Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pathology by week > W15 - Lower GI pathology > Flashcards

W15 - Lower GI pathology Flashcards

1
Q

What does congenital atresia mean?

A

atresia = parts are not fully formed. for example duodenal atresia!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Congenital hirschsprung’s disease

Explain the pathophysiology

A

Absence of ganglion cells in myenteric plexus = distal colon fails to dilate!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Congenital hirschsprung’s disease

Explain the symptoms (4)

A
  1. Constipation
  2. Abdominal distension
  3. Vomiting
  4. overflow diarrhoea
    5.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Congenital hirschsprung’s disease

  • Male:Female ratio?
  • Associated diseases?
A
  • 80:20 M:F
  • Associated with Down’s syndrome (2%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the treatment of Hischsprung’s disease? How to know if fully treated?

A

Treatment = resection of affected (constricted) segment until we reach segment that have ganglion

affected region is = hypertrophied nerve fibers but no ganglia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Define a volvulus

A

–Complete twisting of a loop of bowel at mesenteric base, around vascular pedicle, causing intestinal obstruction +/- infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

________ volvulus is more common in infants, and _________ volvulus is more common in elderly

A

small bowel volvulus is more common in infants, and sigmoid volvulus is more common in elderly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What do you see?

A

This is an example of cecal volvulus.

Volvulus is a twisting of the bowel. Volvulus is most common in adults, where it occurs with equal frequency in small intestine (around a twisted mesentery) and colon (in either sigmoid or cecum which are more mobile). In very young children, volvulus almost always happens in the small intestine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the pathogenesis of diverticular disease?

A

Low fibre diet + other factors lead to high intraluminal pressure, and lead to weak points in wall of bowel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What does this barium enema show?

A

Outpouchings from side of the colon = diverticular disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What does this endoscopy show?

A

All of these smaller holes are the divertulae and some can get filled with food/debris/pus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What do the gross specimen and the histo slide show?

A

gross specimen = outpouchings

histo: outpouching circled

(diverticular disease)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

In which part of the GI tract does diverticular disease usually occur?

A

90% occurs in left colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does this endoscopy show?

A

inflamed diverticulum = diverticulitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What does this gross pathology of the colon show?

A

large bowel and mucosa:

  • very oedematous and red
  • wet corn flakes = pseudomembranes

pseudomembranous colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What does this show?

A

colonic mucosa shows volvanic eruption + puss moving to surface of mucosa = pseudomembranous colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are 5 complications of diverticular disease?

A
  1. Pain
  2. Diverticulitis
  3. Gross perforation
  4. Fistula (bowel, bladder, vagina)
  5. Obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Inflammatory disorders of large bowel can be divided into acute and chronic colitis. Name causes under each category

A

•Acute colitis

–Infection (bacterial, viral, protozoal etc.)

–Drug/toxin (esp.antibiotic)

–Chemotherapy

–Radiation

•Chronic colitis

–Crohn’s

–Ulcerative colitis

–TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What does this histo slide of the colon show?

A

inflammation + haemorrhage = ISCHAEMIC colitis!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is pseudomembranous colitis? What causes it?

A

antibiotic associated colitis with acute onset, cused by protein exotoxins of C diff

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What 2 investigations can be used to confirm pseudomembranous colitis?

A
  1. Histology - characteristic microscopic features (volcanic eruption)
  2. Lab - C diff toxin stool assay
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What do you see?

A

2 skip lesions = Crohn’s Disease!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What do you see?

A

some parts of the colon are inflamed and others are healthy = CD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

This is a histo slide of the colon - what do you see?

A

non-caseating granuloma = CD!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Ischaemic colitis usually happens in segments in ___________

A

watershed zones = splenic flexure (1) and rectosigmois region (2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Name the arteries associated with each:

  • Splenic flexure
  • Rectosigmoid region
A
  • Splenic flexure = SMA, IMA
  • Rectosigmoid region = IMA, internal iliac artery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Name 5 aetiology for ichaemic colitis

A

–Arterial Occlusion: atheroma, thrombosis, embolism

–Venous Occlusion: thrombus, hypercoagulable states

–Small Vessel Disease: DM, cholesterol emboli, vasculitis

–Low Flow States: CCF, haemorrhage, shock

–Obstruction: hernia, intussusception, volvulus, adhesions

36
Q

What do you see in this gross specimen?

A

Right bottom is anus

all inflamed and haemorrhaged

no skip lesion

= UC!

37
Q

What do you see in this gross specimen?

A

All inflamed, no skip lesions = UC!

38
Q

Crohn’s disease - Risk factors (5)

A
  1. Western populations
  2. White 2-5x > non-white
  3. teens-20s
  4. Jewish population
  5. Smoking
39
Q

In terms of the inflammation in CD:

  • area of GI tract affected?
  • thickness of inflammation?
A
  • Whole of GI tract can be affected (mouth to anus)
  • Transmural inflammation
40
Q

What does this endoscopy and histo slide show?

A

hyperplastic polyps = a non-neoplastic polyp of the colon

41
Q

Name 8 charactersitic features of CD

A
  1. Skip lesions
  2. Non-caseating granulomas
  3. sinus/fistula formation
  4. fat wrapping
  5. Thick rubber-hose like wall
  6. Narrow lumen
  7. Cobblestone mucosa
  8. Fissures/abscesses
42
Q

Does CD have extra-intestinal symptoms? If yes, name them

A

Yes

  1. Arthritis
  2. Uveitis
  3. Stomatitis/cheilitis
  4. Skin lesions

–Pyoderma gangrenosum

–Erythema multiforme

–Erythema nodosum

44
Q

What do these endoscopy images show?

A

adenoma polyps of colon

45
Q

What does this gross pathology show?

A

Adenoma polyp of the colon

46
Q

What do these gross specimens and histo slide show?

A

Normal mucosa, a stalk, and a polyp = TUBULAR ADENOMA

47
Q

What does this histo slide show?

A

stalk, polyp = tubular adenoma!

48
Q

What does this histo slide show?

A

villious adenoma (sea cloral looking)

49
Q

What do these show?

A

Villious adenoma = looks like a carpet

Left (low magnification), right (high magnification)

50
Q

What does this gross specimen show?

A

This adenocarcinoma is arising in a villous adenoma. The surface of the neoplasm is polypoid and reddish pink. Hemorrhage from the surface of the tumor creates a guaiac positive stool. This neoplasm was located in the sigmoid colon, just out of reach of digital examination, but easily visualized with sigmoidoscopy

53
Q

UC - in what ethnic group and age group does it present?

A

Whites > non-whites

peak 20-25 years but can affect any age

54
Q

In terms of the inflammation in UC:

  • area of GI tract affected?
  • thickness of inflammation?
A
  • involves rectum and colon in contiguous fashion
  • inflammation confined to mucosa = shallow ulcers
55
Q

Name 3 complications of UC

A
  1. Severe haemorrhage
  2. Toxic megacolon
  3. Adenocarcinoma (20-30x risk)
56
Q

What does this gross specimen show?

A

1000s of polyps = Familial adenomatous polyposis (FAP)

57
Q

Does UC have extra-intestinal symptoms? If yes, name them

A

Yes

  1. Arthritis
  2. Myositis
  3. Uveitis/iritis
  4. Skin changes:
    - Erythema nodosum
    - pyoderma gangrenosum

5. Primary sclerosing cholangitis (PSC)

60
Q

What does this endoscopy show?

A

colon growth, red/angry looking, bleeding, irregular = colorectal carcinoma

61
Q

What do these histo slides of the colorectal region show?

A

Lots of purple, lots of activity and cellular infiltration = colorectal carcinoma

remember: pink is good, purple is bad!

62
Q

tumours of the colon and rectum - polyps => can be either ______________ or _____________

A

tumours of the colon and rectum - polyps => can be either non-neoplastic or neoplastic

63
Q

Name 3 types of non-neoplastic polyps of colon/rectum

A
  1. Hyperplastic
  2. Inflammatory (pseudo-polyps)
  3. Hamartamatous (juvenile, Peutz Jeghers)
65
Q

hyperplastic polyps - can they develop into cancer?

A

no!

66
Q

Name the 3 types of neoplastic polyps of the colon/rectum

A
  1. Tubular adenoma
  2. Tubulovillious adenoma
  3. Villious adenoma
67
Q

What sort of colon polyps most commonly predispace to adenocarcinoma of the colon?

A

Adenomas

(doesn’t matter if tubular or villious)

75
Q

What are the risk factors (3) for a colonic polyp to develop to cancer?

A
  1. Size of polyp (> 4 cm approx 45% have invasive malignancy)
  2. Proportion of villous component
  3. Degree of dysplastic change within polyp
76
Q

Can colon adenomas develop into carcinomas?

A

yes!

77
Q

What are the symptoms of colon adenomas?

A
  1. None (hence why there’s screening for over 60s)
  2. Bleeding/anaemia
78
Q

What 3 familial syndromes predispose to colon polyps?

A
  1. Peutz Jeghers
  2. Familial adenomatous polyposis (FAP)
  3. Hereditary non-polyposis colon cancer (HNPCC)
79
Q

FAP:

  • inheritance mode?
  • age of onset?
  • nature of polyps + # polyps + distrubution of polyps?
A

FAP:

  • inheritance mode = autosomal dominant
  • age of onset = average 25 years
  • nature of polyps + # polyps + distrubution of polyps = adenomatous polyps + 1000s on average (min 100) + mostly colorectal
81
Q

Hereditary non-polyposis colorectal cancer ( HNPCC):

  • inheritance mode?
  • age of onset?
  • nature of polyps + # polyps + distrubution of polyps?
  • extracolonic cancers?
A

Hereditary non-polyposis colorectal cancer ( HNPCC):

  • inheritance mode = autosomal dominant (uncommon disease)
  • age of onset = early age (40s?) colorectal cancer
  • nature of polyps + distrubution of polyps = poorly differentiated and mucinous carcinoma + high frequency proximal to splenic flexure
  • extracolonic cancers = endomtrium, prostate, breast, stomach
82
Q

Colorectal carcinomas:

  • type of cancer?
  • Age of onset?
A
  • 98% are adenocarcinomas
  • age: 60-79 years
83
Q

Risk factors (5) for colorectal carcicnoma?

A
  1. Diet (low fibre, high fat etc)
  2. Lack of exercise
  3. Obesity
  4. Familial
  5. Chronic IBD
86
Q

Symptoms (6) of colorectal carcinoma

A
  • Change of bowel habit
  • Bleeding
  • Anaemia
  • Weight loss
  • Pain
  • Fistula
87
Q

What is grading and staging in terms of colorectal carcinoma?

What staging system is used?

A

Grade = level of differentiation

Stage = how fat has it spread?

Duke’s staging

–A = confined to wall of bowel

–B = through wall of bowel

–C = lymph node metastases

–D = distant metastases

*NB: TNM also used.

88
Q

Impaired blood supply to the colon/bowel most commonly causes what?

A

Ischaemic colitis

89
Q

A patchy inflammatory bowel condition affecting the stomach, small bowel and colon is most likely to be what?

A

Crohn’s Disease

90
Q

A 76 year old man presents with rectal bleeding. The diagnosis that must be exluded first is what?

A

Colorectal carcinoma

Pathology by week (70 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions