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Clinical pathology > Lower gastrointestinal pathology > Flashcards

Lower gastrointestinal pathology Flashcards

1
Q

Diverticula of the Large Bowel

A
  • Blind ending sac like protrusions from the bowel wall in communication with the bowel lumen
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2
Q

Diverticulosis of the Colon

A
  • Protrusions of mucosa and submucosa through the bowel wall
  • Commonly sigmoid colon
  • Relationship with fibre content of diet
  • Irregular, uncoordinated peristalsis
  • Points of relative weakness in the bowel wall
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3
Q

Diverticular Disease definition

A

Small bulges in the large intestine (diverticula) developing and becoming inflamed

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4
Q

Acute complications of Diverticular Disease

A
  • Diverticulitis/peridiverticular abscess
  • bacteria get into bowel wall = left iliac fossa pain
  • Perforation leading to diffuse peritonitis
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5
Q

Chronic complications of Diverticular Disease

A
  • Fistula -abnormal passageway that connects two organs or vessels that do not usually connect
  • Diverticular colitis
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6
Q

Diverticula with no symptoms =

A

Verticular disease

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7
Q

Ulcerative colitis epidemiology

A
  • Incidence of UC is increased in urban areas
  • UC equally common in males and females
  • Risk of ulcerative colitis in 1st degree relative: 8 times
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8
Q

Ulcerative colitis clinical presentation

A
  • Diarrhoea with urgency/tenesmus
  • Constipation 2 %
  • Rectal bleeding > 90 %
  • Abdominal pain
  • Anorexia, Weight loss
  • Anaemia
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9
Q

Ulcerative colitis complications

A
  • UC ONLY affects the large bowel - Inflammation limited to the Mucosa
  • Toxic megacolon and perforation
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10
Q

Crohn’s disease epidemiology

A
  • Incidence same as UC
  • CD more common in females 1.3:1
  • Risk factors = oral contraceptive, smoking
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11
Q

Crohn’s disease clinical presentation

A
  • Chronic relapsing disease, affects all levels of GIT from mouth to anus
  • Colicky abdominal pain
  • MOST likely to be Ileocolic presentation
  • Diarrhoea: may be bloody
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12
Q

Crohn’s disease complications

A
  • Fistula - faeces when urinate
  • Stricture -narrowing of the lumen
  • Adenocarcinoma - risk of large and small bowel cancer
  • Short bowel syndrome -repeated resection
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13
Q

Risk factors for colorectal cancer in ulcerative colitis

A
  • UC biggest cause of colorectal cancer
  • Total or extensive colitis beyond splenic flexure
  • Early age of onset; Duration of disease > 8-10 years
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14
Q

Ischaemic Colitis definition

A
  • Colonic injury secondary to an acute, intermittent or chronic reduction in blood flow
  • May be occlusive (obstruction of the arteries) or non-occlusive (reduction of flow)
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15
Q

Ischaemic Colitis 3 clinical forms

A
  • Transient/evanescent: >80%: lasts for hrs, few days and then gets better
  • Chronic segmental ulcerating: ischaemic stricture
  • Acute fulminant and gangrenous: Complete necrosis, infarction of bowel wall, surgical emergency
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16
Q

Ischaemic Colitis clinical symptoms

A
  • Acute onset cramping abdominal pains;
  • Urge to defaecate
  • Bloody diarrhoea/rectal bleeding
17
Q

Ischaemic Colitis distribution

A
  • Most cases of ischaemic colitis affect left colon
  • Right colon: 35%
  • Water shed area around the splenic flexure, less blood supply therefore greater risk
  • Left colon (rectum to splenic flexure): 33%
18
Q

Colorectal Polyps definition

A
  • Mucosal protrusion – basically a bump in the mucosal lining
19
Q

Types of colorectal polyps

A
  • Solitary or multiple = polyposis
  • Pedunculated (with stalk), sessile (no stalk) or flat
  • Neoplastic, hamartomatous, inflammatory or reactive
  • Benign or malignant
  • Epithelial or mesenchymal
20
Q

Hyperplastic polyp

A
  • Located in rectum and sigmoid colon
  • Small distal HPs have no malignant potential
  • right sided “hyperplastic polyps” can give rise to unstable carcinoma
21
Q

Juvenile Polyp

A
  • Often spherical and pedunculated - common in children
  • Typically occur in rectum and distal colon
  • Sporadic polyps have no malignant potential
  • Rare genetic condition: juvenile polyposis causes increased risk of colorectal and gastric cancer
22
Q

Peutz-Jeghers Syndrome

A
  • Autosomal dominant condition: mutation in STK11 gene on chr 19
  • Present clinically in teens/20s with abdominal pain, GI bleeding, anaemia
  • Multiple gastro-intestinal tract polyps: predominantly small bowel
23
Q

Neoplastic Polyps

A
  • Benign = Adenoma: most common

- Malignant: Carcinoma, Carcinoid, Leiomyosarcoma

24
Q

Adenomas

A
  • Benign epithelial tumours; commonly polypoid but may be flat
  • Precursor of colorectal cancer: min. 80% cancers develop in already developed adenoma - adenocarcinoma
25
Q

Colorectal cancer definition

A
  • 2nd or 3rd commonest cancer causing mortality
  • Most bowel cancers (75%) = sporadic
  • weak genetic risk
26
Q

Colorectal cancer risk factors

A
  • Fat, red meat, calcium inc
  • Obesity/ physical activity
  • HRT and oral contraceptive
  • Pelvic radiation: radiotherapy
  • Ulcerative colitis and Crohn’s disease
27
Q

Colorectal cancer types

A
  • Adenocarcinoma 95%: gland forming tumours
  • Adenosquamous carcinoma
  • Squamous cell carcinoma
  • Neuroendocrine carcinoma
  • Undifferentiated (large cell) carcinoma
  • Medullary carcinoma
28
Q

Colorectal cancer spread

A
  • Lymphatic metastasis
  • Haematogenous metastasis
  • Direct invasion of adjacent tissue
  • Iatrogenic spread e.g. needle track recurrence or port site recurrence
29
Q

Colorectal cancer protective substances

A
  • High fibre + folate diet

- NSAIDS and aspirin decrease risk

30
Q

Familial adenomatous polyposis: FAP

A
  • 100% lifetime risk of large bowel cancer
  • Associated with multiple benign adenomatous polyps in the colon
  • Due to mutation in the APC tumour suppressor gene
31
Q

Lynch Syndrome: HNPCC

A
  • 50-70% lifetime risk of large bowel cancer
  • Due to mutations in DNA mismatch repair genes
  • Two thirds distal to splenic flexure: most common where they occur
32
Q

Colorectal cancer grading

A
  • Well differentiated: 10-20%: mimicking normal lining of the bowel
  • Moderately well differentiated: 60-80%
  • Poorly differentiated: 10-20% - poor prognosis
33
Q

neoplastic cells and colorectal cancer

A
  • Neoplastic cells must have invaded through the muscularis mucosae into the submucosa (as can access lymphatics and blood vessels in submucosa)
34
Q

Colorectal cancer key clinical features

A
  • Ulceration causes bleeding – fresh and bright red
  • If it is in the right side of the colon (more proximal), bleeding is occult (not noticed) – so patients present with anaemia due to chronic bleeding
  • Stenosis – pain or emergency
  • Weight loss and altered bowel habit
35
Q

Colorectal cancer treatment

A
  • Bowel resection – partial
  • If near rectum, anal sphincter may need to be removed = colostomy
  • Radiotherapy for increased chance of cure
  • May give some further chemotherapy

Clinical pathology (69 decks)

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