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Clinical Pathology > 21 - Pathology of the GI Tract - 2 > Flashcards

21 - Pathology of the GI Tract - 2 Flashcards

1
Q

Epidemiology of diverticulosis

A

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

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2
Q

Pathogenesis of diverticulosis

A

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

Points of relative weakness in bowel wall

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3
Q

Pathology of diverticulosis

A

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

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4
Q

Diverticular disease - clinical features

A

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

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5
Q

Diverticular disease - complications

A

Acute - diverticulitis (20%), perforation, haemorrhage

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

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6
Q

Classification of colitis

A

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

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7
Q

Causes of acute colitis

A 
Acute infective colitis
Antibiotic associate colitis
Drug induced colitis
Acute ischaemic colitis
Acute radiation colitis
Neutropenic colitis
Phlegmonous colitis
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8
Q

Causes of chronic colitis

A 
Chronic idiopathic inflammatory bowel disease
Microscopic colitis
Ischaemic colitis
Diverticular colitis
Chronic infective colitis
Diversion colitis
Eosinophilic colitis
Chronic radiation colitis
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9
Q

Idiopathic inflammatory bowel disease e.g.s

A

Ulcerative colitis
Crohn’s disease
Indeterminate colitis

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10
Q

Epidemiology of IBD - area

A

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

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11
Q

Epidemiology of IBD - age

A

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

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12
Q

Risk factors for IBD

A 
Cigarette smoking
Oral contraceptive
Childhood infections
MMR
Domestic hygiene
Appendicectomy
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13
Q

Ulcerative colitis - clinical presentation

A 
Diarrhoea (>66%)
Constipation
Rectal bleeding
Ab pain
Anorexia
Weight loss
Anaemia
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14
Q

Ulcerative colitis - complications

A

Toxic megacolon and perforation
Haemorrhage
Stricture
Carcinoma

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15
Q

Crohn’s Disease - clinical features

A 
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
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16
Q

Crohn’s Disease - complications

A 
Toxic megacolon
Perforation
Fistula
Stricture
Haemorrhage
Carcinoma
Short bowel syndrome
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17
Q

UC vs Crohns - area of GIT

A

colon, appendix & terminal ileum vs all parts

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18
Q

UC vs Crohns - how it looks in colon

A

Continuous vs skip lesions

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19
Q

UC vs Crohns - involvement of rectum

A

Always involved vs rectum normal in 50%

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20
Q

UC vs Crohns - terminal ileum involvement

A

10% vs 30% chance

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21
Q

UC vs Crohns - pathology

A

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

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22
Q

UC vs Crohns - serosa

A

Normal vs serositis (fat wrapping)

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23
Q

UC vs Crohns - strictures present

A

Rare vs common

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24
Q

UC vs Crohns - fistulae

A

No spontaneous vs 10% presence

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25
Q

UC vs Crohns - anal lesion presence chance

A

25% vs 75%

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26
Q

UC vs Crohns - pathology - invasion of mucosa

A

Mainly mucosal vs transmural

27
Q

UC vs Crohns - pathology - crypt abscesses

A

Common vs less common

28
Q

UC vs Crohns - pathology - crypt distortion

A

Severe vs less severe

29
Q

UC vs Crohns - pathology - granulomas presence

A

Sarcoid like granulomas present in 60%

30
Q

UC vs Crohns - pathology - polyps

A

Inflammatory polyps common vs uncommon

31
Q

Extra-intestinal manifestations of IBD - hepatic

A

Fatty change
Granulomas
PSC
Bile duct carcinoma

32
Q

Extra-intestinal manifestations of IBD - skeletal

A

Polyarthritis
Sacro-ileitis
Ankylosing spondylitis

33
Q

Extra-intestinal manifestations of IBD - muco-cutaneous

A

Oral apthoid ulcers
Pyoderma gangrenosum
Erythema nodoum

34
Q

Extra-intestinal manifestations of IBD - ocular

A

Iritis/uveitis
Episcleritis
Retinitis

35
Q

Extra-intestinal manifestations of IBD - renal

A

Kidney and bladder stones

36
Q

Extra-intestinal manifestations of IBD - Haematological

A

Anaemia
Leucocytosis
Thrombocytosis
Thrombo-embolic disease

37
Q

Extra-intestinal manifestations of IBD - systemic

A

Amyloid

Vasculitis

38
Q

Risk factors in UC

A 
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
Q

Colorectal polyps - what are they?

A 
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
Q

Colorectal polyps - classifications

A

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

41
Q

Hamartomatous polyps types

A

Peutz-jeghers polyps

Juvenile polyps

42
Q

Hyperplastic polyps

A 
Common
1-5mm in size
Often multiple
Located in rectum & sigmoid colon
Small distal hyperplastic polyps have no malignant potential
43
Q

Juvenile polyp

A

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

44
Q

Peutz-jeghers syndrome

A 
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
Q

Benign polyp-types

A 
Adenoma
Lipoma
Leiomyoma
Haemangioma
Neurofibroma
46
Q

Malignant polyp-types

A 
Carcinoma
Carcinoid
Leiomyosarcoma
GIST
Lymphoma
Metastatic tumour
47
Q

What is an adenoma?

A

Benign epithelial tumour

48
Q

What do adenomas look like?

A

Pedunculated sessile or flat

Villous, tubulo-villous or tubular

Grade histologically by high grade vs low grade

49
Q

What is progression of an adenoma?

A

To adenocarcinoma

Usually over 10-15 years

50
Q

What factors affect progression of an adenoma?

A 
Flat adenomas = increase
Size (>10mm is usually malignant)
Villous & tubulo-villous
High dysplasia
HNPCC associated adenomas
51
Q

Risk factors for colorectal cancer

A 
Diet - fibre, fat, red meat, folate, calcium
Obesity
Alcohol
NSAIDs
HRT & oral contraceptives
Schistomiasis
Pelvic radiation
Ulcerative colitis and crohn's
52
Q

What 3 letter genetic condition makes you get colorectal cancer?

A 
FAP
AD
100% lifetime risk of large bowel cancer
Multiple benign adenomatous polyps in colon
Mutation in APC tumour suppressor gene
53
Q

What 5 letter genetic condition makes you get colorectal cancer?

A

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
Q

Where are most colorectal cancers found?

A

Rectum

Sigmoid colon

55
Q

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

A

Adenocarcinoma (95%)

56
Q

Where can colorectal cancer spread?

A

Direct invasion of adjacent tissues

Lymphatically to lymph nodes

Via blood to liver and lung

Transcoelomic mets through peritoneum

57
Q

TNM staging

A

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

58
Q

Dukes staging

A

Stages A-D

59
Q

Stage A (Duke’s)

A

Adenocarcinoma confined to bowel wall with no lymph node mets

60
Q

Stage B (Duke’s)

A

Adenocarcinoma invading through bowel wall with no lymph node mets

61
Q

Stage C (Duke’s)

A

Adenocarcinoma with regional lymph node mets regardless of depth of invasion

62
Q

Stage D (Duke’s)

A

Distant mets present

63
Q

Frequency of each Duke stage

A

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

64
Q

5 yr survival of each Duke stage

A

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

Clinical Pathology (65 decks)

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