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Clinical Pathology > Theme 11 L2: Lower GI Pathology > Flashcards

Theme 11 L2: Lower GI Pathology Flashcards

1
Q

What is diverticulosis of the colon?

A

protrusions of mucosa and submucosa through the bowel sall

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2
Q

Which part of the colon does diverticulosis usually occur?

A

sigmoid colon - located between the mesenteric and anti-mesenteric taenia coli

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3
Q

What are the two types of diverticula of the large bowel?

A
  1. True “congenital” diverticulum

2. Acquired / “false”/ “pseudo” diverticulum

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4
Q

What food group in the diet are diverticula associated with?

A

fibre content

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5
Q

What is the pathogenesis of diverticula of the large bowel?

A
  1. increased intra-luminal pressure
    - irregular, unco-ordinated peristalsis
    - over lapping (valve like) semi circular arcs of bowel wall
  2. Points of relative weakness in the bowel wall
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6
Q

What are the clinical features of diverticular disease?

A
  • asymptomatic in 90%
  • cramping abdo pain
  • alternating constipation and diarrhiea
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7
Q

What are the acute complications of diverticular disease?

A
  • diverticulitis/ peri diverticular abscess
  • perforation
  • haemorrhage
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8
Q

How does diverticulitis or a peridiverticular abscess arise?

A
  • faeces get stuck in diverticulum
  • bacteria accumulates
  • causes inflammation or an abscess
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9
Q

What are the chronic complications of diverticular disease?

A
  • intestinal obstruction
  • fistula
  • diverticular colitis
  • polypoid prolapsing mucosal folds
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10
Q

What is colitis?

A
  • inflammation of the colon
  • usually mucosal inflammation
  • occasionally transmural e.g Chron’s
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11
Q

What are the types of acute colitis?

A
  1. Acute infective colitis e.g campylobacter, salmonella
  2. antibiotic associated colitis
  3. Drug induced colitis
  4. Acute ischaemic colitis (transient or gangrenous)
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12
Q

What are the two types of chronic colitis?

A
  1. Chronic idiopathic inflammatory bowel disease

2. Ischaemic colitis

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13
Q

What are the 3 types of idiopathic inflammatory bowel disease?

A
  1. ulcerative colitis
  2. crohn’s disease
  3. unclassified and indeterminate colitis
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14
Q

What are the risk factors for the different IBD?

A
  1. CD is more common in females, UC has equal incidence
  2. Cigarette smoking is a risk factor for CD, but a protective factor from UC
  3. Oral contraceptive
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15
Q

What is the clinical presentation of a patient with Ulcerative colitis?

A
  • diarrhoea with urgency/ tenesmus
  • rectal bleeding
  • abdominal pain
  • anorexia
  • weight loss
  • anaemia
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16
Q

What are the complications of ulcerative colitis?

A
  • toxic megacolon and perforation
  • haemorrhage
  • stricture
  • carcinoma
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17
Q

What is the clinical presentation of Crohn’s disease?

A
  • chronic relapsing disease
  • affects all levels of GIT from mouth to anus
  • bloody diarrhoea
  • abdominal pain/ mass
  • weight loss/ failure to thrive
  • anorexia
  • fever
  • oral ulcers
  • peri-anal disease
  • anaemia
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18
Q

What are the top 3 sites that Crohn’s disease occurs?

A
  1. Ileocolic
  2. Small bowel
  3. Colonic
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19
Q

What is a characteristic feature of Crohn’s disease?

A

skip lesions - unequal distribution around the GI tract

20
Q

What are the complications of Crohn’s?

A
  • toxic megacolon (colonic distension)
  • perforation
  • fistula
  • stricture
  • haemorrhage
  • carcinoma
  • short bowel syndrome (repeated resection)
21
Q

What are some extra intestinal manifestations of IBD?

A
  1. Hepatic
    - fatty change and granulomas
    - PSC and bile duct carcinoma
  2. Osteo-articular
    - polyarthritis
    - sacro-ileitis & ankylosing spondylitis
  3. Muco-cutaenous
    - oral ulcers
    - pyoderma gangrenosum & erythema nodosum
  4. Ocular
    - uveitis and retinitis
  5. Systemic
    - amyloidosis
    - thrombo-embolic disease
22
Q

What are the risk factors of ColoRectal Cancer in UC?

A
  • early age of onset
  • duration of disease > 10 years
  • total or extensive colitis
  • PSC
  • family history of CRC
  • severity of inflammation
  • presence of dysplasia
23
Q

Explain the development of UC to colorectal cancer?

A
  1. inflammed mucosa
  2. low grade dysplasia
  3. high grade dysplasia
  4. colorectal cancer
24
Q

What is ischaemic colitis?

A
  • colonic injury secondary to a acute, intermittent or chronic reduction in flow
  • may be occlusive or non-occlusive
25
Q

What are the 3 clinical forms of ischaemic colitis?

A
  1. Transient - acute onset cramping abdominal pains; urge to defaecate; bloody diarrhoea
  2. Chronic segmental ulcerating (ischaemic stricture)
  3. Acute fulminant and gangrenous
26
Q

What are the 3 causes of mesenteric ischaemia?

A
  1. Arterial embolism
  2. Arterial thrombosis
  3. Non-occlusive mesenteric ischaemia
27
Q

What is a colorectal polyp?

A
  • a ‘mucosal protrusion’
  • solitary or multiple (polyposis)
  • pedunculated, sessile or “flat”
28
Q

How are colorectal polyps classified?

A
  • neoplastic
  • hamartomatous
  • inflammatory
  • reactive
29
Q

What are the commonest non-neoplastic polyp in the colo-rectum?

A

hyperplastic polyps

30
Q

Where are hyperplastic polyps located?

A

in the rectum and the sigmoid colon

31
Q

Why is a small, distal hyperplastic polyp safer than a large hyperplastic polyp?

A

-small, distal HPs have no malignant potential

32
Q

What are the two types of hamartomatous polyps?

A
  1. Juvenile polyps

2. Peutz-Jeghers poylps

33
Q

What is the classical appearance of a juvenile polyp?

A

-often spherical and pedunculated

34
Q

What is the most common type of polyp in children?

A

juvenile polyp

35
Q

Where do juvenile polyps typically occur?

A

rectum and distal colon

36
Q

Do juvenile polyps have malignant potential?

A
  • sporadic polyps do not have malignant potential

- juvenile polyps associated with increased risk of gastric and colorectal cancer

37
Q

What is Peutz-Jeghers syndrome?

A
  • autosomal dominant condition
  • mutation in STK11 gene on chromosome 19
  • very rare
38
Q

How does Peutz-Jeghers syndrome present?

A
  • in teens/20s
  • with abdo pain, GI bleeding, anaemia, increased risk of cancer
  • multiple GIT polyps (predominanatly small bowel)
  • muco-cutaneous pigmentation
39
Q

Which benign epithelial tumour a precursor of colorectal cancer in at least 80% of cases?

A

adenomas

40
Q

What features of an adenoma are associated with a higher risk of malignant change?

A
  • “flat” adenomas
  • > size
  • villous and tubule-villous
  • severe (high grade) dysplasia
  • lynch syndrome associated adenomas
41
Q

What are the risk factors for colorectal cancer?

A
  • diet
  • dietary fibre, fat, red meat, folate, calcium
  • obesity
  • alcohol
  • NSAIDs & aspirin
  • HRT and oral contraceptives
  • schistosomiasis
  • pelvic radiation
  • UC and Crohn’s
42
Q

What is FAP?

A
  • autosomal domianant familial adenotomatous polyposis

- associated with multiple benign adenomatous polyps in the colon

43
Q

FAP is due to a mutation in which gene?

A

APC tumour suppressor gene

44
Q

What is Lynch syndrome?

A
  • autosomal dominant
  • 60% lifetime risk of small bowel cancer
  • due to mutations in DNA mismatch repair genes
  • increased risk of endometrial, ovarian, gastric, small bowel, urinary tract and biliary tract cancer
45
Q

Where do 2/3rds of colorectal cancers occur?

A

left colon between splenic flexure and rectum

46
Q

what type of tumour are 95% of colorectal cancers?

A

adenocarcinoma (glandular/ producing mucin)

47
Q

What are the 4 stages of Dukes staging of colorectal cancer?

A

Stage A: adenocarcinoma confined to the bowel wall with no lymph node metastasis
Stage B: adenocarcinoma invading through the bowel wall with no lymph node metastasis
Stage C: adenocarcinoma with regional lymph node metastasis regardless of depth of invasion
Stage D: distant mets present

Clinical Pathology (57 decks)

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