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Pathology of Large Bowel Flashcards

1
Q

Common large bowel diseases

A 
Dma of colon and rectum
Colonic polyps
Crohn's colitis and ulcerative colitis
Diverticular disease
Functional disorders
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2
Q

Less common large bowel disease

A

Colonic volvulus, colonic angiodysplasia, ischaemic colitis, psudo-obstruction

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3
Q

What is diverticular disease

A

Mucosal herniation through muscle coat

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4
Q

True vs false herniation

A

True herniation has all layers of the wall whereas false only has the mucosa and submucosa protruding

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5
Q

Common cause of diverticular disease

A

Low fibre intake, congenital

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6
Q

Diverticulosis vs diverticulitis

A

Diverticulosis is formation of small, bulging pouches in the GI tract whereas diverticulitis is inflammation of this pouches

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7
Q

Risk of sigmoidoscopy in diverticulosis

A

Lots of pockets may develop in diverticulosis and the operator must be careful in sigmoidoscopy not to go through these and cause further perforation

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8
Q

When can appendicitis be mistaken for sigmoid colon diverticulitis

A

Diverticulitis is inflammation and this can cause the sigmoid colon to enlarge and move into the right iliac fossa causing appendicitis like pain

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9
Q

Complications of diverticulitis

A

Pericolic disease, perforation, haemorrhage, fistula, stricture

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10
Q

When can a patient have bubbles in urine

A

Colovesical fistula which is a compliation of diverticular disease causing a fistula between colon and bladder

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11
Q

Acute diverticulitis can be classifed by

A

Hinchey classification

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12
Q

Treatment options for different stages in Hinchey classification

A

Stage 0 - Oral antibiotics
Stage 1a or 1b - IV antibiotics
Stage 2 - Percutaneous drain, pass drain through CT
Stage 3 - Laproscopic surgery to drain out pus + antibiotics
Stage 4 - Surgery possible to remove bowels

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13
Q

What is stage 0 Hinchey classification of acute diverticulitis

A

Clinically mild diverticulitis

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14
Q

What is stage 1a Hinchey classification of acute diverticulitis

A

Confined pericolic inflammation and phlegmonous inflammation

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15
Q

What is stage 1b Hinchey classification of acute diverticulitis

A

Abscess (<5cm) formation in proximity of inflammatory process

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16
Q

What is stage 2 Hinchey classification of acute diverticulitis

A

Intra-abdominal abscess, pelvic or retroperitoneal abscess, abscess distant from primary inflammation

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17
Q

What is stage 3 Hinchey classification of acute diverticulitis

A

Generalized purulent peritonitis

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18
Q

What is stage 4 Hinchey classification of acute diverticulitis

A

Fecal peritonitis

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19
Q

How is complex diverticulitis treated

A

Percutaneous drainage
Hartmann’s procedure
Laparoscopic lavage and drainage
Primary resection/anastomosis

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20
Q

Cause of acute and chronic colitis

A

Inflammatory bowel disease (Crohn’s and UC), pathogens, ischaemia

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21
Q

Symptoms of acute and chronic colitis

A

Diarrhoea +/- blood, abdominal cramps +/-, dehydration, septis, maybe weight loss and anaemic

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22
Q

X-ray features of acute and chronic colitis

A

Lead piping on descending colon - Smooth layers

Thumb printing on ascending colon - Severe mucosal inflammation

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23
Q

Diagnosing colitis

A

Sigmoidoscopy, x-ray, CT scan, stool cultures, barium enema (rarely used now)

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24
Q

Commonest site of Crohn’s

A

Terminal Ilium

25
Treatment of ulcerative colitis/crohns
IV fluids and electrolytes, IV steroids once infection/infarction ruled out, GI rest
26
What to do if steroids don't help colitis within 3-5 days of steroidal use
Try not to re-CT scan as it's high dose of ionizing radiation. Insead, use a stool chart, bowel habits (>8/day), inflammatory markers (CRP>45mg/L) Consider rescue medical therapy or surgery
27
What colonic disease is usually seen on right side in caecum or ascending colon
Colonic angiodysplasia - Obscure cause of rectal bleeding due to vascular malformations in the gut
28
Investigating colonic angiodysplasia
CT angiogram, colonosopy
29
Treating colonic angiodysplasia
Embolisation, endoscopic ablation, surgical resection
30
What parts of colon can undergo volvulus
Sigmoid and transverse. In children, the entire bowel can twist
31
Cardinal signs of bowel obstruction
Abdominal pain, constipation, distended abdomen and vomiting
32
Investigating sigmoid volvulous
Abdominal x-ray, rectal contrast
33
What can sigmoid volvulus cause
Obstruction of bowels, infarction
34
Treatment of sigmoid volvulus
Flatus tube, surgical resection
35
What is intestinal pseudo-obstruction
Impairment in the ability of intestines to push food through. Patient presents with classic signs of obstruction but no apparent pathology can be found
36
Causes of intestinal pseudo-obstruction
Patients poor health, neurodegeneration, myopathy, genetics
37
If patient with functional bowel disorder such as constipation gets better with laxatives, should an invasive investigation such as endoscopy be performed?
No, if patient responds to laxative, they are likely to respond to a change in diet too. Try this first
38
What is faecal impaction
Solid, immobile bulk of faeces that can develop in rectum due to chronic constipation.
39
Who are affected with faecal impaction
Elderly, bed ridden, on strong analgesics
40
Treatment of faecal impaction
Enemas, laxatives, manual evacuation
41
Why can low fibre diet cause diverticular disease
Low fibre diet causes a less bulky stool and so the muscles of the colon have to work harder to pump out this liquid stool. If this pressure get's too high, the layers of colonic wall can herniate
42
Fibrin and blood found in mucosa on histology
Ischaemia
43
Causes of large bowel ischaemia
CVS disease, atherosclerosis of mesenteric arteries, atrial fibrillation, shock, vasculitis, embolus
44
Histopathological clues of large bowel ischaemia
Withering of crypts, pink smudgy lamina propriae, fewer chronic inflammatory cells (lymphocytes)
45
How does large bowel ischaemia clinically present
Elderly, left sided, segmental on endoscopy
46
How can massive bleeding cause stricture in large bowel
Massive bleeding can clot, re-bleed and clot again to occlude the lumen
47
Explosive - volcano/flamethrower type lesions on mucosa seen as yellow exudates on endoscopy
Pseudomembranous collitis - Antibiotic induced
48
Treatment for antibiotic induced pseudomembranous colitis
Discontinue or change antibiotics, maintain fluid and electrolytes, enteric isolation, vancomycin (first line PO) or metronidazole (flagyl)
49
How do toxins released from Clostridium difficile affect the body
Toxin A attacks endothelium whereas toxin B attacks epithelium
50
50-60 year old woman, watery diarrhoea, no blood or mucous mixed. Nothing of interest in endoscopy, biopsy taken and thickened basement membrane with increase in epithelial collagen found. Diagnosis?
Collagenous colitis. Associated with increased intraepithelial inflammatory cells. Autoimmune disease
51
50 year old man/woman with watery diarrhoea, no blood or stool. Normal histological architecture with increased intraepithelial lymphocyte numbers. Diagnosis?
Lymphocytic colitis, can be autoimmune or due to long-term use of NSAIDs, proton pump inhibitors and other drugs.
52
What is microscopic colitis
Two medical conditions causing non-watery, non-bloody diarrhoea - collagenous and lymphocytic colitis. They have normal appearance on colonoscopy and characteristic histopathological findings
53
What should be raised in report upon finding lymphocytic coeliac disease
Possibility of coeliac disease
54
What is radiation colitis
Inflammation of colon due to radiotherapy. This leads to a disturbance in colonic architecture with vascular spaces appearing in mucosa. These might have been vessels supplying the tumour.
55
What can radiation colitis cause
Telangiectasia - Widened venules (tiny blood vessels) cause threadlike red lines or patterns on skin. Known as 'spider veins'
56
What is cryptitis
Inflammation of intestinal crypts. Can be due to inflammatory bowel disease, diverticular disease, radiation colitis and infectious colitis
57
What is focal acute cryptitis
Neutrophils migrating into intestinal crypts causing inflammation of these crypts
58
Do we do endoscopy for infective colitis
No
59
Common causes of infective colitis
Salmonella, Campylobacter, Shigella

GI (32 decks)

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