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Clinical Pathology > Pathology of GI Tract > Flashcards

Pathology of GI Tract Flashcards

1
Q

What is the histological morphology of coeliac disease?

A

Villi atrophy
Increased intraepithelial lymphocytes
Crypt elongation
lamina propria inflammation

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2
Q

What are diverticula of the large bowel? What are the main types?

A

Blind ending out-pouchings of large bowel (protrusions of mucosa and submucosa)

Congenital or acquired*

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3
Q

Where do diverticulosis of the colon take place the most?

A

Sigmoid colon (rarely proximal)

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4
Q

What is diverticulosis associated with?

A

Low fibre diet

Older age

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5
Q

What is the pathogenesis of diverticulosis?

A

Increased intra-luminal pressure due to IRREGULAR PERISTALSIS and development of compartments through weak parts of colon wall

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6
Q

Where (weak points) do diverticula develop in the colon?

A

Where arteries penetrate mesenteric and antimescenteric tania coli

Age related changes in connective tissue

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7
Q

What are the acute complications of diverticula?

A
  • Diverticulitis/abcess
  • perforation - infects parietal cavity (peritonitis)
  • Ulceration - haemorrhage
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8
Q

What are the chronic complications of diverticulosis?

A

Intestinal obstruction (stricture development)
Fistula
Diverticular colitis

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9
Q

What is colitis? How it is divided?

A

Inflammation of colon

Acute (days - weeks) or chronic (months to years)

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10
Q

Where does colitis usually occur? where else can it occur?

A

Usually confined to mucosa

But can be transmural (i.e. all) e.g. crohns or submucosa/muscular

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11
Q

What are the two types of chronic idiopathic inflammatory bowel diseases?

A

Ulcerative colitis* (more common)

Crohns disease

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12
Q

Who is effected by chronic idiopathic inflammatory bowel disease the most?

A

young adults

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13
Q

Are females/males more effected by ulcerative colitis/crohns disease

A

Crohns = female

UC = equal

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14
Q

What are the risk factors for chronic idiopathic inflammatory bowel disease?

A

Smoking (EXCEPT ulcerative colitis = protective)

Contraceptive pill

Family history

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15
Q

What are the main clinical presentations of ulcerative colitis?

A 
Diarrhoea (with urgency)
RECTAL BLEEDING*
Weight loss/anorexia
Abdominal pain
Anaemia (if blood loss = severe)
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16
Q

What are the clinical complications of ulcerative colitis?

A
  • Toxic megacolon and perforation (severe colitis - dilated transverse colon)
  • haemorrhage
  • Stricture (rare)
  • carcinoma
17
Q

What part of bowel does ulcerative colitis effect?

A

Limited to rectum and colon (CONTINUOUS DISEASE i.e. spreads upwards)

18
Q

What layers does ulcerative colitis affect?

A

Mucosa (superficial) - crypt distortion

19
Q

What is a distinctive histological feature of ulcerative colitis?

A

Crypt abcess - neutrophil in crypts

20
Q

What part of GI tract does crowns disease effect?

A

All of GI tract - from mouth to anus

Mostly Ileocolic (terminal ileum)

21
Q

What are the clinical features of crowns disease?

A 
Diarrhoea (can be bloody)
Palpable bowel
Weight loss
Loss of appetite 
Ulcers (ANYWHERE in GI!)
22
Q

What is a distinctive feature of Crohns disease?

A

Granuloma (~60% though)

23
Q

What are the clinical complications of crown’s disease?

A 
Toxic megacolon
Perforation
FISTULAS
STRICTURES
Haemorrhage 
Carcinoma
Short bowel syndrome - repeated resection
24
Q

What are the macroscopic/microscopic features of Ulcerative colitis?

A
  • Colon, terminal ileum, appendix
  • CONTINUOUS lesions
  • ALWAYS involves rectum
  • Terminal ileum involved 10% of time
  • red, granular mucosa - flat, undermining ulcers
  • Mucosa involvement
  • Anal lesions = 25%
  • No granulomas
  • Fistulas DONT occur
  • Strictures rare
  • Inflammatory polyps = common
25
Q

What are the macro/microscopic features of crowns disease?

A
  • All GI tract effected
  • Rectum involved 50% time
  • SKIP LESIONS
  • Fistulas above 10%
  • Strictures common
  • Anal lesions = 75%
  • Cobblestone lesions
  • Sarcoid like granulomas
  • Inflammatory polyps less common
  • Transmural (all layers) inflammation
26
Q

Developing colorectal cancer can occur with colitis. What are the risk factors for developing colorectal cancer with colitis?

A
  • Duration of disease
  • Early onset of disease
  • Total/extensive colitis
  • Family history of cancer
  • Presence of dysplasia
27
Q

What is a colorectal polyp?

A

Mucosal protrusion (bulge in bowel)

Can be solitary or multiple (polyposis)

28
Q

What are the characteristics of hyperplastic polyps?

A
  • common
  • 1-5mm
  • Often multiple
  • Sigmoid colon/rectum
  • small polyps - NO MALIGNANT potential; larger (over 10mm) have malignant potential
29
Q

What are the two types of hamartomatous polyps?

A

Juvenile

Peutz-jeghers

30
Q

What are the characteristics of juvenile polyps?

A
  • 10-30mm
  • Spherical and pedunculated
  • rectum/distal colon
  • Sporadic polyps has no malignant potential, (J polyposis increases risk of CR cancer)
31
Q

What is Peutz-Jeghers syndrome?

A

Rare autosomal dominant condition resulting in multiple GI tract polyps (mostly in small bowel but can occur in colon)

Associated with cancers, especially in small bowel

32
Q

How are adenomas histologically classified?

A

Architectural type - villous, tubulovillous or tubular

Low grade dysplasia or high grade dysplasia

33
Q

What is the adenoma-carcinoma sequence?

A

Small % of adenomas will progress to adenocarcinoma within 10-15 years

Dependent on size, villous vs tuberous, and severity of dysplasia

34
Q

Name two conditions which increase inherited susceptibility to colorectal cancer?

A
  • Familial Polyposis (APC tumour suppressor gene mutation) - multiple adenomas along bowel
  • Hereditary Non-Polypoidal Colorectal Cancer (mutation of MLH1, MSH2 DNA mismatch repair genes)
35
Q

How are colorectal cancers staged?

A

Dukes stage

TMN scale

36
Q

What is the pathology of diverticula?

A

Thickening of muscular propria (pre-diverticula)

Elastosis of teniae coli (shortening of colon)

Mucosal fold develop with shortening

Sacculations then diverticula

37
Q

What are the clinical features of diverticular?

A

Asymptomatic (90-99%)

10-30% - acute and chronic complications

Clinical Pathology (50 decks)

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