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Pathology of Colon Flashcards

1
Q

Types of large bowel neoplasia

A 
Dysplasia 
- low grade
- high grade
Malignancy 
- colorectal carcinoma
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2
Q

Types of dysplasia of the large bowel

A

Adenoma (polyp)

  • tubular (90% occur in colon)
  • villous
  • tubulovillous
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3
Q

What % of dysplasias of the large colon are solitary?

A

50%

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4
Q

What is seen in low grade dysplasia of adenoma of the large colon?

A

Increased nuclear numbers
Increased nuclear size
Reduced mucin

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5
Q

What is seen in high grade dysplasia of adenoma of the large colon?

A

Carcinoma in situ
Crowded
Very irregular
Not yet invasive

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6
Q

What % of colorectal carcinomas are adenocarcinomas?

A

98%

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7
Q

Risk factors for colorectal carcinoma

A 
Lifestyle
Family history 
IBD 
Genetics
- FAP
- HNPCC
- Peutz-Jeghers
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8
Q

Presentation of right sided colorectal adenocarcinoma

A

Anaemia (altered blood PR)
Vague pain
Weakness
Obstruction

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9
Q

Presentation of left sided colorectal adenocarcinoma

A

Bleeding; fresh/altered blood PR
Altered bowel habit
Obstruction

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10
Q

Parts of the small bowel

A

Duodenum
Jejunum
Ileum

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11
Q

Parts of the large bowel

A 
Caecum 
Ascending colon 
Transverse colon 
Descending colon 
Sigmoid 
Rectum
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12
Q

Which parts of the large bowel are retroperitoneal?

A

Ascending colon

Descending colon

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13
Q

Where does the sigmoid originate?

A

Pelvic brim

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14
Q

3 types of cells in the small bowel

A

Goblet cells
Columnar absorptive cells
Endocrine cels

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15
Q

What is the mucosa of the small bowel?

A

Villi

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16
Q

Histology of small bowel

A 
Villi 
Goblet cells
Columnar absorptive cells
Endocrine cells
Crypts
Lamina propria, Muscularis mucosa, submucosa
Muscularis propria and subserosa
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17
Q

What type of crypts are found in the small bowel?

A

Stem
Goblet
Endocrine
Paneth

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18
Q

Histology of the large bowel

A 
Flat
No villi 
Tubular crypts 
Columnar absorptive cells on the surface
Crypts 
- goblet 
- endocrine
- stem
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19
Q

Cell turnover of the small bowel

A

4 - 6 days

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20
Q

Cell turnover of the large bowel

A

3 - 8 days

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21
Q

What controls large bowel peristalsis?

A

Intrinsic - myenteric plexus

Extrinsic - autonomic innervation

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22
Q

What makes up the myenteric plexus? Where are these found?

A

Meisseners plexus - base of the submucosa

Auerbach plexus - between the inner circular and outer longitudinal layers of the Muscularis propria

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23
Q

What does IBD have pathological features of?

A 
UC
CD
Ischaemic colitis
Radiation colitis
Appendicitis
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24
Q

Definition of 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 intraluminal flora

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25
Two main disease of IBD
Ulcerative colitis | Crohn's disease
26
What does IBD stand for?
Inflammatory bowel disease
27
Where can crohn's disease affect?
Any part of the GI tract from mouth to anus
28
Where can UC affect?
Colon and rectum
29
Which of the IBD diseases have extra intestinal manifestations?
Both CD and UC
30
What % of patients with IBD have 1st degree relatives with IBD?
15%
31
What is the lifetime risk of getting IBD if a sibling is affected?
9%
32
What gene in particular is seen in association with CD?
NOD2 gene
33
What associations are seen in UC?
HLA associations
34
What % of patients is Panca +ve in IBD patients?
75% UC | 11% CD
35
Which gender gets UC more?
M = F
36
What does Panca stand for?
Perinuclear antineutrophilic cytoplasmic antibody
37
Peak ages for UC
20 - 30 years | 70 - 80 years
38
Where does UC more commonly spread?
Proximally
39
What can also be involved in UC?
Appendix
40
Features of UC
Large bowel only Continuous pattern of inflammation Rectum to proximal
41
Pathology of UC
Pseudopolyps Ulceration Serosal surface minimal or no inflammation
42
Histology of UC
``` Mucosa inflamed Cryptitis Crypt abscesses Architectrual disarray of crypts Mucosal atrophy Ulceration into submucosa-pseudopolyps Limited mainly to mucosa and submucosa NO granulomas Submucosal fibrosis ```
43
Risk of developing cancer if have pancolitis >10 years
20-30x higher risk
44
Complications of UC
Cancer Haemorrhage Perforation Toxic dilatation
45
Where can CD affect?
Any level of GIT from mouth to anus
46
Which gender gets CD more?
F > M
47
Peak ages of crohn's disease
20 - 30 | 60 - 70
48
Where does crohns disease affect?
40% small intestine 30% colon 30% small and large intestine
49
Pathology of CD
Granular serosa/dull grey Wrapping mesenteric fat Mesentery - thickened, oedematous and fibrotic Wall thick and oedematous Narrowing of lumen Sharp demarcation of disease segments from adjacent normal tissue "skip lesions" Ulceration - "cobblestone"
50
Histology of CD
``` Cryptitis Crypt abscess Architectural distortion Deep ulceration Transmural inflammation - chain of pearls Non caseating granulomas Fibrosis Lymphagiectasia Hypertrophy of mural nerves Paneth cell metaplasia Islands of macrophages all grouped together Bowel tries to heal itself - fibrosis ```
51
Long term features of CD
``` Small intestine malabsorption Strictures Fistulas Abscesses Perforation Increased risk of cancer - 5x ```
52
What can lead to infarction of the bowel? What is this called?
``` Acute occlusion of 1 of the 3 major supply vessels leads to infarction - coeliac - inferior mesenteric - superior mesenteric Ischaemic enteritis ```
53
Why can gradual occlusion in the bowel have little effect?
Anastomotic circulation
54
Predisposing conditions for ischaemia of the bowel
``` Arterial thrombosis - severe atherosclerosis - systemic vasculitis eg. PAN, HSP - Dissecting aneurysm - Hypercoagulable stress - Oral contraceptives Arterial embolism - cardiac vegetations - acute atheroembolism - cholesterol embolism Non occlusion - cardiac failure - shock / dehydration - vasoconstrictive drugs e.g. propranolol ```
55
Histology of acute ischaemia of the bowel
Oedema Interstitial haemorrhages Sloughing necrosis of mucosa-ghost outlines Nuclei indistinct Initial absence of inflammation 1 - 4 days; bacteria - gangrene perforation Vascular dilatation
56
Histology of chronic ischaemia of the bowel
``` Mucosal inflammation Ulceration Submucosal inflammation Fibrosis Stricture ```
57
Definition of radiation colitis
Abdominal irradiation can impair the normal proliferate activity of the small and large bowel epithelium
58
Where does radiation colitis usually effect and why?
Usually rectum | Pelvic radiotherapy
59
What does the damage of radiation colitis depend on?
The dose
60
Symptoms of radiation colitis
Anorexia Abdominal cramps Diarrhoea Malabsorption
61
What can chronic radiation colitis mimic?
IBD
62
Histology of radiation colitis
``` Bizarre cellular changes Inflammation - crypt abscesses and eosinophils Later arterial stenosis Ulceration Necrosis Haemorrhage Perforation ```
63
How often does the GI system turn over?
Once a week
64
What is the appendicitis a remnant of?
Possible bowel remnant
65
How big is the appendix?
Average 6 - 7cm
66
What is the appendix?
Prominent lymphoid tissue that regresses with age
67
Causes of appendicitis
``` Obstruction e.g. feocolith (faecal stone) Enterobius vermicularis (worms) Infection ```
68
Pathology of appendicitis
Increased intraluminal pressure - ischaemia - still proliferating so increases the pressure which leads to ischaemia as reduced blood flow
69
Histology of appendicitis
Macro - fibrinopurulent exudate, perforation, abscess Micro - acute suppurative inflammation in wall and pus in lumen - Acute gangrenous - full thickness necrosis +/- perforation

Gastrointestinal Pathology (26 decks)

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