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Year 2 Pathology > LOWER GI tract > Flashcards

LOWER GI tract Flashcards

1
Q

Name some parts of the Lower GI system…

A
  • Appendix
  • Colon (ascending, transverse, descending, Sigmund)
  • Rectum
  • Anus
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2
Q

What is appendicitis?

A

It’s an acute bacterial infection of the appendix precipitated by the obstruction of the lumen.

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3
Q

What are some clinical signs/symptoms of appendicitis?

A
  • Pain
  • Rebound tenderness
  • Systemic symptoms
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4
Q

What problem is this describing:
Acute inflammation of the colon presenting with the formation of plaquelike fibrinous exudate (pseudomembranes) covering parts of the large intestinal mucosa. Caused by a toxin produced by C.Difficile which is replacing the normal intestinal flora.

A

PSEUDOMEMBRANOUS COLITIS

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5
Q

What’s pseudomembranous colitis?

A

It’s acute inflammation of the colon. With the formation of plaquelike fibrinous exudate (pseudomembranes) covering parts of the large intestinal mucosa. It’s caused by a toxin produced by an overgrowth of C.Difficile replacing the normal intestinal flora.

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6
Q

What are pseudomembranes?

A

They’re plaque like fibrinous exudate which covers the large intestine in pseudomembranous colitis

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7
Q

What bacteria causes pseudomembtanous colitis?

A

C. Diff

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8
Q

Who is at risk of pseudomembranous colitis?

A

Patients who have been treated with broad spectrum antbix because it provides a nice environment for C.Diff

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9
Q

Treatment for Pseudomembranous colitis.

A
  • Discontinuation of antibiotics (that may have caused it in first place)
  • Hydration
  • Specific antibacterial therapy
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10
Q

Mrs X has fever and lower abdominal tenderness, she has just been treated with broad spectrum antibiotics, what could be wrong with her?

A

PSEUDOMEMBRANOUS COLITIS

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11
Q

Crohn’s disease and Ulcerative colitis are two types of what disease?

A

Inflammatory Bowel Disease

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12
Q

What’s Inflammatory Bowel Disease

A

It’s chronic inflammatory conditions of unknown aetiology affecting the GI tract. (Crohn’s and ulcerative colitis)

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13
Q

True or false?

Crohn’s disease only affects the colon.

A

FALSE

Crohn’s can affect any part of the GIT from mouth to anus!

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14
Q

What are some pathological features of IBD Crohn’s disease.

A
  • Mucosal ulceration typically fissuring
  • Oedema of adjacent epithelium (cobblestone)
  • Pseudopolyp formation regeneration
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15
Q

What disease are these pathological features of:

  • Mucosal ulceration typically fissuring
  • Oedema of adjacent epithelium (cobblestone)
  • Pseudopolyp formation regeneration
A

Crohn’s Disease (Inflammatory Bowel Disease)

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16
Q

Which lower GI disease can cause fistula formation?

A

Crohn’s disease can cause fistula formation:

  • Bowel to bowel
  • Bowel to vagina
  • Bowel to bladder
  • Bowel to skin
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17
Q

What are some of the complications of Crohn’s Disease?

A
  • Anemia
  • Malabsorbsion of fat, vit a.b.e.k from iron deficiency
  • Fistulas
  • Extra Intestinal: skin, eyes, joints
  • Slight increased risk of bowel cancer
18
Q

True or false

Ulcerative colitis can have an affect anywhere from mouth to anus?

A

FALSE
It’s a disease of the colon only and starts in rectum and spreads proximally. Only a disease of the mucosa (unlike crohn’s)

19
Q

Which Inflammatory Bowel disease has transmural involvement (all layers of the colon)

A

Crohn’s Disease

Ulcerative colitis is a disease of the mucosa only

20
Q

What inflammatory bowel disease causes crypt abscess formation and pseudopolyp formation?

A

Ulcerative Colitis

21
Q

What are some of the complications associated with Ulcerative colitis?

A
  • Anaemia: Iron deficiency from blood loss
  • Elecrolyte loss from diarrhoea
  • Extra-intestinal disease: skin, eyes, joints, bile ducts (psc)
  • Increased risk of carcinoma (depends on disease severity)
  • Need to monitor for dysplasia (abnormal growth)
22
Q

There are some diseases that can mimic IBD (crohn’s and ulcerative colitis) what are some?

A

What are the mimics of IBD?

  • Ischaemic colitis
  • Radiation colitis
  • Behcet’s disease
  • Pouchitis
  • Diversion colitis
  • Microscopic (lymphocytic/collagenous) colitis
  • Infectious colitis
  • Iatrogenic colitis
23
Q

What factors can predispose someone to getting Colorectal carcinoma?

A
  • Genetic Factors (Family adenomatous polypis, lynch syndrome)
  • Chronic Inflammation (IBD- UC, Crohn’s)
  • Bad diet (low fibre, bile aerobes, red meat, lack of vits and antioxidents)
24
Q

What is the NBCSP?

A

It stands for the national bowel cancer screening programmme.

All peop’ 60-75 yo are screened. Consists of Faecal occult blood test and if positive they have a colonoscopy and look for polyps (adenomas) and carcinomas)

25
Q

What’s a lower Gastro-intestinal Adenoma?

A

It’s a benign tumour of glandular epithelium

26
Q

Whats a lower GI polyp?

A

It’s a projection above an epithelial surface. Can be benign. They can be composed of epithelium, stroma, mixture (hamartoma), inflammatory tissue and lymphoid tissue)

27
Q

True or false?

It’s very rare that malignant carcinomas of the lower GI tract can arise from benign adenomas (polyps)?

A

FALSE

Almost all carcinomas arise from benign adenomas (polyps). The more polyps, the greater risk. The larger the polyp, the more likely it is to be malignant.

28
Q

What does FAP stand for in terms of lower gastrointetinal disease?

A

It stands for Familial Adenomatous Polyposis.

It’s where polyps develop mid teens and onwards. Carcinoma is inevetable (usually 15 years later). Need for genetic councelling.

29
Q

What are Gardeners and Turcot syndromes variants of?

A

Gardeners and Turcot syndrome are variants of the lower GI disease of Familial Adenomatous Polyposis (FAP).

30
Q

What genetically inherited lower GI disease (chromosome 5 APC gene 5a21) causes inevitable carcinoma ~15 years later?

A

Familial Adenomatous Polyposis

31
Q

What genes/Chromosomes are associated with FAP (Familial Adenopmatous Polyposis)?

A
  • Chromosomes 5

- APC gene 5q21

32
Q

What’s another name for ‘Hereditary Non-Polyposis Colorectal Carcinoma’ (HNPCC)

A

Lynch Syndrome

33
Q

What’s Lynch Syndrome?

A

It’s an hereditary disease, also known as Non-Polyposis Colorectal carcinoma (HNPCC). It is associated with cororectal cancer (70-85%) but also other cancers such as endometrial, small bowel, renal and ureter)

34
Q

What is ‘Dukes’ in terms of Lower GI diseas?

A

It’s used for staging Colorectal Carcinoma.:

  • Dukes stage A (above muscle layer, 5yr survival 95%)
  • Dukes stage B (into serosal fat, LN negative, 66% 5yr survival)
  • Dukes stage C (LN involvement, 33% 5 yr survival).
35
Q

What Stage of the Dukes staging sytem for colorectal cancer encompases Lymph Node involvement?

A

DUKES STAGE C! (35% 5 year survival)

A- above mucle layer
B- Serosal fat layer

36
Q

What’s the TNM tumour grading system for Colorectal Carcinoma?

A

T (Tumour size) , N (nodes?), M (metastesis)

37
Q

What does ‘Tx’ Mean in the TNM grading system for Colorectal Carcinoma?

A

It means the primary tumour is not assesable.

38
Q

What does ‘T0’ mean in the TNM grading system for Colorectal carcinoma>

A

It means no primary tumour

39
Q

What does ‘T1. T2. T3. T4’ mean in the TNM grading system for colorectal cancer?

A 
It means to tumour has spread to:
T1- submucosa
T2- Muscularis propria
T3- Subseosa, perirectal tissues
T4- Perforates visceral peritoneum (a) or invades other organs (b)
40
Q

What does ‘N0’ mean in the TNM grading system for colorectal cancer?

A

It means no Lymph node metastasis.

41
Q

What does ‘N1 and N2’ mean in the TNM grading system for colorectal cancer?

A

It mean the tumour has spread to lymph nods:
N1- 1-3 lymph node spread
N2- More than 4 LN spread

42
Q

What certain features can affect the prognosis of colorectal carcinoma?

A
  • Features of the primary tumour (TNM-dukes, invasion, ext)
  • Surgical factors
  • Evidence of vessel invasion (venous, lymmphatic envolvement)
  • Evidence of host response (local inflam response, angiogenesis)

Year 2 Pathology (19 decks)

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