Lower GI pathology Flashcards
The turnover of the large is faster than the small, true or false
False,
Large 7 days
Small is 4-5 days
How is the small and large bowel peristalsis mediated in terms in innveration
Intrinsic- myenteric
Extrinsic- autonomic
What’s ar the different plexus of the myenteric plexus
Meisseners plexus
Auerbach
Where is the meisseners plexus located
Base of submucosa
Where is th Auerbach plexus located
Betweeen the inner circular and outer longitudinal layers of muscularis propria
List the different pathological features of IBD
UC CD RC Ischemic colitis Appendicitis *if you don’t know what these stand for get yo shite together
What does it mean by “idiopathic IBD”
Does not need infective primer
It’s your immune system usually going fucking mental
Of IBD what are the two main diseases
CD and UC
What is a disease associate with NOD2 gene
CD
What is a disease assoicated with HLA gene
UC
How might someone with suspected IBD be diagnosed
Clinical history
Radiography examination CT
Blood to detect antibody pANCA
Patients with positive pANCA is more likely to be CD, true or false
False,
CD -11%
UC- 75
Describe a clinical profile for someone with UC
Large only No gender bias Peaks 20-30, 70-80 Pancolitis = whole colon Can spread to small= backwash ileitis Appendix can be involved Systemic malformations
What are the histological signs of someone with UC
Ulceration
Limited to mucosa and sub
No granulomatous
Fibrosis
What does having UC and CD increase risk of and why
Cancer
Consistent damage leads to repair therefore more division leading to increased risk of mutation
What are th complications with someone with UC
Haemorrhage >anaemia
Perforation
Toxic dilation
Describe a clinical profile for CD
Any level of GIT again systemic malformations like UC Gender bias, females cause we get every fucking disease Peaks 20-30, 60-70 More common in Jewish Caucasians
When looking at the bowel, what would you see in someone with CD look like
Segements of normal and gross bowel
Histolgoical what are the features of CD
Non- caseating granulomatous
Fibrosis
Need to learn difference between CD and UC
See slide
Can ischemic enteritis effect both large and small instesine
Yes- depends on vessels
What is better acute or chronic occlusion in reference to infarction
Non is smashing
But
A gradual occlusion allows time for the vessels to get there shite together, rearrange and cope “ANASTOMIC CIRCULATION
Acute they be like what’s happening and infarction occurs, this occurs if it happens in the big three
What are the causes of ischemia
Arterial thrombosis
Arterial embolism
Non -occlusive like cardiac failure, so vessels be ok but the heart or blood is not
Where in the large intestine is vunverable to acute ischemia
Splenic fletcher
Describe acute ischaemia in its progression and how this relates histolgically
See necrosis
At first non- inflammatory
But as wall is lost, bacteria can infiltrate
Vascular dilation occurs
In chronic ischaemia, what is occurring
Muscosal inflammation Ulceration Submucosal inrlammation Fibrosis Stricter
What is radiation colitis
When someone has had therapy which results in impairment of normal prolifative barrier
This is dose dependent
Why are the cells in the intestines so prone to radiotherapy
Constantly dividing
What are the symptoms of radiation colitis
Camps, anorexia, abdominal cramps, diarrhoea , malabsorption
What is a likely cause of appendicitis
Obstruction example worms
What is the pathology of appendicitis
Increased intraluminal pressure can lead to ischaemia
What is dysplasia
Epithelial cells dividing out of control loosing specificity
Precursor to cancer
In relation to dysplasia what are the 3 types of Adenoma
Tubular - glands
Villus- develop from cells in the villi
Tubulovillous - both
In relation to dysplasia, which adenoma is most common
Tubular - 90%
Histologically what are the difference in features of high grade and low grade dysplasia
Low grade = increased nuclear size and number but lower mucin
High grade = same but more irregular
Both appear dark and busy, just a mess really
What is the most common colorectal canc r
Adenocarcinomas
What are risk factors for adenocarcinomas
Lifestyle
Family history
IBD
genetics
What are considered genetic risk factor for adenocarcinoma
FAP= familial adenomatous polyposis
HNPCC = herediary non polyposis colorectal cancer
Peutz- Jeghers
Colorectal andnocarcinoma can be divided into right and left sided, describe the diff
R- grow large before causing a problem, exophytic, anemia , bleeding (old blood), vague pain, weakness, obstruction
L- annular (ring lesion) , bleeding fresh blood, altered bowl habit (constipation then diahhrea), obstruction
What scale is used alternatively to TNM for colorectal
Dukes
