21 - Pathology of the GI Tract - 2 Flashcards Preview

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Flashcards in 21 - Pathology of the GI Tract - 2 Deck (64):
1

Epidemiology of diverticulosis

Common in developed western world
Rare in Africa, Asia, S.America
Common in urban
Relationship with fibre content of diet

2

Pathogenesis of diverticulosis

Increased intra-luminal pressure -> irreguar, uncoordinated peristalsis.

Points of relative weakness in bowel wall

3

Pathology of diverticulosis

Thickening of muscularis propria
Elastosis of taeniae coli
Redundant mucosal folds and ridges
Sacculation and diverticula

4

Diverticular disease - clinical features

Asymptomatic (90%-99%)
Cramping abdominal pain
Alternating constipation and diarrhoea
Acute and chronic complications (10-30%)

5

Diverticular disease - complications

Acute - diverticulitis (20%), perforation, haemorrhage

Chronic - intestinal obstruction, fistula, diverticular colitis, polypoid prolapsing mucosal folds

6

Classification of colitis

inflammation of the colon
Usually mucosal inflammation but occasionally transmural or predominantly submucosal/muscular
Divided into acute / chronic

7

Causes of acute colitis

Acute infective colitis
Antibiotic associate colitis
Drug induced colitis
Acute ischaemic colitis
Acute radiation colitis
Neutropenic colitis
Phlegmonous colitis

8

Causes of chronic colitis

Chronic idiopathic inflammatory bowel disease
Microscopic colitis
Ischaemic colitis
Diverticular colitis
Chronic infective colitis
Diversion colitis
Eosinophilic colitis
Chronic radiation colitis

9

Idiopathic inflammatory bowel disease e.g.s

Ulcerative colitis
Crohn's disease
Indeterminate colitis

10

Epidemiology of IBD - area

5-15 cases per 100,000 pa
Incidence highest in Scandinavia, UK, Northern Europe, USA
Lower in Japan, Southern Europe, Africa

11

Epidemiology of IBD - age

Peak age incidence 20-40 years of age
CD more common in females 1.3:1
UC equally common in males and females

12

Risk factors for IBD

Cigarette smoking
Oral contraceptive
Childhood infections
MMR
Domestic hygiene
Appendicectomy

13

Ulcerative colitis - clinical presentation

Diarrhoea (>66%)
Constipation
Rectal bleeding
Ab pain
Anorexia
Weight loss
Anaemia

14

Ulcerative colitis - complications

Toxic megacolon and perforation
Haemorrhage
Stricture
Carcinoma

15

Crohn's Disease - clinical features

Chronic relapsing disease
Affects all levels of GIT from mouth to anus
Diarrhoea
Colicky ab pain
Palpable ab mass
Weight loss / failure to thrive
Anorexia
Fever
Oral ulcers
Peri-anal disease
Anaemia

16

Crohn's Disease - complications

Toxic megacolon
Perforation
Fistula
Stricture
Haemorrhage
Carcinoma
Short bowel syndrome

17

UC vs Crohns - area of GIT

colon, appendix & terminal ileum vs all parts

18

UC vs Crohns - how it looks in colon

Continuous vs skip lesions

19

UC vs Crohns - involvement of rectum

Always involved vs rectum normal in 50%

20

UC vs Crohns - terminal ileum involvement

10% vs 30% chance

21

UC vs Crohns - pathology

Granular red mucosa with flat, undermining ulcers vs cobblestone appearance with apthoid and fissuring ulcers

22

UC vs Crohns - serosa

Normal vs serositis (fat wrapping)

23

UC vs Crohns - strictures present

Rare vs common

24

UC vs Crohns - fistulae

No spontaneous vs 10% presence

25

UC vs Crohns - anal lesion presence chance

25% vs 75%

26

UC vs Crohns - pathology - invasion of mucosa

Mainly mucosal vs transmural

27

UC vs Crohns - pathology - crypt abscesses

Common vs less common

28

UC vs Crohns - pathology - crypt distortion

Severe vs less severe

29

UC vs Crohns - pathology - granulomas presence

Sarcoid like granulomas present in 60%

30

UC vs Crohns - pathology - polyps

Inflammatory polyps common vs uncommon

31

Extra-intestinal manifestations of IBD - hepatic

Fatty change
Granulomas
PSC
Bile duct carcinoma

32

Extra-intestinal manifestations of IBD - skeletal

Polyarthritis
Sacro-ileitis
Ankylosing spondylitis

33

Extra-intestinal manifestations of IBD - muco-cutaneous

Oral apthoid ulcers
Pyoderma gangrenosum
Erythema nodoum

34

Extra-intestinal manifestations of IBD - ocular

Iritis/uveitis
Episcleritis
Retinitis

35

Extra-intestinal manifestations of IBD - renal

Kidney and bladder stones

36

Extra-intestinal manifestations of IBD - Haematological

Anaemia
Leucocytosis
Thrombocytosis
Thrombo-embolic disease

37

Extra-intestinal manifestations of IBD - systemic

Amyloid
Vasculitis

38

Risk factors in UC

Early age of onset
Duration of disease >8-10 years
Total or extensive colitis
PSC
Family history CRC
Severity of inflammation
Presence of dysplasia

39

Colorectal polyps - what are they?

Mucosal protrusion
Solitary or multiple polyposis
Pedunculated, sessile or flat
Small or large
Due to mucosal or submucosal pathology or a lesion deeper in the bowel wall

40

Colorectal polyps - classifications

Neoplastic, hamartomatous, inflammatory or reactive
Benign or malignant
Epithelial or mesenchymal

41

Hamartomatous polyps types

Peutz-jeghers polyps
Juvenile polyps

42

Hyperplastic polyps

Common
1-5mm in size
Often multiple
Located in rectum & sigmoid colon
Small distal hyperplastic polyps have no malignant potential

43

Juvenile polyp

Spherical and pedunculated
10-30mm
Commonest type of polyp in children
Typically occur in rectum & distal colon
Sporadic polyps have no malignant potential

44

Peutz-jeghers syndrome

AD condition
1 in 50,000 - 1 in 120,000
Present clinically in teens or 20s with ab pain, gi bleeding & anaemia
Multiple GI tract polyps
Muco-cutaneous pigmentation

45

Benign polyp-types

Adenoma
Lipoma
Leiomyoma
Haemangioma
Neurofibroma

46

Malignant polyp-types

Carcinoma
Carcinoid
Leiomyosarcoma
GIST
Lymphoma
Metastatic tumour

47

What is an adenoma?

Benign epithelial tumour

48

What do adenomas look like?

Pedunculated sessile or flat

Villous, tubulo-villous or tubular

Grade histologically by high grade vs low grade

49

What is progression of an adenoma?

To adenocarcinoma

Usually over 10-15 years

50

What factors affect progression of an adenoma?

Flat adenomas = increase
Size (>10mm is usually malignant)
Villous & tubulo-villous
High dysplasia
HNPCC associated adenomas

51

Risk factors for colorectal cancer

Diet - fibre, fat, red meat, folate, calcium
Obesity
Alcohol
NSAIDs
HRT & oral contraceptives
Schistomiasis
Pelvic radiation
Ulcerative colitis and crohn's

52

What 3 letter genetic condition makes you get colorectal cancer?

FAP
AD
100% lifetime risk of large bowel cancer
Multiple benign adenomatous polyps in colon
Mutation in APC tumour suppressor gene

53

What 5 letter genetic condition makes you get colorectal cancer?

HNPCC
1-2% of colorectals
Heriditary non-polyposis colorectal cancer
AD
50-70% lifetime risk
Increased chance of other GI and genitourinary cancers
Due to mutations in DNA mismatch repair genes

54

Where are most colorectal cancers found?

Rectum
Sigmoid colon

55

What type of cancer is most common form of colorectal cancer?

Adenocarcinoma (95%)

56

Where can colorectal cancer spread?

Direct invasion of adjacent tissues

Lymphatically to lymph nodes

Via blood to liver and lung

Transcoelomic mets through peritoneum

57

TNM staging

N0 - no nodes involved
N1 - 1-3 nodes involved
N2 - 4 or more nodes involved

58

Dukes staging

Stages A-D

59

Stage A (Duke's)

Adenocarcinoma confined to bowel wall with no lymph node mets

60

Stage B (Duke's)

Adenocarcinoma invading through bowel wall with no lymph node mets

61

Stage C (Duke's)

Adenocarcinoma with regional lymph node mets regardless of depth of invasion

62

Stage D (Duke's)

Distant mets present

63

Frequency of each Duke stage

A: 15%
B: 35%
C: 45%
D: 20%

64

5 yr survival of each Duke stage

A: 90%
B: 70%
C: 45%
D:

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