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Year 3 - Met3a > Lower GI pathology > Flashcards

Lower GI pathology Flashcards

1
Q

where do the colon start for

A
  • Extends from the terminal ileum to the anal canal
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2
Q

How long is the colon

A

1-1.5m long

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3
Q

What does the colon include

A
  • caecum
  • ascending colon
  • hepatic flexure
  • transverse colon
  • splenic flexure
  • descending colon
  • rectum
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4
Q

What is the blood supply of the colon

A
  • Superior mesenteric artery (caecum - splenic flexure)

- inferior mesenteric artery (remainder of colon - rectum)

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5
Q

What are the two types of polyps

A
  • Bengin v malignant

- non-neoplastic v neoplastic

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6
Q

What do the symptoms of polyps depend on

A
  • size and site
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7
Q

What are the symptoms if the polyps are on the left side of the colon

A
  • frank blood
  • constipation
  • diarrhoea
  • obstruction
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8
Q

What are the symptoms if the polyps are on the right side of the colon

A
  • less overt blood
  • intussuscpetion (rare)
  • constipation
  • diarrhoea
  • obstruction
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9
Q

what are inflammatory polyps

A
  • non-neoplastic

- mix of epithelial and stromal elements

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10
Q

What conditions are inflammatory polyps associated with

A
  • inflammatory bowel disease

- surgical anastomosis or with other causes of inflammation such as ischaemic colitis, infection

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11
Q

What is the incidence of patients with inflammatory polyps

A
  • incidence of 10-20% in patients with ulcerative colitis
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12
Q

What does the histology of inflammatory polyps look like

A
  • may be relatively normal with a polypoid shape
  • may have ulceration, erosion and distortion of the normal crypt architecture
  • differential diagnosis: juvenile polyp, pyogenic granuloma
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13
Q

What are hyperplastic polyps

A
  • this is a serrated polyp
  • not dysplastic
  • asymptomatic
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14
Q

what is the most common polyp

A
  • hyperplastic polyps (up to 90% of polyps in the colon)
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15
Q

Where are the hyperplastic polyps and what side of the colon are they in

A
  • up to 5mm in size, rarely greater than 10mm
  • left sided
  • may occur as part of syndromes
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16
Q

What are sessile serrated lesions, polyps, adenomas

A
  • neoplastic polyps with premalignant features
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17
Q

describe sessile serrated lesions, polyps, adenomas

A
  • greater than 10mm in size

- serrated architecture with crypt dilatation and may have low grade or high grade dysplasia

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18
Q

what mutation are sessile serrated lesions, polyps, adenomas associated with

A
  • they are associated with BRAF mutation and microsatellite instability
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19
Q

describe a traditional serrated adenoma

A
  • tubulovilour architetcutre

- often left sided

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20
Q

Describe a hamartomatous polyps

A
  • rare
  • tend to occur in children and young adults
  • normal tissue in abnormal location
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21
Q

Name a type of hamartomatous polyps

A

peutz jegher

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22
Q

describe peutz-jegher polyp

A

hamartomatous polyp with characteristic features; absorbing smooth muscle
- can have dysplasia and adenocarcinoma

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23
Q

What is the WHO criteria for peutz-jegher polyps

A
  • 3 or more PJ polyps
  • any number of PJ polyps with family history of PJS
  • characteristic mucocutaneous pigmentation with family history of PJS
  • any number of PJ polyps and mucocutaenous pigmentation
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24
Q

What is the most common polyp in children

A

Juvenile polyps

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25
Q

What is the definition of juvenile polyposis syndrome

A
  • 5 or more juvenile polyps in colorectum
  • juvenile polyps throughout GI tract
  • any number of polyps and family history
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26
Q

What is the genetics of juvenile polyposis syndrome

A

autosomal dominant

27
Q

describe the histology of juvenile polyposis syndrome

A
  • sessile or pedunculated
  • 5-50mm in size
  • histology - similar to inflammatory polyps but usually have a cystically dilated crypt
28
Q

describe adenoma polyps

A
  • common, i ndice increases with age
  • usually sporadic but can be familial
  • premalignant lesions
29
Q

what is the most common adenoma polyps

A

tubular adenoma

30
Q

Name two types of adenoma polyps

A
  • tubular adenoma

- villous adenoma

31
Q

What is tubular adenoma polyps risk factors that increase the chance of getting them

A
  • smoking
  • high BMI
  • red meat
32
Q

what increases risk of invasion of tubular adenoma polyps

A
  • size = less than 1% if less than 1cm versus 10% if they are greater than 2cm
  • 3 or more
  • villous component
  • high grade dysplasia
33
Q

what are follow ups dependent on

A
  • presence of invasive carcinoma
  • number of polyps
  • size of polyps
  • presence of villous architecture, high grade dysplasia
34
Q

what is the most common type of colorectal cancer

A

98% is adenocarcinoma

35
Q

who is colorectal more common in

A

men

36
Q

What is the peak age of incident of colorectal cancer

A
  • Peak age is 60-79
  • less than 20% beofre age 50
  • if before age 40 probably related to syndrome
37
Q

what side is colorectal cancer more on

A

left side more than right

38
Q

What are the risk factors for colorectal cancer

A
  • older age
  • obesity
  • physical inactivity
  • alcohol consumption
  • IBD
  • family history
  • polyposis syndromes - FAP, Lynch, juvenile polyposis, PJS
  • dietary risk factors - low fibre and increased beef consumption
39
Q

What is the presentation of colorectal cancer

A
  • colonscopy

- faecal occult blood test

40
Q

What are the symptoms of colorectal cancer

A

Right

  • aneamia
  • pain

Left

  • change in bowel habit
  • rectal bleeding

may be asymptomatic

41
Q

What are common metastasise of colorectal cancer

A
  • lymph nodes
  • liver
  • peritoneum
  • lung
  • ovaries
42
Q

What is the prognosis of colorectal cancer

A
  • 5 year survival 40-60%

- most recurrences are within 2 years

43
Q

What are the poor prognostic features of colorectal cancer

A
  • high stage
  • positive margins
  • poor differentiation
  • tumour budding
  • tumour perforation
  • involvement of peritoneal cavity
44
Q

Describe the staging of colorectal cancer

A

TX - primary tumour cannot be assessed
T0 - no evidence of primary tumour
T1- tumour invades submucosa
T2 - tumour invades muscularis propria
T3 - tumour invades through muscularis propria
T4a - tumour invades serosa/visceral peritoneum
T4b- tumour directly invades or aderes to adjacent organs or structures

NX - nodes cannot be assessed
N1 - metastasis in 1-3 nodes
N2 - metastasis in 4 or more nodes

45
Q

what are the subtypes of colorectal cancer

A
  • adenocarcinoma
  • adenosquamous carcinoma
  • squamous cell carcinoma
  • neuroendocrine carcinoma
46
Q

What are the types of inflammatory bowel disease

A
  • Ulcerative colitis

- Crohn’s disease

47
Q

describe ulcerative colitis

A
  • relapse, remitting
  • inflammation limited to the mucosa
  • involves large bowel only
48
Q

describe crohn’s disease

A
  • recurrent granulomatous
  • transmural inflammation - can cause pain
  • involves any part of the GI tract
49
Q

What disease can you see angular stomatitis in

A

crohns disease

50
Q

What age does UC occur in

A

Peak onsets 20-25 or 70-80

- 60% have mild disease, 97% have one relapse per 10 years

51
Q

What is the peak onset of crohn’s disease

A
  • peak onset - teens/twenties and 50-69
52
Q

What is the concordance rate in Crohn’s disease

A

30-50% monozygotic in twins

53
Q

where is ulcerative colitis

A
  • start in rectum and spreads proximally
  • continuous
  • can be patchy due to treatment invovlement
54
Q

Where is crohn’s disease

A
  • usually involves the small intestine
  • 40% of patients have colon involvement
  • discontinous involvement (skip lesions)
55
Q

What are the symptoms of ulcerative colitis

A
  • relapsing bloody mucoid diarrhoea
  • pain, cramps = but this is relieved by defecation
  • lasts for months to days
56
Q

describe the symptoms of crohns disease

A
  • episodic mild diarrhoea
  • fever and pain
  • anaemia
  • growth failure
  • 20% have abrupt onset of symptoms resembling acute appendicitis
57
Q

What are the macroscopic features of UC

A

Active

  • red
  • friable
  • granular
  • oedematous mucosa

Quiescent
- atrophic/featureless mucsoa

58
Q

What are the macroscopic features of Crohn’s disease

A
  • thickened rigid bowel
  • granular, scarred serosa
  • apthoid, fissuring and serpiginous ulcers with cobblestoning
59
Q

What are the complications of ulcerative colitis

A
  • acute fulminant colitis - acute dilatation of transverse colon - increase in extensive ulceration, transmural inflammation and perforation
  • malignant change
60
Q

what are the complications of Crohn’s disease

A
  • Strictures - that lead to obstruction
  • fistula formation - between the bowel and abdominal viscera, between bowel and skin
  • malabsorption
  • perianal disease
61
Q

Name the systemic complications of UC

A

ULCERATIVE COLITIS

  • SKIN: Erythema nodosum, pyoderma gangrenosum
  • JOINTS: Seronegative polyarthritis
  • EYE: Iritis, episcleritis
  • KIDNEY: Calculi, pyelonephritis
  • LIVER: Sclerosing cholangitis
62
Q

Name the systemic complications of Crohn’s disease

A
  • SKIN: Erythema nodosum, pyoderma gangrenosum
  • JOINTS: Seronegative polyarthritis
  • EYE: Iritis, episcleritis
  • KIDNEY: Calculi, pyelonephritis
  • AMYLOIDOSIS
63
Q

what IBD condition are you more likely to get carcinoma from

A

Ulcerative colitis

Year 3 - Met3a (43 decks)

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