T1 PC Pathology of the Gut

Question 1

What happens in Baretts Oesophagus?

Answer 1

the distal (end) oesophagus lined by gastric mucosa undergoes intestinal metaplasia to develop into goblet cells and columnar cells

Question 2

From what part of the oesophagus does intestinal metaplasia start in Baretts Oesophagus?

Answer 2

the abnormal cells start from where the oesophagus meets the stomach and spread upwards

Question 3

What type of epithelium lines the oesophagus?

Answer 3

Non keratinising stratified squamous epithelium

Question 4

What causes metaplasia?

Answer 4

the reflux of gastric contents leading to reflux oesophagitis

Question 5

Where is the oesophago-gastric junction located?

Answer 5

between the oesophagus and the stomach

Question 6

What are the risk factors for BO?

Answer 6

High BMI, alcohol, smoking
Drugs which relax the lower oesophageal sphincter
having a familial / genetic predisposition

Question 7

What’s an example of a drug that relaxes the lower oesophageal sphincter?

Answer 7

Nitroglycerins

Question 8

What is the process by which Baretts Oesophagus occurs?

Answer 8

reflux oesophagitis is caused by the reflux of acidic contents from the stomach into the oesophagus
triggers the metaplasia of squamous epithelium into columnar epithelium, which is an adaption to injury caused by the gastric contents

Question 9

What does the presence of columnar epithelium in BO increase the risk of?

Answer 9

of adenocarcinoma of the oesophagus via dysplasia

Question 10

What are the features of a BO with cancer?

Answer 10

a polyp protrudes into the open lumen
the oesophagus is lined by white squamous epithelium
ther stomach is the same colour (pink) as BO

Question 11

What are the stages of pathogenesis of Barrett’s Associated Carcinoma?

Answer 11

Squamous epithelium < Reflux oesophagitis < Gastric epithelium <
Intestinal metaplasia < Low grade dysplasia < High grade dysplasia < Adenocarcinoma

Question 12

How does a patient with oesophageal cancer present?

Answer 12

Dysphagia initially for solids then for liquids

Question 13

What is the difference between TX and T0 in cancer staging?

Answer 13

TX: Main tumor cannot be measured.
T0: Main tumor cannot be found.

Question 14

What does T1 - T4 refer to in cancer staging?

Answer 14

the size and/or extent of the main tumor
the higher the number after the T, the larger the tumor or the more it has grown into nearby tissues
T’s may be further divided to provide more detail, such as T3a and T3b

Question 15

What are the four microscopic features of coeliac disease in small bowel mucosa?

Answer 15

Villous atrophy
Crypt hyperplasia
Increase in intra-epithelial lymphocytes
Chronic inflammation

Question 16

What are examples of complications of coeliac disease?

Answer 16

Refractory to treatment
Cancers of the small bowel, large bowl and pancreas
Osteoporosis, infertility

Question 17

What conditions are associated with coeliac disease?

Answer 17

Dermatitis herpetiformis
Primary biliary cirrhosis
Autoimmune hepatitis, Autoimmune thyroiditis
Type 1 Diabetes mellitus

Question 18

What is the predominant cell of chronic inflammation?

Answer 18

Lymphocytes

Question 19

What is the predominant cell of acute inflammation?

Answer 19

Neutrophil or polymorph

Question 20

What are the features of normal large bowel mucosa?

Answer 20

The crypts are arranged in a row reminiscent of test tubes
The goblet cells are full of mucin
The crypts are separated by the lamina propria with vessels and connective tissue

Question 21

What are the features of UC in small bowel mucosa?

Answer 21

inflammation is confined to the mucosa

crypt architecture distortion

Question 22

What are the indications for colectomy in UC?

Answer 22

Refractory to treatment
Toxic megacolon
Severe bleeding
High grade dysplasia
Cancer

Question 23

What are the risk factors for dysplasia in UC?

Answer 23

UC at an early age
Total UC - involving the whole large bowel
Repeated bouts of acute inflammation with short periods of remission
Long duration with UC; patients with total UC for 8years require annual surveillance colonoscopy to look for dysplasia

Question 24

What proportion of the intestine can be covered in creeping fat?

Answer 24

as much as half o fth eintestine

Question 25

What is the histology of Crohn’s Disease?

Answer 25

Transmural inflammation = involves full thickness of bowel wall
fissuring ulcer
No crypt architecture distortion

Question 26

What are the symptoms of strictures in the SI or LI?

Answer 26

Abdominal pain due to intestinal obstruction

Question 27

What are examples of complications of Crohn’s disease??

Answer 27

strictures
Intra-abdominal abscess
Sinus tract formation
Fistulas e.g. colo-vesical;  patient will present with pneumaturia
Cancer

Question 28

What are the effects of a colovesical fistula?

Answer 28

painful infections and other complications

Question 29

What causes a colovesical fistula?

Answer 29

an open connection between the LI and the bladder

Question 30

What is change in bowel habit?

Answer 30

Constipation alternating with diarrhoea

What is normal varies for each patient

Question 31

What does Stage 0 mean in cancer?

Answer 31

that abnormal cells are present but have not spread to nearby tissue - is not cancer, but it may become cancer

Question 32

What is Stage 0 otherwise known as?

Answer 32

carcinoma in situ

Question 33

What does Stage 1-3 mean in cancer?

Answer 33

that cancer is present. The higher the number, the larger the cancer tumor and the more it has spread into nearby tissues

Question 34

What does Stage IV mean in cancer?

Answer 34

that the cancer has spread to distant parts of the body.

Question 35

What are outpouchings caused by?

Answer 35

Diverticular Disease - the herniation of the mucosa and submucosa through the bowel wall at sites of weakness

Question 36

In what populations are outpouchings common in?

Answer 36

in the populations on low fibre diet

Question 37

What percentage of diverticular disease cases affect the sigmoid colon?

Answer 37

95%

Question 38

What are the complications of diverticular disease?

Answer 38

peritonitis caused by diverticulitis & perforation

Question 39

How might diverticular disease present?

Answer 39

with intestinal obstruction
can mimic cancer
colo-vesical fistula
pneumaturia