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2ND YEAR SYSTEMS: GI > Pathology of colon > Flashcards

Pathology of colon Flashcards

1
Q

GI tract: role in immunity

A

GI tract presents a large surface area for exposure to environmental antigens

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2
Q

what poses a threat to intestinal immune system

A

chronic disease

life threatening acute conditions

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3
Q

what is the small and large bowel peristalsis mediated by?

A

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

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4
Q

what is another term for the myenteric plexus and where are they found

A

auerbach’s plexus

found between the inner circular and outer longitudinal layers of the muscularis propria

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5
Q

what is another term for the submucosal plexus and where are they found

A

meissener’s plexus

found at the base of the submucosa

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6
Q

types of inflammatory bowel disease? (5)

A 
ulcerative colitis
Crohn's disease
ischaemic colitis 
radiation colitis 
appendicitis
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7
Q

how do they think ulcerative colitis or Chron’s disease come about?

A

chronic inflammatory conditions resulting from inappropriate immune response against the gut flora in a genetically susceptible person

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8
Q

what are the 2 main types of idiopathic inflammatory bowel disease?

A

Crohn’s disease

ulcerative colitis

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9
Q

what part of the GI tract does Chron’s affect?

A

it can affect any part of the GI tract from mouth to anus

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10
Q

where does ulcerative colitis affect

A

only the colon

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11
Q

name the gene associated with Chron’s disease

A

NOD2 gene

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12
Q

name the gene associated with ulcerative colitis

A

HLA gene

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13
Q

how is inflammatory bowel disease diagnosed?

A

clinical history
radiographic examination
pathological correlation

pANCA antibodies = positive in 75% UC patients but only 11% CD patients

in children it is harder to tell the diagnosis but as you grow older the phenotype becomes clearer - tends to be uc>cd

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14
Q

what does pANCA stand for

A

perinuclear antineutrophilic cytoplasmic antibody

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15
Q

Ulcerative colitis general info: what is it? prevalence etc

A

relapsing and remitting inflammatory disorder of the colonic mucosa

it never spreads back into the ileum (except for backwash ileitis)

M=F
only affects the colon but it can be localised to the rectum. The appendix can be involved sometimes

10% get pancolitis (whole large intestine + rectum and this may or may not involve the distal part of the ileum too

more commonly spreads proximally

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16
Q

Pathology of ulcerative colitis (6)

A

Large intestine and rectum only

Continuous pattern of inflammation

Rectum to proximal

Pseudopolyps

Ulceration

Serosal surface minimal or no inflammation

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17
Q

what might you see in the histology of colon with ulcerative colitis

A

Mucosa inflammation
Cryptitis
Crypt abscesses

NO granulomas

18
Q

what is the risk of having pancolitis for over 10 years? (4)

A

could develop cancer
haemmorrhage
perforation
toxic dilatation

19
Q

ulcerative colitis causes reactive atypia - what does this mean?

A

results in changes due to inflammation or injury without neoplastic change

20
Q

Describe what Chron’s disease is? (5 points)

A

an IBD - characterised by transmural granulomatous inflammation - same cause as ulcerative colitis

Anywhere from mouth - anus
40% Small intestine
30% SI and LI
30% colon

systemic manifestations

more common in females

more common in caucasians or Jewish population

21
Q

what does chron’s disease do to nearby structures/tissues in the GI tract?

A

mesentery thickens and becomes oedematous and fibrotic

thick wall

narrowing of the lumen

ulceration that looks like cobblestones

22
Q

what does the term ‘skip lesions’ refer to and which disease is it linked with

A

in chron’s disease there are parts of unaffected bowel between areas of active disease - this is not the case with uc

23
Q

What types of things would you expect to see in the histology of chron’s disease? (8)

A

Cryptitis and crypt abscesses

Architectural distortion

Atrophy –crypt destruction

Ulceration-deep

Transmural inflammation

Chain of pearls - gas bubbles - bowel destruction

Non-caseating granulomas

Fibrosis

24
Q

Long term features of chron’s disease? (5)

A

small intestine malabsorption

strictures - narrowing

fistulas (abnormal collection) and abscesses

perforation

increased risk of cancer - 5 x

25
Q

3 types of Ischaemia of the bowel

A

acute mesenteric ischaemia

chronic mesenteric ischaemia

chronic colonic ischaemia

26
Q

where can ischaemic lesions affect the bowel?

A

restricted to either the small intestine or large intestine or can affect both depending on the vessel affected

a gradual occlusion can have little effect due to anastomotic circulations

27
Q

what are the 3 major supply vessels

A

coeliac artery
inferor mesenteric artery
superior mesenteric artery

28
Q

a major vessel occlusion can cause what?

A

transmural injury

acute/chronic hypoperfusion - mucosal and/or submmucosal injury

29
Q

predisposing conditions for ischaemia (3)

A

arterial thrombosis - severe atherosclerosis, dissecting anuerysm

arterial embolism - cardiac vegetations, acute atheroembolism

non-occlusive ischaemia - cardiac failure, shock/dehydration

30
Q

Chronic ischaemia can be caused by what (5)

A 
Mucosal inflammation
Ulceration
Submucosal inflammation
Fibrosis 
Stricture
31
Q

what is radiation colitis

A

inflammation of your small and/or large intestine from radiation treatments in your stomach, sexual organs, or rectum (pelvic radiotherapy)

can damage cells, tissues, epithelium activity

radiation targets actively dividing cells esp blood vessels and crypt epithelium

32
Q

dysplasia in the large bowel can be of two types

A

low grade

high grade

33
Q

define dysplasia

A

the presence of cells of an abnormal type within a tissue, which may signify a stage preceding the development of cancer

34
Q

dysplasia: polyps can be of 3 types

A

tubular (90% occur in colon)
villous
tubulovillous

these adenomas can turn into cancerous ones

50% are solitary = benign

35
Q

Histological characteristics of low grade dysplasia

A

increased nuclear size and numbers

reduced mucin

36
Q

Histological characteristics of high grade dysplasia

A

carcinoma in situ
crowded
very irregular
not yet invasive

37
Q

Risk factors for colorectal carcinoma (4)

A

lifestyle

family history

IBD - UC and Chron’s

genetics - Familial adenomatous polyposis (FAP), Hereditary nonpolyposis colorectal cancer (HNPCC), Peutz-Jeghers syndrome - develop benign polyps

38
Q

Symptoms of right sided colorectal adenocarcinoma (ascending colon and caecum)

A

anaemia - altered blood pressure
vague pain
weakness
weight loss

39
Q

Symptoms of left sided colorectal adenocarcinoma (descending colon, sigmoid colon and rectum)

A

annular - napkin ring lesion

bleeding - fresh/ altered blood pressure

altered bowel habit or obstruction

40
Q

how common is colorectal cancer?

A

3rd m ost common cancer and 2nd most common cause of UK cancer deaths
usually presents in >60 year olds

2ND YEAR SYSTEMS: GI (38 decks)

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