures more common
Crohn’s
Serositis
Crohn’s
Inflammatory polyps more common
UC
The name of the chronic liver disease, often in UC patients, which is a big risk factor for colorectal cancer
Primary sclerosing cholangitis
Types of colorectoal polyps
Pedunculated
Sessile
Flat
2 main types of non-neoplastic polyps
Hyperplastic
Hamartomatous
Describe hyperplastic polyps
1-5mm in size, often multiple. Only when large (>10mm) and on the right side are they capable of becoming malignant.
2 types of hamatomatous polyps
Peutz-jegher’s
Juveline
Juveline polyps are common in what age group, what do they look like, where are they found and what tpe of cancers are they associated with?
Teenagers and children
Spherical and pedunculated
Found in the rectum and distal colon
Associated with colorectal cancer and gastric cancer
AD condition- polyps
Peutz-Jeghers syndrome
Multiple GI tract polyps and muco-cutaneous pigmentation (lips, buccal mucosa, fingers and toes)
Peutz Jeghers
Peutz jeghers polyps are found where?
Small bowel
Peutz jeghers syndrome predisposes you to what types of cancer?
colon, pancreas, stomach
What type of benigh neoplastic polyp may be a precursor to colorectal cancer?
Adenoma
What types of adenoma are most at risk of malignant change?
‘flat’
>10mm
Vilous and tubulo villous
HNPCC associated adenomas
Risk factors for colorectal cancer
Diet Obesity Alcohol NSAIDs HRT and oral contraceptives Schistosomiasis Pelvic radiation UC, Crohns
What staging is used for colorectal cancer
Duke’s staging
Dukes stage A
Confined to wall no lymph node metastasis
Dukes stage B
Invades through wall, no lymph node metastasis
Dukes stage C
Regional lymph node metastasis
Dukes stage D
Distant metastasis present
familial cancer syndrome with a 100% lifetime risk of large bowel cancer
FAP
Familial cancer syndrome with a mutation in the APC tumour suppressor gene
FAP
familial cancer syndrome with a 50-70% lifetime risk of large bowel cancer and other cancers
HNPCC
familial cancer syndrome with a mutation in the DNA mismatch repair gene
HNPCC
Most common colorectal cancer
Adenocarcinoma (>95%)
