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Alimentary System: Pathology SA > Pathology of Colon > Flashcards

Pathology of Colon Flashcards

1
Q

What bowel has the presence of innumerable villi

A

Small intestine

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2
Q

What are the cryptic and cells present in the large intestine

A

Tubular crypts

Surface-columnar absorptive cells

Crypts -goblet cells

endocrine cells

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3
Q

How often is the stem cell turnover in the large intestine

A

3-8days

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4
Q

What is the neural control of the small and large intestine

A 
Both the small and large bowel peristalsis is mediated by intrinsic           
(myenteric plexus)
and 
extrinsic 
(autonomic  innervation)
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5
Q

What are the two myenteric plexus and where are they located

A

Meissener’s plexus: base of the submucosa

Auerbach plexus: between the inner circular and outer longitudinal layers of the muscularis propria

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6
Q

What is the definition of inflammatory bowel disease

A

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

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7
Q

What are the two main and other diseases of IBD

A

Crohns disease
Ulcerative disease

also

  • ischaemic colitis
  • radiation colitis
  • Appendicitis
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8
Q

What is the differences between Crohns disease and ulcerative colitis

A

CD - affect any part of the GI tract where UC is limited to the colon

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9
Q

An NOD2 gee mutation is associated with what IBD condition

A

Crohns disease

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10
Q

HLA is associated with what IBD condition

A

Ulcerative colitis

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11
Q

What is the pathology of IBD

A

Strong exaggerated immune response against normal flora due to a defects in the epithelial barrier function allowing microbes access to muscle lymphoid tissue

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12
Q

What is required for the diagnosis

A 
Clinical history 
Radiographic examination
Pathological correlation 
pANCA 
(perinuclear antineutrophilic cytoplasmic antibody)
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13
Q

What is the presentation go Ulcerative colitis

A

Can be localised to the rectum (proctitis)

More commonly spreads proximally

10% Pancolitis, +/- “backwash ileitis”

Appendix can be involved

Association with systemic manifestations

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14
Q

What is the pathology of UC

A

A continous pattern of inflammation in the large bowel only starting rectum to proximal

Results in
Pseudopolyps
Ulceration

Minimal or no inflammation on serosal surface

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15
Q

Where is UC mostly limited to histologically

A

Mucosa and submuscia

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16
Q

What happens to the mucosa in UC

A 
Inflammation 
causing 
Cryptitis 
Crypt abscesses 
Mucosal atrophy
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17
Q

What happens to the submucosa in UC

A

Ulceration resulting in pseuodopolyps

submucosal fibrosis

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18
Q

What is the complications of UC

A

Dysplasia can occur increasing risk of cancer if adenomatous change

Haemorrhage
Perforation
Toxic dilatation

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19
Q

What do crohns and UC both have in common

A

Both have systemic manifestation

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20
Q

What is the pathology of crohns disease

A

= Granular serosa

Wrapping of mesenteric fat means

  • Mesentry
    = thickened, oedematous and fibrotic
  • Wall
    = thick and oedematous

so overall narrowing of the lumen occurs

Resulting in Sharp demarcation of disease segments from adjacent normal tissue “skip
lesions”

Ulceration- “cobblestone”

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21
Q

What is present in the histology of crohns disease

A

Cryptitis and crypt abscesses

Architectural distortion

Atrophy –crypt destruction

Ulceration-deep
Transmural inflammation
(Chain of pearls)

Non-caseating granulomas

Fibrosis

Lymphangiectasia

Hypertrophy of mural nerves

Paneth cell metaplasia

22
Q

What IBD disease has granulomas present

A

Crohns

23
Q

What is the complications of CD

A

Small intestine malabsorbtion

Strictures

Fistulas

Abscesses

Perforation

Increased risk of cancer.

24
Q

How does ischeamic enteritis occur

A

Acute occlusion of 1 of the 3 major supply vessels leads to infarction - (Coeliac, Inferior and Superior mesenteric arteries)

Leading to hypo perfusion injuring mucosal and/or submucosal

Is either acute or chronic

25
Q

What happens in gradual occlusion of major BV supply of bowels

A

Little effect

anastomotic circulation

26
Q

What kind of injury is iscaemic enteritis causing major vessel occlusion

A

Transmural injury to mucosal +/- submucosa

27
Q

What is the predisposing conditions for ischaemia

A

Arterial thrombosis

Arterial embolism

Non-occlusiove ischemia
eg cardiac failure, vasoconstrictive drugs/shock

28
Q

What is the pathology of acute ischaemia

A

Splenic flexure vulnerable

Early-intense congestion
dusky/purple/blue
Lumen – sanguinous mucin

Arterial sharp demarcation

Venous fade gradually

29
Q

What is the histology go acute ischaemia

A

Oedema

Interstitial haemorrhages

Sloughing necrosis of mucosa-ghost outlines

Nuclei indistinct

Initial absence of inflammation

1-4 days –bacteria-gangrene and perforation

Vascular dilatation

30
Q

What is the pathology of chronic ischaemia

A

Mucosal inflammation

Ulceration

Submucosal inflammation

Fibrosis

Stricture

31
Q

What is likely aetiology of radiation colitis

A

Rectum-pelvic radiotherapy impairing the normal proliferative activity of the bowels

32
Q

What is damaged in radiation colitis and what does the damage depend on

A

Actively dividing cells esp. blood vessels

and crypt epithelium are all targeted for damage which is dependant on the dose of radiotherapy

33
Q

What is the symptoms of radiation colitis

A

Anorexia
Abdominal cramps
Diarrhoea
Malabsorption

34
Q

What is the histology of radiation colitis

A

Bizarre cellular changes

Inflammation-crypt abscesses and eosinophils

35
Q

What is the complications of radiation colitis

A 
Later-arterial stenosis
Ulceration
Necrosis
Haemorrhage
perforation
36
Q

What prominent lymphoid tissue regresses with age

A

Bowel remnant - Appendice (6-7cm)

37
Q

What is the pathology of appendicitis

A

Fibrous obliteration causing acute inflammation

38
Q

What is the aetiology of appendicitis

A

Obstruction of appendix
(eg enterobius vermicularis - worms in lumen)

or
Increased intraluminal pressure causing ischaemia

39
Q

What is seen in the histology of appendicitis

A

Macro
- fibrinopurulent exudate, perforation, abscess

Micro
-Acute suppurative inflammation in wall and pus in lumen

-Acute gangrenous-full thickness necrosis +/- perforation

40
Q

What are the 3 adenoma/polyps found in the colon

A

Tubular

Villous Tubulovillous

41
Q

What happens in low grade dysplasia in adenomas of the colon

A

Increased nuclear nos.

Increased
nuclear size

Reduced mucin

42
Q

What happens in high grade dysplasia of adenomas of the colon

A

Carcinoma in situ
Crowded/Very irregular
Not yet invasive

43
Q

What are the risk factors of colorectal cancer

A

Lifestyle
Family History
IBD
Genetics

44
Q

What are the genetic genes increasing the risk of colorectal cancer

A

FAP
HNPCC
Peutz-Jeghers

45
Q

What kind of cancer is the majority of colorectal cancers

A

98% are adenocarcinomas

46
Q

What is the more specific symptoms of right sided colorectal adenocarcinoma

A

Anaemia
Vague pain
Weakness
Obstruction

47
Q

What is the appearance of right sided colorectal adenocarcinoma

A

Polypoid

48
Q

What is the appearance of left sided colorectal adenocarcinoma

A

Annular = napkin ring lesion

49
Q

What are the specific symptoms of left sided colorectal adenocarcinoma

A

Bleeding
Altered bowel habit
Obstruction

50
Q

What is the carrying large bowel neoplasia

A

Low - high grade dysplasia
to
Malignancy

Alimentary System: Pathology SA (27 decks)

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