Sos: Pathology of Large Intestine Flashcards
RLQ pain
+ McBurney’s sign
acute appendicitis
Lumen obstruction > wall compression from continued mucus formation > wall necrosis > acute inflammation > perforation
acute appendicitis pathophys
pt has fever
N/V
RLQ pain
acute appendicitis
acute appendicitis
common chronic disorder involving large intestine w/ unknown cause
IBS
control sx’s of this w/ stress reduction, diet management, and healthy lifestyle choices
IBS
No histopathologic findings of this syndrome or increase chance of colorectal adenocarcinoma
IBS
chronic inflammation of GI tract resulting in permanent damage possibly leading to adenocarcinoma
IBD
2 types of IBD
Ulcerative colitis
Crohn’s disease
chronic inflammation of intestines that can lead to cancer
IBD
20s and 60s
starts in rectum and progresses to cecum in a linear fashion
Ulcerative colitis
large intestine lose haustra and contains pseudopolyps
Ulcerative colitis
normal mucosa surrounded by erosion
pseudopolyps
“lead pipe” appearance on imaging
ulcerative colitis
inflammation restricted to mucosa and submucosa
UC
contains crypt abscesses
UC
pt presents w/ LLQ abdominal pain and bloody diarrhea
ulcerative colitis
associated w/ primary sclerosing cholangitis and pANCA
ulcerative colitis
can develop toxic megacolon and adenocarcinoma if disease progresses
ulcerative colitis
L: normal
middle: UC
R: UC
lead pipe (loss of haustra)
ulcerative colitis
ulcerative colitis
pseudopolyp
2 ways to describe large intestine on histology
test tubes and daisy fields
test tubes (large intestine)
crypt abscess on daisy field (large intestine)
crypt abscess
15 to 35 yrs
lesions found anywhere on GI tract (from oral cavity to anus—->rectum sparing)
Crohn’s disease
most common site for Crohn’s disease
Ileum
least common site for Crohn’s disease
rectum
contains skip lesions and strictures
Crohn’s disease
in Crohn’s disease, wall can become so thick that mesenteric fat wraps around serosa
“creeping fat”
mucosal “cobblestone” appearance
Crohn’s disease
people with this disease can develop malabsorption w/ nutritional deficiency and fistula formation
Crohn’s disease
sx’s of this focus on RLQ abdominal pain and non-bloody diarrhea
Crohn’s disease
cobblestone mucosa
Crohn’s disease
string sign of Kantor (Crohn’s disease)
Crohn’s disease
can be associated with internal or external fistulas
Crohn’s disease
“blue balls in the wall”
Crohn’s disease
“granuloma in mucosa”
Crohn’s disease
dysplasia to adenocarcinoma by what 2 IBDs
UC and Crohn’s
C. difficile overgrowth, within days, due to antibiotic treatment during hospital stay
Pseudomembranous colitis
Symptoms include watery diarrhea, abdominal cramps/pain, fever, nausea and dehydration
pseudomembranous colitis
Rx C.diff
Vancomycin or Fidaxomicin
pseudomembranous colitis
mushroom exudate living on top of mucosa
pseudomembranous colitis
pseudomembranous colitis
Thinning and dilation of the abdominal aorta caused by smoking, diet and hypertension increasing atherosclerosis of the wall
Abdominal Aortic Aneurysm (AAA)
Atherosclerosis and increased inflammation destroys the elastic properties of the wall allowing for both dilation and obstruction
AAA
Typically asymptomatic until rupture which is often quickly fatal
Symptoms include back and naval pain, sharp extreme pain during rupture
AAA
____ can cause IMA obstruction or insufficiency
AAA
AAA
Caused by atherosclerosis or hypoperfusion commonly at the splenic flexure due to the SMA being occluded
Ischemic Colitis
Sudden or gradual onset of Abdominal pain
Bright red blood in stool
Nausea/vomiting
Ischemic Colitis
portal vein has huge clot
Ischemic colitis
Ischemic colitis
most common type of colorectal polyp that CAN become cancer
tubular adenoma
common type of colorectal polyp that does NOT become cancer
Hyperplastic polyp
hyperplastic glands (polyp)
polyp most often found in rectosigmoid region
hyperplastic polyp
Due to lack of apoptosis of cells at the surface of the glands causing cells to push into the lumens of the glands appearing sawtooth in pattern
hyperplastic polyp
hyperplastic polyp
3rd most commonly diagnosed cancer
colorectal cancer
85% of colorectal cancer is due to what
chromosomal instability (adenoma to adenocarcinoma)
adenoma to adenocarcinoma following genetic mutations
colorectal cancer
tubular adenoma
tubular adenoma
forms from a stalk
tubular adenoma
25% risk of malignant potential
Tubulovillous adenoma
tubulovillous adenoma
40% risk of malignant potential
Villous Adenoma
can be polyps (15%) or sessile (85%)
villous adenoma
Villous Adenoma
Right?
Villous Adenoma
villous adenoma
90% of adenomas will have ____ mutations
APC
what gene mutation would be identified in these cells if they show a POLYP?
APC
APC to KRAS to ____ mutation for carcinoma
p53
what is the most common mutation in this LESION
p53
uncontrolled cell growth without differentiation
APC mutation
system stays on; TF’s constantly being produced for cell growth and can migrate or metastasize
KRAS mutation
most common mutation in carcinomas
p53 mutation
triggers both mitochondrial and death receptor induced apoptotic pathways
p53
cancer cell survives if _____ is mutated
p53
these make up 96% of the neoplasms for colorectal cancer
adenocarcinomas
commonly tested for colorectal cancer recurrence
carcinoembryonic antigen (CEA)
elderly patient with iron deficiency anemia, blood in stool; what to rule out
colorectal carcinoma
Feces is reshaped to “pencil-thin” in descending colon due to what
adenocarcinoma
apple core sign
adenocarcinoma
colon mass
metastatic lymph nodes
normal colon
adenocarcinoma
adenocarcinoma
cancer going all the way into fat (high stage)
neural invasion (painful)
what to stain for adenocarcinoma
IHC: cytokeratin
No polyps present or polyps at early age before cancer;
Autosomal dominant, family member with colon cancer before age of 50
Lynch syndrome
due to mutations in DNA repair genes
Lynch syndrome
Increased risk of cancer of uterus and ovaries, gastrointestinal tract, urinary tract and kidneys
Lynch syndrome
60% risk of uterine cancer by 70 yrs
Lynch syndrome
80% risk of colorectal cancer by 70 yrs
Lynch syndrome
autosomal dominant disorder characterized by colorectal cancer due to APC mutation
familial adenomatous polyposis (FAP)
1000s of polyps identified, usually start to develop in their teens
Familial adenomatous polyposis (FAP)
teeth and soft tissue tumors associated with FAP
Gardner syndrome
APC, MLH1, PMS2 mutations
Turcot syndrome
FAP w/ CNS tumors
Turcot syndrome
hamartomatous polyps
pigmentation of lips and tongue area
Peutz-Jeghers syndrome
Peutz-Jeghers syndrome
left?
Peutz-Jeghers syndrome
elderly
most common vascular malformation of the intestines
Angiodysplasia
Angiodysplasia
intestines
angiodysplasia
innervated by parasympathetic NS and made of smooth muscle
internal anal sphincter
under conscious control
made of skeletal muscle
external anal sphincter
The inability to correctly tighten and relax the pelvic floor muscles to have a bowel movement
Pelvic Floor Dysfunction
can have urine or stool leakage
age contributes to this
pelvic floor dysfunction
best position to defecate
squatting
below pectinate line (aka dentate line)
painful and itchy
external hemorrhoids
above pectinate line
painless but pressure
internal hemorroids
tears in mucosa around anus
fissures
blood in stool think what
fissures
hemorrhoids
scope for cancer or IBD
above pectinate line receive ____innervation and not painful
visceral
below pectinate line receive ___innervation and are painful
somatic
tear in anal mucosa (fissure) area innervated by what nerve
Pudendal
artery and vein supplying area above pectinate line
superior rectal a and v
superior rectal a. is branch of what
IMA
artery and vein supplying area below pectinate line
inferior rectal a and v
inferior rectal a. is a branch of what
internal pudendal a.
anal warts associated with HPV
Condyloma acuminata
most common cancer of anus often found in advanced stage in older people
anal SCC
risk factor for anal SCC
HPV
anal wart
Condyloma
