HRP - Gastro

Question 1

Barium enema in a Crohn’s patient, what does it show?

Answer 1

Deep ulceration of colon

Question 2

If there is a tumour/polyp in the caecum there will be obstructive symptoms, true or false?

Answer 2

Not necessarily true. NB may be anaemia if there is bleeding.

Question 3

‘Apple core’ stricture is typical of what?

Answer 3

Colonic carcinoma

Question 4

What is ‘thumbprinting’?

Answer 4

Thumbprinting is a radiographic sign of large bowel wall thickening, usually caused by oedema, related to an infective or inflammatory process (colitis). The normal haustra become thickened at regular intervals appearing like thumbprints projecting into the aerated lumen.

Question 5

What makes up the mucosa?

Answer 5

Epithelium, lamina propria and muscularis mucosae

Question 6

What are the layers of the gut?

Answer 6

Mucosa, submucosa, muscularis externa, serosa/adventitia

Question 7

What’s the difference between serosa and adventitia?

Answer 7

Both connective tissue ‘coatings’ but serosa found in peritoneal cavity, adventitia found outside peritoneal cavity

Question 8

Are there villi in the colon?

Answer 8

No

Question 9

What are there lots of in the colon?

Answer 9

Glands and goblet cells

Question 10

What epithelium lines the colon?

Answer 10

Simple columnar epithelium?

Question 11

What are the two major cell types in the colon?

Answer 11

Enterocytes (absorptive cells) and goblet cells

Question 12

What happens to the number of goblet cells as you move distally through the colon?

Answer 12

Goblet cells increase in number as move distally through colon

Question 13

How does the histology of the colon differ from the oesophagus?

Answer 13

Oesophagus has stratified squamous epithelium

Question 14

How does the histology of the colon differ from the stomach?

Answer 14

No goblet cells in stomach

Question 15

How does the histology of the colon differ from the small intestine?

Answer 15

Villi in small intestine

Question 16

How does the histology of the colon differ from the anal canal?

Answer 16

Distal third of anal canal is keratinised stratified squamous epithelium

Question 17

How does the histology of the colon differ from the appendix?

Answer 17

Appendix has glandular epithelium and lymphoid tissue

Question 18

Which parts of GIT have serosa and which have adventitia?

Answer 18

Above diaphragm - adventitia; below diaphragm - serosa.

Question 19

Anastomosis between portal system and drainage of abdominal wall is between which veins? what is the clinical sign called?

Answer 19

Portocaval anastomosis between paraumbilical veins and superior and inferior epigastric veins. Caput medusae

Question 20

What does colonic adenoma look like histologically?

Answer 20

Lots of crypts, increased number of cells, size of nuclei and mitotic activity. still forms glandular stuctures, low grade dysplasia (so looks reasonably normal)

Question 21

What does pseudomembranous colitis look like histologically and what can cause it?

Answer 21

Errupting volcano appearance, lots of neutrophils, dead tissue, pus - forms a ‘pseudomembrane’
Antibiotic use - kills ‘good’ gut flora, leaves c.diff, c.diff takes over and damages epithelium

Question 22

What cells attack the epithelium in collagenous colitis?

Answer 22

Lymphocytes (not neutrophils)

Question 23

Are non-caseating granulomas present in Crohns and UC?

Answer 23

Just in Crohns, not in UC

Question 24

What criteria is used to stage the invasion of the cancer and to determine the prognosis and treatment?

Answer 24

Duke’s Staging

Question 25

What are the stages of Duke’s staging?

Answer 25

A- tumour limited to wall of bowel
B- Tumour spread beyond muscularis externa
C1- LNs positive but the highest LN is spared
C2- All LNs affected

Question 26

What is the lymphatic drainage of the colon?

Answer 26

Ascending colon and proximal 2/3 of transverse colon superior mesenteric LNS, distal 1/3 of transverse colon and descending colon inferior mesenteric LNs

Question 27

Which organ most likely to be colonised with mets from portal venous circulation?

Answer 27

Liver