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GI AM > Pathology of the colon > Flashcards

Pathology of the colon Flashcards

1
Q

What is the structure of the colon, from proximal to distal?

A 
Caecum
Ascending colon
Transverse colon
Descending colon
Sigmoid colon
Rectum
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2
Q

What is the peritoneum of the colon?

A 
Caecum- inta
A- retro
T- intra
D- retro
S- intra
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3
Q

What is the histology of the colon?

A

Flat
Tubular crypts
-goblet and endocrine cells
Columnar absorptive epithelium

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4
Q

What is idiopathic IBD?

A

Chronic inflammatory conditions resulting from inappropriate and persistent activation of mucosal immune system

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5
Q

What are the 2 main inflammatory bowel diseases?

A

Crohn’s

Ulcerative colitis

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6
Q

What is the main difference between Crohn’s and UC?

A

Crohn’s can affect anywhere from mouth to anus

UC can only affect colon

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7
Q

What is the cause of IBD?

A

Strong immune response against normal flora with defects in epithelial barrier function in genetically suseptibel individuals

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8
Q

How is IBD diagnosed?

A

History, x ray, pathological correlation

pANCA- good for differentiating UC and Crohn’s

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9
Q

Who does UC most commonly affect?

A

Males

20-30 and 70-80 years

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10
Q

How does UC spread?

A

Most commonly proximally

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11
Q

What is the pathology of UC?

A 
Large intestine only
Continuous pattern of inflammation
Often spreads from rectum proximally
Pseudopolyps
UlcerationSerosal surface has minimal or no inflammation
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12
Q

What is the histology of UC?

A 
Inflammation of mucosa
Crypitis
Crypt abscesses and disarray
Mucosal atrophy
Ulceration into submucosa creating pseudopolyps
Submucosal fibrosis
No granulomas
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13
Q

What can submucosal fibrosis is UC cause?

A

Stricturing of bowel and obstruction

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14
Q

What are the complications of UC?

A

Haemorrhage
Perforation
Toxic dilation

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15
Q

Where does the majority of Crohn’s affect?

A

Small intestine

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16
Q

What % of Crohn’s affects the small intestine and large intestine?

A

Small- 40%
Both- 30%
Large- 30%

17
Q

What is the pathology of Crohn’s?

A 
Granular serosa
Wrapping mesenteric fat
Thickened, oedematous, fibrotic mesentery and wall
Narrowing of lumen
Ulceration
Patch disease
18
Q

What is the histology of Crohn’s disease?

A 
Cryptitis and crypt abscesses
Architestural distortion
Atrophy
Deep ulceration
Transmural inflammation
Non caveating granulomas
Fibrosis
Lymphangiectasia
Hypertrophy of mural nerves
Paneth cell metaplasia
19
Q

What are the long term features of Crohn’s?

A 
Malabsorption
Strictures
Fistulas and abscesses
Perforation
Increased risk of cancer
20
Q

What is ischaemic enteritis?

A

Occlusion of celiac, s mesenteric or i mesenteric vessels causing infarction

21
Q

What does major vessel occlusion in ischaemic enteritis cause?

A

Transmural injury

22
Q

What are the predisposing conditions for arterial thrombosis in ischaemic enteritis?

A 
Severe atherosclerosis
Systemic vasculitis
Dissecting aneurysm
Hypercoagulate states
Oral contraceptive
23
Q

What are the predisposing conditions for arterial embolism in ischaemic enteritis?

A

Cardiac vegetations
Acute after-embolism
Cholesterol embolism

24
Q

What are the predisposing conditions for non occlusive ischaemic enteritis?

A

Cardiac failure
Shock/dehydration
Vasoconstrictive drugs

25
Q

What part of the gut is vulnerable to acute ischaemic enteritis?

A

Splenic flexure

26
Q

What is the histology of acute ischaemic enteritis?

A 
Oedema
Interstitial haemorrhages
Sloughing necrosis of mucosa
Nuclei indistinct
Initial absence of inflammation
Vascular dilatation
27
Q

What are the features of chronic ischaemic enteritis?

A 
Mucosal inflammation
Ulceration
Submucosal inflammation
Fibrosis
Stricture
28
Q

Where does radiation colitis normally affect?

A

Rectum after pelvic radiotherapy

29
Q

What does radiation colitis normally target?

A

Actively dividing cells, esp blood vessels and crypt epithelium

30
Q

what are the symptoms of radiation colitis?

A

Anorexia
Abdo cramps
Diarrhoea
Malabsorption

31
Q

What is the histology of radiation colitis?

A 
Inflammation
Arterial stenosis
Ulceration
Necrosis
Haemorrhage
Perforation
32
Q

What is the histology of appendicitis?

A

Fibrinopurulent exudate
Perforation
Abscess
Acute inflammaation in wall, pus in lumen
Acute gangrenous full thickness necrosis, w/ possible perforation

33
Q

What are the forms of colorectal dysplasia?

A

Tubular, villous or tubulovillous adenomas

34
Q

What are the features of low grade colorectal dysplasia?

A

Increased nuclear number and size

Reduced mucin

35
Q

What are the features of high grade colorectal dysplasia?

A

Carcinoma in situ
Crowded
Very irregular
Not yet invasive

36
Q

What are the majority of colorectal cancers?

A

Adenocarcinomas

37
Q

What are the risk factors of colorectal cancer?

A

Lifestyle
Family history
IBD
Genetics

38
Q

What are the signs and symptoms of right sided adenocarcinoma of the colon?

A

Anaemia
Vague pain
Weakness
Obstruction

39
Q

What are the signs and symptoms of left sided adenocarcinoma of the colon?

A

Fresh blood PR
Altered bowel habit
Obstruction

GI AM (34 decks)

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