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Study Notes - Gastroenterology > *Intestinal Problems (lecture 4) > Flashcards

*Intestinal Problems (lecture 4) Flashcards

1
Q

Normal appearance of the large bowel?

A

Flat with no villi but contains straight crypts lined by absorptive and mucus-producing goblet cells

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2
Q

What is a polyp?

A

An abnormal growth of tissue projecting from a mucous membrane (it is a swelling and therefore a tumour)

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3
Q

What are the general categories of benign epithelial polyps with examples? (4)

A

Neoplastic e.g. adenoma
Inflammatory e.g. in inflammatory bowel disease
Hamartomatous (different to neoplasm as if the tissue stops growing the polyp will too) e.g. juvenile polyp
Metaplastic (or hyperplastic)

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4
Q

What are the general malignant types of colon polyps (tumours) found in the epithelium?

A

Polypoid e.g. adenocarcinomas

Carcinoid polyps

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5
Q

What are the 5 types of benign mesenchymal tumours?

A 
Lipoma (fat)
Lymphangioma (lymphatics)
Haemangiomas (vascular)
Fibromas (fibrous/ connective tissue)
Leiomyoma (smooth muscle)
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6
Q

What are 2 possible malignant mesenchymal polyps that develop in the large intestine?

A

Sarcomas

Lymphomatous polyps

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7
Q

What are the differential diagnosis of a colonic polyp? (4)

A 
Adenoma
Serrated polyp ("saw-tooth" like structure)
Polypoid carcinoma
Other 
*need histopathology to tell them apart
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8
Q

Macroscopic descriptions of a polyp (5)?

A

Pendunculated (attached via a stalk)
Sessile (like a carpet - harder to treat)
Flat (barely prude above the peithelial surface)
Irregular surface
Long stalk

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9
Q

What is a polyp which has a dysplastic epithelial lining on histopathological examination?

A

Adenomas (adenomas are always dysplastic but not all dysplasia is adenomas - mostly is)

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10
Q

Do adenomas invade or metastasise?

A

No - they can becomes adenocarcinomas however

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11
Q

What are the 3 microscopic appearances of adenomas?

A

Tubular (contains tubular crypts)
Villous (velvety surface made up from numerous epithelium-lined projections)
Tubullovillous (mixture of both of the above features)

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12
Q

What is the 5 stages of the adenoma-carcinoma sequence?

A 
Normal mucosa
Small Adenoma (dysplastic)
Large adenoma (dysplastic)
Adenocarcinoma (invasive)
Metastases
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13
Q

Main genetic mutations that cause normal epithelium to develop a small adenoma? (5)

A 
APC mutation
MCC mutation
5q deletion
c-myc activation
bci-2 mutation
(not all adenomas have the same molecular genetic origins - separate pathways for inherited tumours and serrated adenomas)
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14
Q

Main 2 genetic mutations that cause a small adenoma to become a large adenoma?

A

K-ras mutation

c-yes mutation

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15
Q

Main 3 genetic mutations that causes a large adenoma to become an invasive adenocarcinoma?

A

Chromose 17p
18q
p53 mutation

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16
Q

Main mutation that causes invasive adenocarcinoma to metastasise?

A

nm23 deletion

17
Q

Do adenomas have to be removed?

How are they removed? (2)

A

Yes as they are all premalignant

Either endoscopically or surgically

18
Q

How are malignant tumours of the large bowel removed?

A

Surgically (as they tend to be quite big) - mesentery is removed at the same time in order to get rid of the lymph nodes
Removed section is sent to pathology for staging

19
Q

What types of cancers are most large bowel malignant tumours?

A

Adenocarcinoma

20
Q

Microscopic features of large bowel cancers?

A

Moderately differentiated
“dirty” necrosis pattern
Invades through muscularis propria

21
Q

Colorectal carcinoma staging method?

A

Dukes (predicts prognosis)

22
Q

Dukes staging for colorectal carcinoma + 5 year survival?

A

Dukes A = confined by muscularis propria - 90+%
Dukes B = through muscularis propria - 75%
Dukes C = metastatic to lymph nodes - 50-60%

23
Q

what is the most common side to develop colorectal carcinoma?
What are the common side effects for this sided colon cancer? (3)

A 
Left sided - 75%
Blood PR
Altered bowel habit
Obstruction
(tend to be more genetic related)
24
Q

What % of colorectal cancers are right sided (caecum and ascending)?
What are the presenting complaints for this? (2)

A

25% right sided
Anaemia, weight loss
(tend to be more dietary related)

25
Q

What are 3 examples of gross appearance of colorectal carcinomas?

A

Polypoid
Stricturing
Ulcerating
(varied gross appearance)

26
Q

What is the typical histopathological appearance of colorectal carcinomas?

A

Adenocarcinomas

27
Q

Where do colorectal carcinomas tend to locally invade? (3)

A

Mesorectum
Peritoneum
Other organs

28
Q

Where do colorectal carcinomas lympatically spread?

A

Mesenteric nodes

29
Q

Where do colorectal cancers tend to spread maematogenously?

A

Liver, distant sites

30
Q

What are 2 inherited cancer syndromes which cause multiple polyps?
How many polyps does each tend to cause?
Onset?
Autosomal dominant/ recessive?

A

Hereditary non polyposis coli (HNPCC) - 100 polyps - tends to have an early onset with many patients having their colon removed in their teenage years to prevent them dining of colorectal cancer
Both autosomal dominant

31
Q

In both HNPCC and FAP, what is the defect in?

What genes are the inherited mutation in?

A

HNPCC - defect in DNA mismatch repair
-MLH-1, MSH-2, PMS-1 or MSH-6 genes mutated

FAP = defect in tumour supression
Inherited mutation in FAP gene

32
Q

Where are the polyps found in HNPCC and FAP?

A

Right sided in HNPCC

Throughout the colon in FAP

33
Q

What type of tumours develop in HNPCC and FAP?

A

Mucinous in HNPCC

Adenocarcinoma in FAP

34
Q

Inflammatory responses in HNPCC and FAP?

A

HNPCC - chron’s like inflammatory response

FAP - no specific inflammatory response

35
Q

What other carcinomas are HNPCC and FAP associated with?

A

HNPCC - gastric and endometrial carcinoma

FAP - desmoid tumours and thyroid carcinoma

Study Notes - Gastroenterology (42 decks)

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