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CP > Pathology of the GI Tract 2 > Flashcards

Pathology of the GI Tract 2 Flashcards

1
Q

What are diverticulum?

A

outpouchings/thickenings of muscularis propria

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2
Q

What are true ‘congenital diverticulum’?

A

present from birth. through all layers of bowel wall

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3
Q

What are ‘pseudo’ diverticulum?

A

during post natal life. not through all the layers of the bowel wall

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4
Q

Where specifically on the colon are diverticulum located?

A

protrusion of the mucosa and submucosa through the bowel wall
between the mesenteric and taenia coli
less common in proximal colon e.g. caecum
shortening of the colon due to increased elastin in the taeniae coli

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5
Q

Who is less likely to get diverticulum?

A

vegetarians

people with high fibre diets

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6
Q

How do diverticulum form?

A

increased intra-luminal pressure → irregular, uncoordinated peristalsis
points of weakness in the bowel wall

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7
Q

What are the clinical features of diverticular disease?

A

asymptomatic
cramping abdominal pain
alternating constipation and diarrhoea

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8
Q

What is colitis?

A

inflammation of the colon. Usually submucosal/muscular

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9
Q

What is colitis divided into?

A

Acute and chronic

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10
Q

What are the acute types of colitis?

A

acute infective colitis
antibiotic associated colitis (inc pseudo-membranous colitis)
drug induced colitis
acute ischemic colitis

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11
Q

What are the chronic types of colitis?

A 
chronic idiopathic inflammatory bowel disease
microscopic colitis
ischemic colitis
diverticular colitis
chronic infective colitis e.g. TB
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12
Q

What are the 3 idiopathic inflammatory bowel diseases?

A

ulcerative colitis
crohns disease
indeterminate colitis (overlap between UC and CD)

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13
Q

What are the risk factors for IBD?

A 
smoking (protective in UC)
oral contraceptives
childhood infections
domestic hygeine
apendicectomy - protective
family history
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14
Q

what are the clinical presentations of UC?

A

diarrhoea
rectal bleeding (anaemia)
abdominal pain
weight loss

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15
Q

What are the complications of UC?

A

toxic megacolon/perforation (dilated transverse colon - gas and fluid accumulate)
haemorrhage
stricture (rare)
carcinoma

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16
Q

does UC run a remitting/relaxing course?

A

yes - flare ups occur

17
Q

What part of the colon does UC always effect?

A

appendix, colon and terminal ileum - always rectum

18
Q

What are the histological features of UC?

A 
crypt abscesses
increase in neutrophils 
crypt distortion
granula red mucosa - inflammed
flat undetermining ulcers
normal serosa
inflammatory polyps
19
Q

What are the clinical features of crohns disease?

A 
chronic relapsing disease - flare ups
affects all levels of the GI tracts
diarrhoea (bloody)
colicky abdominal pain 
weight loss
fever
oral ulcers
peri-anal disease (fistulas)
20
Q

What are the histological features of CD?

A

formation of granulomas

cobblestone appearance

21
Q

What are the complications of CD?

A 
toxic megacolon
perforation
apthoid and fissuring ulcers
strictures (common)
haemorrhage
carcinoma
short bowel symdrome - repeatedly removing too much bowel makes it too small
22
Q

What are the hepatic extra-intestinal manifestations of IBD?

A

fatty changes
granulomas
Primary Sclerosing Cholangitis (bile ducts inside and outside the liver progressively decrease in size due to inflammation and fibrosis)
bile duct carcinoma

23
Q

What are the skeletal extra-intestinal manifestations of IBD?

A

polyarthritis
sarco-ileitis
ankylosing spondylitis (a form of spinal arthritis)

24
Q

What are the muco-cutaneous extra-intestinal manifestations of IBD?

A 
oral apthoid ulcers
pyoderma gangrenosum (rare skin condition that causes painful ulcers)
erythema nodosum (inflammation of the fat cells under the skin, resulting in tender red nodules or lumps)
25
Q

What are the ocular extra-intestinal manifestations of IBD?

A

iritis/uveitis
episcleritis
retinitis

26
Q

What are the renal extra-intestinal manifestations of IBD?

A

kidney and bladder stones

27
Q

What are the haematological extra-intestinal manifestations of IBD?

A

anaemia
leucocytosis
thrombocytosis
thrombo-embolic disease

28
Q

What are the systemic extra-intestinal manifestations of IBD?

A

amyloid

vasculitis

29
Q

What are the risk factors for colorectal cancer in UC?

A 
early age of onset
duration of disease greater than 8 years
total/extensive colitis
family history
severity of inflammation
presence of dysplasia
30
Q

What are colorectal polyps?

A

mucosal protrusion
varialble size, shape and number
due to mucosal/submucosal pathology or a lesion deeper in the bowel wall

31
Q

What are examples of non neoplastic polyps in the colo-rectum?

A

hyperplastic polyps
juveniles polyps
hamartomatous polyps (i.e. peutz-jeghers syndrome)

32
Q

What are hyperplastic polyps?

A

multiple polyps
common
in rectum and sigmoid colon
no clinical significance - apart from some large right sided polyps that may give rise to unstable carcinomas

33
Q

What are juvenile polyps?

A

spherical/pedunculated
commonest polyp in children
typically in rectum and distil colon
juvenile polyposis (multiple polyps) associated with increased risk of colorectal and gastric cancer

34
Q

What is peutz-jeghers syndrome?

A 
autosomal domincant - mutation to STK11 gene
presents in teens/early 20's
abdominal pain, GI bleeding and anaemia
multiple polyps
muco-cutaneous pigmentation
mostly in small bowel
35
Q

What are adenoma polyps?

A

benign epithelial tumours
common polypoid but may be flat
precursor of colorectal cancer
evenly distributed around colon but larger in recto-sigmoid and caecum
variable shape, tubular/villous and variable grade

36
Q

What are the risks of adenoma polyps progressing into adenocarcinoma?

A 
risk with flat adenomas
size dependent
high grade
villous or tubulo-villous
HNPCC associated adenomas
37
Q

what are the risk factors for colorectal cancer?

A 
diet - fibre is good whilst red meat and fat is bad
obesity/physical activity
alcohol
NSAIDs
HRT and oral contraceptives
schistosomiasis
radiation
UC and CD
38
Q

What are the two inherited susceptibilities to colorectal cancer?

A

Familial adenomatous polyposis (FAD) - autosomal dominant, mutation in APC tumour supressor gene
Hereditary nonpolyposis colorectal cancer (HNPCC) - autosomal dominant, mutation in DNA mismatch repair gene

39
Q

What staging methods are used for colorectal cancer?

A

Dukes staging

TNM staging

CP (50 decks)

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