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pathology 2 > non-neoplastic disease of the colon > Flashcards

non-neoplastic disease of the colon Flashcards

1
Q

function of the colon

A

water and electrolyte absorption
transport, storage and evacuation of faeces
nutrient and vitamin absorption

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2
Q

colon begins as the

A

caecum

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3
Q

between the ascending and the transverse colon

A

hepatic flexure

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4
Q

between the traverse and the descending colon

A

splenic flexure

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5
Q

layers of the colon

A

mucosa
submucosa
musculares externa

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6
Q

inflammatory bowel disease

A

chronic inflammatory condition arising from inappropriate mucosal immunologic activation
chronic illness - punctuated by relapses and remission

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7
Q

inflammatory bowel disease Is composed of 2 major disorders

A

ulcerative colitis

Crohn disease

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8
Q

trends in inflammatory bowel disease

A

increasing incidence
more common in jews and caucasians
more common in urban areas
more common in colder climate regions

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9
Q

peak ages for inflammatory bowel disease

A

2nd - 4th decide and 6th-7th decade

equal proportion in males and females

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10
Q

risk factors for inflammatory bowel disease

A

smoking, diet and exercise

family history is a strong risk factor

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11
Q

clinical features of ulcerative colitis

A

diarrhoea, rectal bleeding, passage of mucus
tenesmus and urgency
abdominal pain, fever and weight loss

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12
Q

clinical features of crohn disease

A

abdominal pain
constitutional symptoms, weight loss and fever, growth retardation, anal fissure/perianal disease
diarrhoea with or without blood
extra intestinal manifestations

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13
Q

skip lesions

A

more characteristic of crohns but can be present in ulcerative colitis
peri-appendiceal inflammation and caecal patch

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14
Q

microscopic pathology of ulcerative colitis

A

confined tp mucosa archetectyral distortion and mucosal metaplasia
lamina propria chronic inflammation
cry-titis and crypt abscesses
erosions, ulcers

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15
Q

gross pathology of crohns disease

A 
mouth to anus 
predilection for distal small bowel and proximal colon 
skip lesson and discontinuous lesions 
rectal sparing 
sinuses, fistulas, anal fissure and perianal disease 
cobblestone mucosa 
thickening of the wall 
creeping fat
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16
Q

Crohn microscopic pathology

A

patchy and focal inflammation
transmural inflammation and lymphoid aggregates
granulomas - well defined aggregates
connective tissue changes - fibrosis, neural hypertrophy

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17
Q

wall appearance in UC vs CD

A

thin in ulcerative colitis and thick in Crohn disease

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18
Q

inflammation in UC vs CD

A

superficial in UC and transmural and patchy in CD

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19
Q

distribution in UC vs CD

A

mainly colon and rectum in UC and mouth to anus in CD

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20
Q

ulcers in UC vs CD

A

shallow in UC and deep, fissuring, knife like in CD

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21
Q

granulomas in UC vs CD

A

none in UC and appearing in 30% of cases in CD

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22
Q

lymphoid reaction in UC vs CD

A

moderate in UC and marked in CD

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23
Q

pseudopolyps in UC vs CD

A

marked in UC and moderate in CD

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24
Q

features of CD

A

strictures, fistulae/sinuses, fat creeping

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25
Q

complications of ulcerative colitis

A

toxic megacolon, perforation
dysplasia and colorectal adenocarcinoma
orchitis
extra intestinal manifestations

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26
Q

complications of crohns disease

A 
fistula or sinuses 
stenosis/stricture 
abscesses 
malabsorption and nutritional deficiency 
toxic megacolon and perforation 
dysplasia and adenocarcinoma 
extra intestinal manifestation
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27
Q

management of ulcerative colitis

A

surgical

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28
Q

management of crohns disease

A

surgical

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29
Q

microscopic colitis

A

macroscopically normal colonic mucosa with microscopic inflammation

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30
Q

microscopic colitis encompasses two entities

A

collagenous colitis

lymphocytic colitis

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31
Q

age and gender in microscopic colitis

A

typically older adults 50-70yr
children may be affected
female predominance, less pronounced in lymphocytic colitis with some studies reporting similar rates among males and females

32
Q

associated diseases and conditions

A

coeliac disease, diabetes, autoimmune or lymphatic gastritis

drugs

33
Q

aetiopathogenesis of microscopic colitis

A

inflammatory disorder arising from epithelial immune responses to intraluminal antigens

34
Q

clinical features of microscopic colitis

A

chronic non-bloody diarrhoea
radiology and colonoscopy normal
abdominal pain, fatigue, weight loss, arthralgia

35
Q

microscopic colitis pathology

A 
normal architecture 
increased intraepithelial lymphocytes 
epithelial injury 
lamina propria chronic inflammation 
thickening of sub epithelial collagen distinguishes collagenous colitis from lymphocytic colitis
36
Q

how to distinguish collagenous colitis from lymphocytic colitis

A

thinking of the sub epithelial collagen

37
Q

prognosis of microscopic colitis

A

good prognosis
most patients répond to cessation of risk factors eg. NSAID
anti-inflammatory therapy and surgery may be needed for those patients that relapse

38
Q

infectious colitis

A

inflammation of the colon

39
Q

infectious colitis often occurs in people

A

extremes of age - children and the elderly

those with impaired immunity

40
Q

agents responsible for infectious colitis

A

campylobacter, salmonella, shigella, E coli, clostridia, yersinia, aeromonas

41
Q

pathogenesis of infectious colitis

A

adherence, enterotoxin production, cytotoxin production, mucosal invasion

42
Q

clinical features of infectious colitis

A

diarrhoea, nausea voliting
abdominal pain, tenesmus, urgency
fevers/chills, malaise, arthralgia/myalgia

43
Q

prognosis of infectious colitis

A

self limiting

1-2 weeks

44
Q

complications of infectious colitis

A

dehydration
sepsis and shock
toxic megacolon
entra intestinal manifestations eg. guillan barre syndrome

45
Q

management of infectious colitis

A

specific antimicrobial therapy

46
Q

antibiotic associated diarrhoea

A

diarrhoea illness or colitis following antibiotic therapy

47
Q

psuedomembranous colitis

A

characterised by formation of pseudomembranes and associates with toxin producing C difficile

48
Q

AAD AND PMC epidemiology

A

diarrhoea is a common side effect of antibiotics
increasing incidence
PMC may be nosocomial or community acquired

49
Q

risk factors for PMC

A

age, antibiotics, hospitalisation, Gi procedures, chemotherapy, acid suppression therapy, surgery, immunosuppressed

50
Q

clinical features of AAD and PMC

A

history of antibiotic use - previous episodes of diarrhoea with antibiotics
diarrhoea with abdominal pain

51
Q

pathology of AAD

A

normal or minor changes

colitis

52
Q

gross pathology of PMC

A

yellow-white pseudomembranes that bleed when scraped off

53
Q

microscopic pathology of PMC

A

volcano lesion with intercrypt necrosis and ballooned crypts
pseudomembrane composed of fibrin, mucin and neutrophils

54
Q

AAD natural history and prognosis

A

mild and self limiting

55
Q

PMC complications

A

fulminating colitis with toxic megacolon or perforation
dehydration
systemic sepsis

56
Q

management of AAD

A

withdrawal of implicated antibiotic

supportive symptomatic treatment and anti peristaltic agents

57
Q

management og PMC

A 
cessation of culprit antibiotic 
supporting and symptomatic treatment 
specific therapy 
binding resins, probiotics 
microbiota transplntation
58
Q

ischaemic colitis

A

colitis due to reduced blood flow to the colon leading to ischaemic injury

59
Q

epidemiology of ischameic colitis

A

most common manifestation of ischaemia to the GIT

most common in the elderly and in females

60
Q

occlusive causes of ischaemic colitis

A

arterial - thromboembolism, cholesterol emboli

venous - venous thrombosis, strangulated hernia, volvulus, obstruction, external compression

61
Q

non-occlusive causes if ischameic colitis

A 
hypotension 
haemorrhahic shock 
heart failure 
sepsis 
medications
62
Q

acute clinical features if ischameic colitis

A

sudden inset of abdominal pain and tenderness
urgent desire to defecate
nausea and vomiting
blood diarrhoea
loss of bowel sounds, abdominal rigidity
shock, vascular collapse

63
Q

subacute/chronic clinical features of ischaemia colitis

A

non-specific symptoms, episodes of blood diarrhoea, blood loss, sepsis, symptomatic strictures, weight loss

64
Q

prognosis of ischaemic colitis

A

symptoms resolve 2-3 days

colon heals 1-2 weeks

65
Q

complications of ischaemic colitis

A

perforation
massive haemorrhage
sepsis
stricture

66
Q

diverticulum

A

acquired pseudodiverticular out pouching of mucosa and submucosa

67
Q

diverticular disease

A

any clinical state caused by colonic diverticula eg. haemorrhage, inflammation

68
Q

diverticulitis

A

implies an inflammatory process associated with diverticula

69
Q

epidemiology of diverticular disease

A

prevalence increases with age
sigmoid colon affected in 95% of cases
seen predominately in western nations

70
Q

diverticular disease - aetiopathogenesis

A

genetic factors
environmental factors
age, geography, life style, ethnicity

71
Q

environmental/lifestyle factors associated with diverticular disease

A 
low fibre diet 
obesity 
decreased physical activity 
corticosteroids 
NSAIDS 
alcohol 
caffeine intake 
cigarette smoking 
polycystic kidney disease
72
Q

clinical features of diverticular disease

A 
asymptomatic 
alternating constipation and diarrhoea 
mimic IBS 
intermittent cramping, continuous lover abdominal discomfort, diarhhea, tenets 
fever 
chronic ir intermittent blood loss 
inflammatory mass 
massive haemorrhage
73
Q

iatrogenic types of colitis

A

diversion colitis
radiation proctitis
graft versus host disease
drug induced

74
Q

diversion colitis

A

inflammation in diverted segment of bowel

75
Q

radiation proctors

A

following radiation injury to the rectum

76
Q

graft versus host disease

A

organ transplant

77
Q

drug induced

A

eg. NSAID - ulcers, strictures, focal active colitis, microscopic colitis
immunomodular therapy

pathology 2 (47 decks)

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