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CP4 = Diseases of the GI Tract > Pathology of the GI Tract 2 > Flashcards

Pathology of the GI Tract 2 Flashcards

1
Q

Define: Diverticulum

A

Abnormal pouch/sac at weak point in intestinal wall.

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2
Q

What type of diverticulum is sigmoid diverticulosis?

A

Acquired

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3
Q

What type of diverticulum is diverticulosis of the right colon?

A

Either congenital or acquired.

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4
Q

What layers of the bowel protrude in a diverticulosis?

A

> Mucosa

> Submucosa

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5
Q

In which part of the colon are diverticula commonly found?

A

Sigmoid Colon

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6
Q

Where are colon diverticuli located between?

A

Mesenteric and anti-mesenteric coli.

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7
Q

What is the pathogenesis of Colon diverticulosis?

A

> Increases intra-luminal pressure

> Increases relative weakness points in the bowel wall.

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8
Q

What is pre-diverticular disease?

A

Thickening of the muscular propria

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9
Q

What pathological changes occur in diverticulosis?

A

> Mucosal folds/ridges become useless
Sacculations/Diverticulations
Taenia coli –> elastic –> shorten

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10
Q

What are the clinical features of Diverticular disease?

A 
MOSTLY ASYMPTOMATIC (90-99%) 
> Abdominal pain
> Alternating constipation/diarrhoea
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11
Q

What are the acute complications of Diverticular disease?

A

> Haemorrhage
Perforation
Diverticulitis

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12
Q

What are the chronic complications of Diverticular disease?

A

> Polypoid prolapsing mucosal folds
Colitis
Fistula
Intestinal obstruction

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13
Q

What can chronic idiopathic inflammatory bowel disease be divided into?

A

Ulcerative Colitis or Crohn’s Disease.

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14
Q

What is the incidence of Ulcerative Colitis?

A

20 - 40 years old.
M = F
Increase in urban areas

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15
Q

What are the risk factors for UC?

A 
> Smoking
> Oral contraceptives
> Childhood infections
> MMR
> Domestic Hygiene 
> Appendicectomy
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16
Q

What is the clinical presentation for Ulcerative Colitis?

A 
> Diarrhoea
> Constipation ( Rectal bleeding
> Abdominal pain
> Anorexia
> Weight loss
> Anaemia
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17
Q

What is the incidence of Chrons disease?

A

F:M = 3:1

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18
Q

What is the clinical presentation of Crohn’s disease?

A 
> Diarrhoea
> Fever
> Weight loss
> Colicky abdominal pain
> Palpable abdominal mass
> Anorexia
> Anaemia
> Oral ulcers
> Peri-anal disease
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19
Q

Where is Crohn’s disease primarily distributed?

A

Ileocolic

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20
Q

Where is Crohn’s disease least distributed?

A

Gastro-duodenal

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21
Q

Which disease affects the colon only?

A

UC

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22
Q

Which disease affects any part of the GI tract?

A

Crohns

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23
Q

Which disease always involves the rectum?

A

UC

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24
Q

Which disease involves more of the terminal ileum?

A

Crohns

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25
Q

Which disease has a granular red mucosa with flat, undermining ulcers?

A

UC

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26
Q

Which disease has a cobblestoned appearance?

A

Crohns

27
Q

What disease has serousitis?

A

Crohns

28
Q

In what disease are strictures rare?

A

UC

29
Q

In what disease are there no spontaneous fistulae?

A

UC

30
Q

In what disease are there more than 75% anal lesions?

A

Crohns

31
Q

In what disease are crypt abcesses common ?

A

UC

32
Q

In what disease is crypt distortion severe?

A

UC

33
Q

In which disease are granulomas absent?

A

UC

34
Q

In which disease are inflammatory polyps less common?

A

Crohns

35
Q

What are the liver manifestations of IBD?

A

> Fatty change
Granulomas
Primary Sclerosing Cholangitis
Bile duct carcinoma

36
Q

What are the skeletal manifestations of IBD?

A

> Ankylosing Spondylitis
Sacro-ileitis
Polyarthritis

37
Q

What are the muco-cutaneous manifestations of IBD?

A

> Oral apthoid ulcers
Pyoderma gangrenosum
Erythema nodosum

38
Q

What are the ocular manifestations of IBD?

A

> Iritis/uveitis

> Episcleritis (retinitis)

39
Q

What are the renal manifestations of IBD?

A

Kidney and bladder stones

40
Q

What are the haematological manifestations of IBD?

A

> Anaemia
Leucocytosis
Thrombocytosis
Thrombo-embolic disease.

41
Q

What are the systemic manifestations of IBD?

A

> Amyloid

> Vasculitis

42
Q

What is the step by step process from inflamed mucosa to colorectal cancer?

A

Inflamed mucosa –> Low grade dysplasia –> High grade dysplasia –> Colorectal cancer.

43
Q

What are colorectal polyps?

A

Mucosal protrusions

44
Q

What causes colorectal polyps?

A

> Submucosal/mucosal pathology

> Lesion deeper in bowel wall

45
Q

What are the two types of hamartomatous polyps in the colorectum?

A

> Peutz-Jeghers polyps

> Juvenile polyps

46
Q

Where are hyper plastic polyps located?

A

Rectum and Sigmoid colon

47
Q

What is Peutz- Jeghers syndrome?

A

GI polyps mainly in small bowel

48
Q

What is the inheritance pattern of Peutz-Jeghers syndrome?

A

Autosomal dominant

49
Q

What is the mutation causing Peutz-Jeghers?

A

SKT11 on Cr 19.

50
Q

What is the appearance of Peutz-Jeghers syndrome?

A

1 in 50,000- 1 in 200,000

51
Q

What are the symptoms of Peutz-Jeghers?

A

> Abdo pain
GI bleeding
Anaemia

52
Q

What are adenomas?

A

Benign epithelial tumours.

53
Q

In whom do adenomas present in?

A

~30% of population >50 years

54
Q

What is the distribution of adenomas?

A

> Even in colon

> Larger in recto-sigmoid and caecum.

55
Q

What type of adenomas have more of a chance becoming cancerous?

A

> Flat

> >10mm

56
Q

What is the main pre-disposer to colorectal cancer?

A

Sporadic

57
Q

What are the risk factors for Colorectal cancer?

A 
> Diet - Red meat, calcium, folate, fibre, fat 
> Obesity
> Alcohol
> NSAIDs
> Oral contraceptives and HRT
> Schistosomiasis 
> Pelvic radiation
> UC and Crohns
58
Q

Describe: Familial Adenomatous Polyposis

A

> Makes up Autosomally dominant inheritance pattern - mutation in APC tumour suppressor gene.
Assc: Multiple colon benign adenomatous polyps
Large bowel lifetime risk : 100%

59
Q

Describe: Hereditary Non-polyposis Colorectal cancer

A

> Mutation in DNA mismatch repair gene
Large bowel lifetime risk : 50-70%
Inc risk of other bowel cancers - endometrial, gastric, ovarian etc

60
Q

What is the most common type of colorectal cancer?

A

Adenocarcinoma - glandular epithelial tissue.

61
Q

What type of adenocarcinoma makes up 10-20% of Colorectal adenocarcinomas?

A

Mucinous adenocarcinoma.

62
Q

What type of differentiation makes up the majority of CRC grading?

A

> Moderately well differentiated.

63
Q

How does colorectal cancer spread?

A 
> Directly invades adjacent tissues
> Iatrogenic spread
> Transcoelomic - metastasis through body cavity. 
> Lymphatic 
> Haematogenous metastasis
64
Q

What are the different dukes staging of Adenocarcinomas?

A 
A = Confined to bowel wall
B = Invade through bowel wall
C = Regional Lymph node invasion
D = Distant metastasis

CP4 = Diseases of the GI Tract (5 decks)

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