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Pathology > H - Lower GI > Flashcards

H - Lower GI Flashcards

1
Q

6 General consequences of lower GI conditions

A

Change in bowel habits
Bleeding
Perforation
Fistula formation
Obstruction
Systemic illness

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2
Q

4 congenital disorders of lower GI

A

Atresia
Stenosis
Duplication
Agenesis

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3
Q

What is atresia

A

No communication between 2 bits of bowel

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4
Q

What is hirschprungs

A

Absence of ganglion cells in submucosal and myenteric plexus

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5
Q

Patterns of hirschprungs

A

Starts in rectum and extends proximally

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6
Q

RFs for hirschprungs

A

Male
Downs

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7
Q

What mutation is present to cause hirschprungs

A

RET proto oncogene

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8
Q

Tx of hirschprungs

A

Resection of affected segment with frozen section to identify any ganglion cells and where they end

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9
Q

PC of hirschprungs

A

Failure to pass meconium in first 24hrs

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10
Q

General causes of bowel obstruction

A

Adhesions
Hernias
Extrinsic mass
Volvulus

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11
Q

Where do infants vs elderly get volvulus

A

Infants = SB
Elderly = sigmoid colon

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12
Q

Pathogenesis of diverticular disease

A

Low fibre diet
High intraluminal pressure
Weak points of bowel
Diverticular formed

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13
Q

What makes a diverticular a true one vs pseudo

A

True has ALL bowel wall layers in them

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14
Q

Where are 90% of diverticular found

A

L colon esp sigmoid

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15
Q

Complications of diverticular disease

A

Pain
Diverticulitis
Gross perforation
Fistula - bowel / bladder / vagina
Obstruction

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16
Q

Broad causes of acute colitis

A

Infection
Drugs / toxins
Chemo / radio

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17
Q

Infections that cause acute colitis

A

Fungal - Candida
Viral - CMV
Bacteria - salmonella
Protozoa - entamoeba histolytica

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18
Q

Who gets CMV colitis

A

Imm supp

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19
Q

Causes of chronic colitis

A

Crohns
UC
TB

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20
Q

When do you get pseudomembranous colitis

A

After ABx Tx

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21
Q

What is pseudomembranous colitis

A

Pseudomembrane formation with acute colitis

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22
Q

Cause of pseudomembranous colitis

A

Protein exotoxins of c.diff

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23
Q

Histology of pseudomembranous colitis

A

Mushroom cloud appearance

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24
Q

Ix for pseudomembranous colitis

A

C.diff stool assay

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25
Q

Where do you get ischaemic colitis

A

Watershed zones - splenic flexures (SMA/IMA) or rectosigmoid (IMA/int iliac)

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26
Q

Patterns of ischaemic colitis

A

Mucosal
Mural
Transmural

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27
Q

5 causes of ischaemic colitis with examples

A

Arterial - atheroma, thrombosis
Venous - thrombus, hypercoagulation
Small vessel disease - emboli, vasculitis
Low flow states - CCF, haemorrhage, shock
Obstruction - hernia, intussusception, volvulus, adhesions

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28
Q

Risk of transmural ischaemic colitis

A

Perforation

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29
Q

What is idiopathic chronic IBD

A

Diagnosis of exclusion that isn’t Crohns or UC

30
Q

Potential RFs for idiopathic chronic IBD

A

Genetics - HLA
Infection - measles, mycobacteria
Abnormal host immunity
Microbiome

31
Q

RFs for Crohns

A

Western
Young adult
White
Jewish
Smoking

32
Q

Features / patterns of IBD

A

Mouth to anus
Skip lesions
Non caseating granulomas
Transmural inflammation - fistulae, fissures, sinuses
Cobblestoned appearance

33
Q

Extra intestinal features of Crohns

A

Arthritis
Uveitis
Stomatitis
Cheilitis
Skin lesions - erythema multiforme / nodosum

34
Q

Which is the more common IBD

A

UC

35
Q

RFs of UC

A

White
20-25

36
Q

Patterns / features of UC

A

Rectum to colon in continuous fashion
Mucosal inflammation not Transmural

37
Q

Complications of UC

A

Severe haemorrhage
Toxic mega colon
Adenocarcinoma

38
Q

Extra intestinal complications of UC

A

PSC
Erythema nodosum, pyoderma gangrenosum
Uveitis / iritis
Myositis
Arthritis

39
Q

Which IBDs get crypt abscesses

A

BOTH

40
Q

7 Types of tumour of large bowel

A

Non neoplastic polyps
Neoplastic epithelial lesions - adenoma, adenocarcinoma, neuroendocrine
Mesenchymal - lipoma, leiomyoma
Lymphoma

41
Q

Types of non neoplastic polyps

A

Hyperplastic
Sessile serrated
Pseudopolyps - inflammation
Hamartomatous - juvenile, Peutz Jeghers

42
Q

Peutz Jeghers has hamartomatous polyps and what other feature

A

Pigment around lips

43
Q

Which type of polyp may be a risk factor for cancer

A

Sessile serrated lesions

44
Q

Types of neoplastic polyps

A

Tubular adenoma
Tubulovillous adenoma
Villus adenoma

45
Q

Tubular vs villous adenoma shape

A

Tubular = can be pedunculated (stalk), round, flat surface
Villous = finger like projections, non flat surface

46
Q

What colour do neoplastic polyps look and why

A

Dark - high nuclear:cytoplasmic ratio

47
Q

RFs for cancer in individual polyps

A

Size
Proportion of villous component
Degree of dysplasia

48
Q

When do adenomas come vs carcinoma

A

Adenomas come 10 years before carcinomas

49
Q

Do adenomas affect the risk of carcinoma

A

YES - risk proportional to number of adenomas

50
Q

Sx of adenomas

A

Often non - can bleed / anaemia Sx

51
Q

3 familial syndromes of colorectal cancer

A

Peutz Jagher
FAP - familial adenomatous polyposis
HNPCC - Hereditary non polyposis colon cancer

52
Q

Age peak of FAP

A

25

53
Q

Inheritance of FAP

A

AD

54
Q

Mutation of FAP

A

Chr 5q21
APC TSG

55
Q

What % of FAP get cancer in 10 years

A

100%

56
Q

Dx cut off for FAP

A

> 100 polyps but usually ~1000

57
Q

What other type of cancer is associated with FAP

A

5% get duodenal periampullary cancer

58
Q

What is Gardeners syndrome

A

FAP + extra intestinal Sx eg osteomas / Desmoid tumours

59
Q

What is Turcot syndrome

A

FAP + brain tumours

60
Q

What is HNPCC aka

A

Lynch syndrome

61
Q

Inheritance of HNPCC

A

AD

62
Q

What % of colorectal cancers is HNPCC

A

3-5%

63
Q

Cause of HNPCC

A

1 of 4 DNA mismatch repair genes involved - resulting in numerous DNA replication errors

64
Q

Features of the cancer you get in HNPCC

A

in caecum (opposite to normal)
Poorly differentiated
Mucinous carcinoma
Multiple synchronous cancers

65
Q

Other extracolonic cancers associated with HNPCC

A

ENDOMETRIUM
Prostate
Breast
Stomach

66
Q

What % of bowel carcinomas are adenocarcinomas

A

98

67
Q

Peak age of carcinoma of bowel

A

60-79

68
Q

RFs for carcinoma of bowel

A

Familial
Diet - low fibre, high fat
Lack of exercise
Obesity
Adenomas
IBD

69
Q

Sx of bowel carcinoma

A

Change in bowel habit
Anaemia
PR bleed
Weight loss

70
Q

What guide is used for grade / stage

A

TNM not dukes

71
Q

TNM T stage 1 of bowel carcinoma

A

Submucosa only

72
Q

TNM T stage 4 of bowel carcinoma

A

Into peritoneum

Pathology (87 decks)

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