Colon Pathology

Question 1

What is peristalsis in the small and large intestine mediated by?

Answer 1

Intrinsically- myenteric plexus
Extrinsically- autonomic innervation

Question 2

Which two plexus’s are found within the myenteric plexus?

Answer 2

Meissner’s plexus
Auerbach plexus

Question 3

Where would you find Meissner’s plexus?

Answer 3

Base of submucosa

Question 4

Where would you find Auerbach plexus?

Answer 4

Between circular and longitudal muscularis layers

Question 5

What is idiopathic inflammatory bowel disease?

Answer 5

Chronic inflammatory conditions which results in constant inappropriate activation of the mucosal immune system because of normal intraluminal flora.

->wordy but read, it makes sense :)

Question 6

What are the two main types of idiopathic inflammatory bowel diseases?

Answer 6

Crohn’s disease
Ulcerative colitis

Question 7

Which part of the GIT can Crohn’s affect?

Answer 7

Any

Question 8

Which part of the body can ulcerative colitis affect?

Answer 8

Colon

Question 9

Why may there be strong immune defences against normal flora in the body in individuals with idiopathic inflammatory bowel disease?

Answer 9

May be defects in the epithelial barrier function meaning immune cells are exposed to flora which doesn’t usually happen

Question 10

Genetics can be a cause for both CD’s and UC.
Which gene mutation can cause CD?

Answer 10

NOD2 gene mutation

Question 11

How can IBD be diagnosed?

Answer 11

Requires-
-Clinical history
-Radiographic examination
-Pathological correlation

Question 12

Which autoimmune antibody can be found in patients with IBD?

Answer 12

pANCA (perinuclear antineutrophilic cytoplasmic antibody)

Question 13

What % of Crohn’s patients are pANCA positive?

Answer 13

Only 11%

Question 14

What % of UC patients are pANCA positive?

Answer 14

75%

->think Panko breadcrumbs, if they get stuck in your throat make you go UC!
gal idk i’m trying to help

Question 15

Which age groups tend to be more likely to get UC?

Answer 15

Peaks at 20-30yrs AND 70-80yrs

Question 16

Where can UC be localised to?

Answer 16

Rectum

Question 17

Which other organ may be affected by UC despite in only affecting the colon?

Answer 17

Appendix
Inflammation may also spread backwards towards small intestine

Question 18

Describe the pathology of UC

Answer 18

Inflammation affecting rectum to proximal.
Pseudocysts and ulceration

Question 19

Why are those with UC at a higher risk of cancer?

Answer 19

Epithelial layer gets repaired so many times there starts to be defects. This causes dysplasia, meaning cells divide of their own accord and this is a step towards malignancy.

Question 20

What are some of the complications of UC?

Answer 20

Perforation
Haemorrhage
Toxic dilatation

Question 21

Are males or females more likely to be affected by Crohn’s?

Answer 21

Females

-> think of Amy Dowden, only person I am aware of having Crohn’s, she’s a women…sorry, memory aids!

Question 22

At which age would you be most likely to develop Crohn’s?

Answer 22

Any age but peaks at 20-30 and 60-70

Question 23

Where do most cases of Crohn’s first present?

Answer 23

Small intestine

Question 24

Describe the pathology of Crohn’s.

Answer 24

Granular serosa, dull grey colour
Wrapped in mesentery fat, almost in a protective way
Thickened wall
Narrowed lumen
Ulceration causing ‘cobblestone’ appearance

Question 25

Are there granulomas present in UC?

Answer 25

No

Question 26

Are there granulomas present in CD?

Answer 26

Yes- non-caseating granulomas

Question 27

What can be a complication of CD in the small intestine?

Answer 27

Malabsorption

Question 28

What are some complications of CD?

Answer 28

Strictures Fistulas, abscesses Perforation Increased risk of cancer

Question 29

Ischaemic enteritis is another type of IBD. What happens in it?

Answer 29

Impinged blood supply to bowel ->think, ischaemia, lack of blood

Question 30

What can happen as a result of ischaemic enteritis?

Answer 30

Bowel can die

Question 31

Where can ischaemic enteritis affect?

Answer 31

Small intestine, large intestine or both

Question 32

What can cause infarction in ischaemic enteritis?

Answer 32

Occlusion to any one of the main three branches supplying the bowel (coeliac trunk, SMA, IMA)

Question 33

List some of the predisposing conditions which can lead to ischaemic enteritis.

Answer 33

-Arterial thrombosis (severe atherosclerosis, oral contraceptives, dissecting aneurysms) -Arterial embolism (cardiac vegetations, acute atheroembolism, cholesterol embolism). -Non-occlusive ischaemia (cardiac failure, shock, vasoconstrictives drugs like beta blockers)

Question 34

What happens in radiation colitis?

Answer 34

Inflammation of intestines after radiotherapy as can impair normal proliferating nature of the cells.

Question 35

Why does radiotherapy affect the cells in the intestines?

Answer 35

It targets rapidly dividing cells, which the colon cells are

Question 36

What are the symptoms of radiative colitis?

Answer 36

Anorexia Abdominal cramps Diarrhoea Malabsorption

Question 37

What happens to the appendix with age?

Answer 37

It regresses (gets smaller)

Question 38

What is acute appendicits?

Answer 38

Inflammation of the appendix

Question 39

What is a common cause of acute appendicitis?

Answer 39

-Faecal stone blocking and causing inflammation -Enterobius vermicularis (type of worm)

Question 40

What can happen to the appendix if it is inflammed?

Answer 40

May perforate

Question 41

What is dysplasia?

Answer 41

Epithelial cells start dividing in an uncontrolled way

Question 42

How does dysplasia usually present in the GIT?

Answer 42

In the form of a polyp/adenoma

Question 43

What would be seen histologically in low grade dysplasia?

Answer 43

Increased number of nucelli Increased nucelli size Reduced mucin

Question 44

What would be seen histologically in high grade dysplasia?

Answer 44

Very crowded Very irregular ->not yet invasive

Question 45

What are some of the risk factors for colorectal adenocarcinoma?

Answer 45

Lifestyle Family history IBD Genetics

Question 46

Describe how a right sided colorectal adenocarcinoma would present.

Answer 46

Anaemia Vague pain Weakness Obstruction

Question 47

Describe how a left sided colorectal adenocarcinoma would present.

Answer 47

Bleeding Altered bowel habit Obstruction

Question 48

What would a left sided colorectal adenocarcinoma look like?

Answer 48

Would encircle the circumference of the lumen, making it narrower

Question 49

What would a right sided colorectal adenocarcinoma look like?

Answer 49

Exophytic lesions, polypoid

Question 50

What type of staging is used for tumours?

Answer 50

TNM