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Year 2 Clinical Pathology > Lower GI diseases > Flashcards

Lower GI diseases Flashcards

1
Q

What are the 2 kinds of diverticula?

A

Congenital diverticula and aquired diverticula

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2
Q

What is diverticulosis of the colon?

A

Protrusions of mucosa and submucosa through the bowel wall - commonly the sigmoid colon, less commonly extending into the proximal colon

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3
Q

Where in the bowel wall do the diverticula tend to be located?

A

Between mesenteric and anti-mesenteric taenia coli - (also between the 2 anti mesenteric taenia coli in 50% of cases)

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4
Q

Name 3 kinds of diverticulosis, do they involved congenital or aquired diverticula?

A

1) Sigmoid diverticulosis - acquired diverticula
2) Diverticulosis of the right colon - acquired and congenital diverticula
3) Giant diverticulum

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5
Q

Which part of the world is diverticulosis most common in?

A

The developed/western world - relationship to dietary fibre

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6
Q

How does the incidence of diverticulosis relate to age?

A

Incidence increases with age

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7
Q

What is the pathogenesis of diverticulosis?

A
  • Increased intraluminal pressure due to irregular, uncoordinated peristalsis and overlapping (valve like) semicircular arcs of bowel wall
  • Protrusion through points of relative weakness in the bowel wall - eg. points of penetration by nutrient arteries, between mesenteric and anti-mesenteric taenia coli and age related changes in connective tissue can also lead to a weaker wall
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8
Q

What 4 steps occur for diverticula to develop?

A

1) Thickening of muscularis propria (earliest change - pre diverticula disease)
2) Elastosis of taenia coli - leading to shortening of colon
3) Redundant mucosal folds and ridges
4) Sacculation and diverticula form

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9
Q

What are the clinical features of diverticulosis?

A

90-99% will be asymptomatic
Some will get cramps and alternating constipation and diarrhoea
Also get acute and chronic complications

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10
Q

What are the 3 main acute complications of diverticulosis?

A

1) Diverticulitis/ peridiverticular abscess (in the peri colonic fat)
2) Perforation
3) Haemorrhage

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11
Q

What are the 4 main chronic complications of diverticulosis?

A

1) Intestinal obstruction
2) Fistula (urinary bladder, vagina)
3) Diverticular colitis (segmental and granulomatous)
4) Polypoid prolapsing mucosal folds

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12
Q

What is colitis?

A

Inflammation of the colon - usually mucosal inflammation but can be transmural (eg. CD) or predominantly submucosal/muscular (eg. eosinophilic colitis)

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13
Q

What are the 7 types of acute colitis?

A

1) Acute infective colitis (campylobacter, salmonella, CMV)
2) Abx associated colitis
3) Drug induced colitis
4) Acute ischaemic colitis
5) Neutropenic colitis
6) Phlegmonous colitis

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14
Q

What are the 8 kinds of chronic colitis?

A

1) Chronic idiopathic IBD
2) Microscopic colitis (collagenous and lymphocytic)
3) Ischaemic colitis
4) Diverticular colitis
5) Chronic infective colitis (amoebic colitis & TB)
6) Diversion colitis
7) Eosinophilic colitis
8) Chronic radiation colitis

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15
Q

What are the 3 types of chronic idiopathic IBD?

A

1) Crohn’s disease
2) Ulcerative colitis
3) Indeterminate colitis

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16
Q

In which parts of the world is IBD more common?

A

Norther Europe, UK and USA

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17
Q

At which age is IBD most common?

A

Between 20-40

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18
Q

Is smoking a risk factor for both CD and UC?

A

Increases the risk of CD

Actually has a protective affect against UC

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19
Q

Other than smoking name a risk factor for both UC and CD?

A

Oral contraceptive

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20
Q

Does IBD show familial clustering?

A

Yes - its likely the genes involved overlap as people having a family member with UC increases your risk of CD and visa versa

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21
Q

What are the 7 most common components of the clinical presentation of UC?

A

1) Diarrhoea
2) Constipation
3) Rectal bleeding
4) Abdo pain
5) Anorexia
6) Weight loss
7) Anaemia
8) Tends to only affect the rectum and sigmoid colon

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22
Q

How does UC lead to toxicmegacolon?

A

UC has a remitting and relaxing course - occasionally get a very severe flare up that badly damages the colon wall, particularly affecting the transverse colon, get a severely inflamed and dilated transverse colon, gas can build up, leading to perforation

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23
Q

What are the 4 main complications of UC?

A

1) Toxic megacolon and perforation
2) Haemorrhage
3) Stricture (rare)
4) Carcinoma

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24
Q

What are the 10 clinical features of

A

1) Affects all the levels of GIT from mouth to anus (skip lesions)
2) Diarrhoea (may be bloody)
3) Colicky abdo pain
4) Palpable abdo mass
5) Weight loss/ failure to thrive
6) Anorexia
7) Fever
8) Oral ulcers
9) Peri-anal disease
10) Anaemia

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25
Q

What is the most common distribution of CD?

A

Ileocolic distribution

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26
Q

What are the 7 main complications of CD?

A

1) Toxic megacolon
2) Perforation
3) Fistula
4) Stricture (common)
5) Haemorrhage
6) Carcinoma
7) Short bowel syndrome (repeated resection)

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27
Q

What are the differences between UC and CD in terms of a) sights b) pattern c) rectum involvement d) terminal ileum involvement?

A 
In UC:
a) Affects colon, appendix and terminal ileum
b) Continuous
c) Rectum always involved
d) Terminal ileum involved in 10%
In CD:
a) affects all parts of GIT
b) skip lesions
c) rectum normal in 50%
d) terminal ileum involved in 30%
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28
Q

What is the difference between UC and CD in terms of macroscopic appearance?

A

CD - cobblestone appearance with apthoid ulcers and fissuring ulcers
UC - granular, red mucosa with flat, undermining ulcers

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29
Q

How is the serosa affected in UC and CD?

A

CD - serositis (fat wrapping)

UC - normal serosa

30
Q

What is the difference between UC in terms of a) stricturing b) fistulae c) anal lesions?

A 
CD:
a) strictures common
b) fistulae in >10%
c) anal lesions in 75%
UC:
a) strictures rare
b) no spontaneous fistulae
c) anal lesions in 25%
31
Q

What is the difference between UC and CD in terms of a) granulomas b) extent of inflammation c) crypt affects d) polyps?

A

in CD:
a) Crypt abcesses are less common and crypt distortion is less severe
b) transmural inflammation
c) sarcoid like granulomas present in 60%
d) Inflammatory polyps are less common
In UC:
a) crypt abscesses are common and crypt distortion is severe
b) mainly only mucosal inflammation
c) granulomas are absent
d) inflammatory polyps are common

32
Q

What are the 4 hepatic extra-intestinal manifestations of IBD?

A

1) fatty change
2) granulomas
3) primary sclerosing colangitis
4) bile duct carcinoma

33
Q

What are the 3 skeletal extra-intestinal manifestations of IBD?

A

1) polyarthritis
2) sacro - ileitis
3) ankylosing spondylitis

34
Q

What are the 3 muco-cutanous extra-intestinal manifestations of IBD?

A

1) oral apthoid ulcers
2) pyoderma gangrenosum
3) erythema nodosum

35
Q

What are the 3 ocular extra-intestinal manifestations of IBD?

A

1) iritis/ uveitis
2) episcleritis
3) retinitis

36
Q

What is the renal extra-intestinal manifestation of IBD?

A

Renal and bladder stones

37
Q

What are the 4 haematological extra-intestinal manifestations of IBD?

A

1) Anaemia
2) Leucocytosis
3) Thrombocytosis
4) Thrombo-embolic disease

38
Q

What are the 2 systemic extra-intestinal manifestations of IBD?

A

1) Amyloid (will get this with any chronic inflammatory process)
2) Vasculitis

39
Q

What are the 7 risk factors for colorectal cancer in UC?

A

1) Early age of onset
2) Primary sclerosing colangitis
3) Total or extensive colitis
4) Duration of disease >8-10 years
5) Family history of colorectal cancer
6) Severity of inflammation (pseudopolyps)
7) Presence of dysplasia

40
Q

What are the 4 steps in the development of colorectal cancer from UC?

A

1) Inflamed mucosa
2) Low grade dysplasia
3) High grade dysplasia
4) Colorectal cancer

41
Q

After 10 years of colitis why are patients offered colonoscopic surveillance?

A

Risk of colorectal cancer - catch early neoplasms

42
Q

What are colorectal polyps?

A

A mucosal protrusion, due to mucosal or submucosal pathology or a lesion deeper in the bowel wall

43
Q

What are multiple polyps termed?

A

Polyposis

44
Q

What are the 3 different classifications of colorectal polyps?

A

1) neoplastic, harmatomatous, inflammatory or reactive
2) Benign or malignant
3) epithelial or mesenchymal

45
Q

What are the 6 types of non-neoplastic polyps in the colo-rectum?

A

1) Hyperplastic polyps
2) Harmatomatous polyps
3) Polyps related to mucosal prolapse
4) Post-inflammatory polyps
5) Inflammatory fibroid polyp
6) Benign lymphoid polyp

46
Q

What are the 2 kinds of harmatomatous polyps?

A

1) Peutz - jeghers polyps

2) Juvenile polyps

47
Q

Do hyperplastic polyps have malignant potential, where do they tend to be located?

A

Tend to be located in sigmoid colon and rectum - small HMs have no malignant potential but large right sided hyperplastic polyps may give rise to microsatellite unstable carcinoma

48
Q

What is the typical shape of a juvenile polyp (commonest type in children)?

A

Often spherical and pedunculated

49
Q

Where are juvenile polyps typically located, do they have malignant potential?

A

Typically located in the rectum and distal colon, sporadic polyps have no malignant potential but juvenile polyposis is associated with increased risk of colorectal cancer and gastric cancer

50
Q

What kind of syndrome is peutz-jeghers syndrome?

A

Autosomal dominant condition with multiple gastro-intestinal tract polyps

51
Q

When does peutz-jeghers syndrome typically present with what 3 symptoms?

A

Typically presents in the teens or 20s

1) Abdo pain (intussusception)
2) GI bleeding
3) Anaemia

52
Q

What is the most common distribution of polyps in peutz-jeghers syndrome?

A

Small bowel

53
Q

Are neoplastic polyps always adenomas?

A

No they can be a range of benign and malignant tumours

54
Q

Neoplastic polyps which are adenomas are most commonly distributed how?

A

Evenly distributed around the colon but larger in recto-sigmoid and caecum

55
Q

What is the common macroscopic appearance of adenomas in the colon?

A

Pedunculated, sessile or flat

56
Q

What are the 3 architectural types of adenomas in the colon?

A

1) Villous
2) Tubulo-villous
3) Tubular

57
Q

Is conversion from an adenoma to a carcinoma common in the colon?

A

No, only a small percentage progress over 10-15 years

58
Q

What 5 factors increase the risk of malignant change of adenomas?

A

1) Flat adenomas
2) Size (most malignant >10mm)
3) Villous and tubulo-villous
4) Severe dysplasia
5) HNPCC associated adenomas

59
Q

Are there clear risk factors for colorectal cancers?

A

75% are sporadic

60
Q

What are the 8 risk factors for colorectal cancer?

A

1) Diet - fibre, fat, red meat, calcium, folate
2) Obesity/ physical activity
3) Alcohol
4) NSAIDs
5) HRT and oral contraceptives
6) Schistosomiasis
7) Pelvic radiation
8) UC and CD

61
Q

What are the 2 main conditions conferring hereditary susceptibility to colorectal cancer?

A

1) FAP

2) HNPCC

62
Q

What is FAP?

A

Multiple benign adenomatous polyps in the colon with a 100% lifetime risk of colon cancer

63
Q

What mutation is FAP due to?

A

Mutation in APC tumour suppressor gene

64
Q

What is HNPCC (lynch syndrome)?

A

Autosomal dominant condition due to mutations in mismatch repair genes with a 50-70% lifetime risk of colorectal cancer

65
Q

Other than colorectal cancer what 6 other cancers in HNPCC associated with?

A

1) Endometrial
2) Gastric
3) Ovarian
4) Small bowel
5) Urinary tract
6) Biliary tract cancer

66
Q

What is the most common type of colorectal cancer?

A

Adenocarcinoma

67
Q

Other than adenocarcinoma, what are the 5 other types of colorectal cancer?

A

1) Adenosquamous carcinoma
2) Sqaumous cell carcinoma
3) Neuroendocrine carcinoma and MANEC
4) Undifferentiated (large cell) carcinoma
5) Medullary carcinoma

68
Q

What are the 3 grades of colorectal cancer?

A

Poorly differentiated
Moderately well differentiated
Well differentiated

69
Q

What are the 2 ways of staging colorectal cancer?

A

1) Dukes stage

2) TMN stage

70
Q

In TNM staging of colorectal cancer, what are the 3 N stages?

A

1) N0 - no nodes involved
2) N1 - 1-3 nodes involved
3) N2 - 4 or more nodes involved

71
Q

What are the 4 stages of dukes staging of colorectal cancer (A-D)?

A

A) confined to bowel wall with no lymph node metastasis
B) invading through the bowel wall with no lymph node metastasis
C) regional lymph node metastasis regardless of depth of invasion
D) distant metastasis present

72
Q

How is each Dukes stage for colorectal cancer correlated with 5 year survival?

A

A - >90%
B - 60-80%
C - 40-50%
D -

Year 2 Clinical Pathology (64 decks)

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