Histo: Lower GI Disease Flashcards
List some congenital disorders of the GI tract.
- Atresia/stenosis
- Duplication
- Imperforate anus
- Hirschsprung disease (MOST COMMON)
What is Hirschsprung disease?
- Caused by the absence of ganglion cells of the myenteric plexus results in failure of dilatation of the distal colon
- Presents with: constipation, abdominal distension, vomiting and overflow diarrhoea
List some genetic associations of Hirschsprung disease.
- Down syndrome
- RET proto-oncogene Cr10
How is Hirschsprung disease diagnosed?
- Clinical impression
- Full thickness rectal biopsy
- Shows hypertrophied nerve fibres but no ganglia
How is Hirschsprung disease treated?
Resection of affected (constricted) segment
What is a volvulus?
Twisting of a loop of bowel at the mesenteric base around a vascular pedicle
Which part of the intestines tend to be affected by volvulus in children and the elderly?
Children - small bowel
Elderly - sigmoid colon
Describe the pathophysiology of diverticular disease.
High intraluminal pressure (e.g. due to poor diet) leads to herniation of the bowel mucosa through weak points in the bowel wall (usually sites of entry of nutrient vessels)
List some causes of acute colitis.
- Infection
- Drugs/toxins
- Chemotherapy
- Radiotherapy
List the effects of infection on the colon.
- Secretory diarrhoea (due to toxin)
- Exudative diarrhoea (due to invasion and mucosal damage)
- Severe tissue damage and perforation
- Systemic illness
What can cause pseudomembranous colitis?
Exotoxins by C. difficile
How can C. difficile colitis be diagnosed?
Toxin stool assay
How is pseudomembranous colitis treated?
Metronidazole or vancomycin
Where in the intestines does ischaemic colitis tend to occur?
Watershed zones (e.g. splenic flexure, rectosigmoid)
List some causes of ischaemic colitis.
- Arterial occlusion (e.g. embolism)
- Venous occlusion (e.g. thrombus)
- Small vessel disease (e.g. diabetes mellitus)
- Low flow states (e.g. CCF)
- Obstruction (e.g. hernia, intussusception)