Bowel pathology Flashcards
Which part of the colon is affected most by cancer?
Rectum and sigmoid colon
How do colorectal cancers arise?
Adenoma-carcinoma sequence:
Adenomatous polyp forms and eventually becomes an adenocarcinoma.
As the polyp becomes larger it accumulates more gene mutations leading to unregulated cell growth, invasive potential and cancer development
What is dysplasia?
A microscopic diagnosis synonymous with intraepithelial neoplasia.
It is a combination of:
1) cytological atypia
2) architectural disorder
What are the two morphological types of Adenoma in the colon?
Villous
Tubular
Name 2 familial polyposis syndromes
Familial adenomatous polyposis (FAP)
Hereditary non polyposis colon cancer (HNPCC)
What % of people with FAP develop adenocarcinoma before age of 45?
100%!
Which gene is mutated in FAP?
APC
How do we screen for colorectal cancer?
FOB- faecal occult blood
What blood tests should be done to investigate malabsorption?
Bone profile Albumin Hb Fe, folate, B12 Prothrombin time LFTs
Special tests:
Faecal fat
Breath tests- e.g. For bacterial overgrowth measure 14CO2 in breath
How can we test small intestine function?
Xylose absorption test
Xylose is absorbed in the jejunum and excreted unchanged in the urine.
This test is limited by renal function.
What are the 2 subtypes of IBD?
Crohn’s disease
Ulcerative colitis
Which inflammatory bowel disease is granulomatous in nature?
Crohn’s disease
What are the main differences between Crohn’s disease and UC?
CROHN'S DISEASE Mouth to anus Skip lesions Thickened bowel wall Transmural inflammation Granulomas Deep fissuring ulcers Fistula formation Cancer rare Non surveillance
ULCERATIVE COLITIS Colon only Continuous lesion Normal bowel wall thickness Mucosal inflammation No granulomas Pseudopolyp formation No fistula formation Cancer common Surveillance
What are the possible complications of diverticula disease?
Diverticulitis- leading to perforation and abscess formation
Fistulae
Intestinal obstruction due to inflammatory mass
Haemorrhage
Which two viruses are the commonest causes of childhood viral enterocolitis?
Rotavirus (commonest)
Norwalk virus
These can kill!