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Year 2 - Clinical Pathology > LGIT Path > Flashcards

LGIT Path Flashcards

1
Q

what is diverticula of the large bowel

A

blind ending sac like proturiosn from the bowel wall to bowel lumen
2 types - true congenital (meckels) all layers of bowel

acquired false pseudo diverticulum - not all bowel walls

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2
Q

what is diverticulosis of the colon and where is it most commonly found

A

protrusions of mucosa and submucosa through the bowel wall - commonly in the sigmoid colon (between mesenteric and anti-mesenteric tania coli)

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3
Q

what is the pathogenesis of diverticulosis of the colon

A

increased intra-luminal pressure - irregular uncoordinated peristalsis
hypertrophy and bowel wall thickened

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4
Q

what are some of the presentations patinet would say for diverticular disease of the colon

A

cramping, alternating constipation and diarrhoea

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5
Q

what are the acute vs chronic clinical presentations of diverticular disease

A

acute - abscess - left iliac fossa pain = perforation or haemorrhage

chronic - fistula or colitis

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6
Q

what is colitis and its subtypes

A

inflammation of the colon divided into acute and chronic

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7
Q

what are the differences between acute and chronic colitis

A

acute - infection or antibiotic associated, drug induced

chronic idiopathic IBD or ischaemic colitis

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8
Q

what are the two types of chronic idiopathic IBD

A

UC and crohns

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9
Q

what are the incidences and risk factors of IDB’s

A 
CD  more common in women but UC equal 
smoking may be protective in UC but x2 in CD
oral contraceptive causes it 
infections 
familial or genetic risks from relatives
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10
Q

what are the clinical presentations of UC

A

diarrhoea, (constipation) rectal bleeding, abdominal pain, weight loss, anaemia

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11
Q

what are the complications of UC

A

inflammation limited to the colon so could have perforation or toxic megacolon more than 6cm

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12
Q

what structures does UC affect

A

only the large bowel

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13
Q

what are the clinical presentations of CD

A

relapsing and affects entire GIT from mouth to anus

diarrhoea, abdominal pain, abdominal mass, weight loos, fever, presence of granulomas

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14
Q

what are the complications of CD

A

fisulta - sticking to other organs
stricture - narrowing of the lumen
adenocarcinoma
short bowel syndrome - removing too much small bowel = malabsorption

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15
Q

where in the GIT does CD affect

A

all - mainly ileocolic then small bowel and colonic rarely stomach and duodenum

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16
Q

where else in the body can IBD affect

A

hepatic - fatty change and granuloma
osteo-articular = joint problems
muco-cutaneous - oral ulcers
ocular - inflammation in the eye

17
Q

what is the leading cause of colorectal cancer

A

UC

18
Q

what are the risk factors of developing CRC in UC patients

A

early stage onset with family history
extensive UC
PSC - primary sclerosising cholangitis - narrowing of bile duct

19
Q

what are the four stages of development of CRC in UC

A

inflamed mucosa
low grade dysplasia
high grade dysplasia
colorectal cancer

20
Q

what is ischaemic colitis and the 3 forms

A

colonic injury secondary to acute or chronic reduction in blood flow, occlusive or not
transient
chronic segmental ulcerating - ischaemic stricture
acute fulminant and gangrenous

21
Q

what would someone present with, with ischameic colitis

A

acute onset cramping, urge to poo, rectal bleeding - recover after 24hrs

22
Q

what are the causes of mesenteric ischameia

A

arterial thrombosis
“ embolism (most common)
non-occlusive ischemia

23
Q

where is ischaemic colitis most commonly affected and why so

A

left colon - splenic flexure between transverse and descending colon on left side has watershed area which is at greater risk to ischameia

24
Q

what are colorectal polyps and what are they causes by and the three structural types

A

mucosal protrusion
peduncled (with stalk), sessile, no stalk or flat
due to mucosal or submucosal lesion/patholohy

25
Q

what type of non-neoplastic polyp is the most common as you get older

A

hyperplastic polyp

26
Q

what is the most common type of polyp in children and how is it associated with genetics

A

juvenile polyp

juvenile polyposis = increased risk of CRC and gastric cancer

27
Q

what is Peutz-jeghers syndrome (PJS), cause and presentation

A

always inherited - AD mutation in STK11 on chromosome 19

teens with GI bleeding, pain and anaemia

28
Q

what is the most common type of neoplastic polyp

A

(benign) adenoma - arising from the epithelium lining the large bowel

29
Q

what is the precursor to colorectal cancer

A

benign colon adenoma

30
Q

what is the 2nd/3rd most common cancer causing mortality

A

CRC

31
Q

what are the risk factors of CRC and what are seen as protective

A

protective - high fibre, folate, aspirin and NSAIDS

risk - fat, red meat, calcium, UC/CD

32
Q

what are the two types of inherited susceptibility to inherited CRC

A

FAP - familial adenomatous polyposis CRC - mutation in APC Tumour SG

lynch syndrome (HNPCC) (not as likely to get)

33
Q

what are the main types of cancer in CRC

A

adenocarcinoma

34
Q

what is the most common site of spread of CRC’s

A

liver and lung (sometimes skin and bone)

35
Q

what are the two routes of spread of CRC to other organs

A

haematogenous or lymphatic

36
Q

what staging is used to grade CRC

A

dukes or TNM (tumour, nodes, metastasis)

37
Q

describe the TNM staging

A

T - 1-4 = how deep into the organ the spread 1 = mucosa 4= all 4 tissue layers of organ
N 0-2 - nodules
M = metastasis present 0 or 1

38
Q

describe the dukes staging of cancer

A

a-d determines the chance of cure or more treatment
a = adenocarcinoma confined in small bowel wall 90% survival
B = through bowel wall
c = ADC with lymph metas
d = distant metastasis

Year 2 - Clinical Pathology (67 decks)

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