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Systems: Alimentary AB > Pathology of Colon > Flashcards

Pathology of Colon Flashcards

1
Q

What type of role does the small bowel play?

A

Absorptive

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2
Q

What 2 types of role does the large bowel play?

A
  • Absorptive

- Secretory

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3
Q

What are the 3 sections of the small intestine?

A
  • Duodenum
  • Jejunum
  • Ileum
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4
Q

What are the different sections of the large intestine?

A
  • Caecum
  • Ascending colon
  • Transverse colon
  • Descending colon
  • Sigmoid colon (originates pelvic brim)
  • Rectum
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5
Q

What is the mucosa of the small intestine made up of?

A

Innumerable villi

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6
Q

What are the 3 types of cells in the small intestine?

A
  • Goblet cells
  • Columnar absorptive cells
  • Endocrine cells
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7
Q

How often are the cells in the small intestine renewed ?

A

4-6 days

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8
Q

What cells are found in the crypts of the large bowel?

A
  • Goblet cells
  • Endocrine cells
  • Stem cells
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9
Q

What are the surface cells of the large bowel?

A

Columnar absorptive cells

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10
Q

Describe the structure of the large bowel,

A
  • Flat: no villi

- Tubular crypts

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11
Q

What must the immune system balance in response to the large surface area of the GIT?

A

-Tolerance of harmless ingested substances against active defence reactions to potential microbial invaders

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12
Q

What does dysfunction of the intestinal immune system cause?

A
  • Chronic disease

- Life threatening acute conditions

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13
Q

What is small and large bowel peristalsis mediated by?

A

Intrinsic (myenteric plexus) and extrinsic (autonomic innervation) neural control

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14
Q

What is the myenteric plexus formed of?

A
  • Meissener’s plexus

- Auerbach plexus

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15
Q

Where is the Meissener’s plexus found?

A

Base of the submucosa

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16
Q

Where is the Auerbach plexus found?

A

Between the inner circular and outer longitudinal layers of the muscularis propria

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17
Q

Inflammatory bowel disease has pathological features of…

A
  • Ulcerative colitis
  • Crohn’s disease
  • Ischaemic colitis
  • Radiation colitis
  • Appendicitis
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18
Q

Idiopathic Inflammatory Bowel Disease

A

Chronic inflammatory conditions resulting from inappropriate and persistent activation of the mucosal immune system driven by the presence of normal flora

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19
Q

What are the 2 main disease in idiopathic IBD?

A
  • Crohn’s disease

- Ulcerative colitis

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20
Q

Where can Crohn’s disease affect?

A

Any part of the GIT from the mouth to the anus

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21
Q

Where is ulcerative colitis limited to?

A

Colon

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22
Q

What role does genetics play in CD and UC?

A
  • 15% have affected 1st degree relatives
  • NOD2 gene mutation associated with CD
  • HLA associations with UC
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23
Q

What is the pathological cause of UC and CD?

A
  • Strong (exaggerated) immune response against normal flora with defects in the epithelial barrier function in genetically susceptible individuals
  • Defects in mucosal barrier could allow microbes access to mucosal lymphoid tissue triggering immune response
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24
Q

What is required for a diagnosis of IBD?

A
  • Clinical history
  • Radiographic examination
  • Pathological correlation
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25
pANCA
Perinuclear antineutrophilic cytoplasmic antibody
26
What is the prevalence of UC?
-M=F
27
When does UC peak?
- 20-30 years | - 70-80 years
28
What is the more common spread of UC?
Proximal
29
What other structure can also be involved in UC?
Appendix
30
What can occur with pancolitis?
Backwash ileitis
31
What is UC also associated with outside the colon?
Systemic manifestations
32
What is the pathology of UC?
- Large bowel only - Continues pattern of inflammation - Rectum to proximal - Pseudo polyps - Ulceration - Serosal surface minimal or no inflammation
33
What is the histology of UC?
- Mucosa shows inflammation - Cryptitis - Cryps abscesses - Architectural disarray of crypts - Mucosal atrophy - Ulceration into submucosa: pseudo polyps - Limited mainly to mucosa and submucosa - NO GRANULOMAS - Sub mucosal fibrosis
34
How can dysplasia be graded?
High or low grade
35
How does flat epithelial atypia become an invasive cancer?
Undergoes an adenomatous change
36
Other than cancer what other complications are associated with UC?
- Haemorrhage - Perforation - Toxic dilatation
37
What is the prevalence of CD?
-F>M
38
When do the peaks in CD occur?
- 20-30 years | - 60-70 years
39
What is the pathology of CD?
- Granular serosa/ dull grey - Wrapping mesenteric fat - Mesentery thickened, oedematous and fibrotic - Wall thick, oedematous - Narrowing of lumen - Sharp demarcation of disease segments from adjacent normal tissue (skip lesions) - Ulcerations is like cobbles
40
What is the histology of CD?
- Cryptitis and crypt abscesses - Architectural distortion - Atrophy and crypt destruction - Deep ulceration - Transmural inflammation (chain of pearls) - NON-CASEATING GRANULOMAS - Fibrosis - Lymphangiectasia - Hypertrophy of mural nerves - Paneth cell metaplasia
41
What are long term features of CD?
- Small intestine malabsorption - Strictures - Fistulas and abscesses - Perforation - Increased risk of cancer
42
Where can ischaemic lesions be restricted to?
- Small intestine - Large intestine - Both
43
Acute occlusion of which vessels can lead to infarction?
- Celiac artery - Inferior mesenteric artery - Superior mesenteric artery
44
Why may gradual occlusion of major supply vessels have little effect?
Anastomotic circulation
45
What does occlusion od small end arteries lead to?
Lesions which are small and focal
46
What conditions predispose for ischaemia?
- Arterial thrombosis - Arterial embolism - Non-occlusive ischaemia
47
What can cause arterial thrombosis ?
- Severe atherosclerosis - Systemic vasculitis - Dissecting aneurysm - Hypercoaguable states - Oral contraceptives
48
What can cause arterial embolisms?
- Cardiac vegetations - Acute atheroembolism - Cholesterol ischaemia
49
What can cause non-occlusive ischaemia?
- Cardiac failure - Shock/dehydration - Vaso-constrictive drugs
50
What is vulnerable to acute ischaemia?
Splenic flexure
51
How does early intense congestion appear?
- Dusky/purple/blue | - Lumen: sanguinous mucin
52
What does arterial acute ischaemia look like?
There is sharp demarcation
53
What does venous acute ischaemia look like?
Venous fade gradual
54
What is the histology of acute ischaemia?
- Oedema - Intestinal haemorrhages - Sloughing necrosis of mucosa-ghost outlines - Nuclei indistinct - Initial absence of inflammation - 1-4 days- bacteria- gangrene and perforation - Vascular dilatation
55
What are the characteristics of chronic ischaemia?
- Mucosal inflammation - Ulceration - Sub mucosal inflammation - Fibrosis - Stricture
56
How does radiation colitis occur?
- Abdominal irradiation can impair the normal proliferative activity of the small and large bowel epithelium - Usually rectum-pelvic radiotherapy
57
What does the damage by radiation depend on?
Dose
58
What does radiation target?
Actively dividing cells especially blood vessels and crypt epithelium
59
What are the symptoms of radiation colitis?
- Anorexia - Abdominal cramps - Diarrhoea - Malabsorption
60
What does radiation colitis mimic?
IBD
61
What is the histology of radiation colitis?
- Bizarre cellular changes - Inflammation: crypt abscesses and eosinophils - Later arterial stenosis - Ulceration - Necrosis - Haemorrhage - Perforation
62
What is the appendix essentially?
- Bowel remnant which is a prominent lymphoid tissue that regresses with age - Undergoes fibrous obliteration
63
How big is the appendix?
Approx 6-7cm
64
Appendicitis
Acute inflammation of the appendix
65
What causes appendicitis?
Obstruction eg. feocolith or enterobius vermicularis
66
What does the increased intraluminal pressure associated with appendicitis lead to?
Ischaemia
67
What is the histology of appendicitis?
- Fibrinopurulent exudate - Perforation - Abscess - Acute suppurative inflammation in wall and pus in lumen - Acute gangrenous full thickness necrosis +/- perforation
68
What is low grade dysplasia reasonably like?
Normal
69
What is high grade dysplasia reasonably like?
Cancer
70
What are the 3 different formations of adenomas (polyps) ?
- Tubular - Villous - Tubulovillous
71
Describe the histology of low grade dysplasia.
- Increased nuclear no - Increased nuclear size - Reduced mucin
72
Describe the histology of high grade dysplasia.
- Carcinoma in situ - Crowded - Very irregular - Not yet invasive
73
What are the risk factors for colorectal carcinomas such as adenocarcinomas?
- Lifestyle - Family history - IBD - Genetics
74
What genes can predispose you to CRC?
- FAP - HNPCC - Peutz-Jeghers
75
Describe right sided colorectal adenocarcinoma.
- Exophytic/polypoid - Anaemia (altered blood PR) - Vague pain - Weakness - obstruction
76
Describe left sided colorectal adenocarcinoma.
- Annular (napkin ring lesion) - Bleeding (fresh/altered blood PR) - Altered bowel habit - Obstruction
77
What determines the prognosis of CRC?
- Tumour grade - TNM staging - Extramural venous invasion - Can it be resected?

Systems: Alimentary AB (37 decks)

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