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Flashcards in diverticula of the bowel Deck (85):
1

what are the 2 types of diverticulum.

1- True "congenital" diverticulum e.g. merkels lined by all layers of the GI wall.
2-acquired "false" pseudo diverticulum.

2

Is diverticulosis of the colon acquired or congenital

acquired

3

define diverticulosis of the colon.

protrusions of the mucosa and submucosa through the bowel wall.

4

what layers of the gut wall does diverticulosis of the colon involve

mucosa and submucosa

5

in which part of the colon does diverticulosis of the colon typically occur

sigmoid colon

6

where are divertculi in the colon located

between the mesenteric and antimesentrtic taneia coli

7

what type of diet protects you from developing diverticula

high fibre diets

8

what is the pathogenesis of diverticulosis formation

increased intra-luminal pressure- ➢ Irregular , uncoordinated peristalsis.

mucosal outpouches at points of relative weakness occur in the bowel.
weakness are due to penetration by nutrient arteries between the mesenteric and anti mesenteric taneia coli and age related elastosis in the taenea coli

9

what change occurs in the bowel bowel in prediverticular disease

the muscularis propria thickens.

10

what are the clinical features of diverticular disease

most commonly asymptomatic
cramping and abdominal pain
alternating constipation and diarrhoea
acute and chronic complications

11

what are acute complications of diverticula disease

diverticultitis- inflammation
peridiverticular abcess- ulceration caused by bacteria resulting in an abcess.
perforation
haemorrage- ulceration in an artery or vein.

12

what are the chronic complications of diverticula disease

intestinal obstruction
fistula- urinary, bladder, vagina.
diverticular colitis- inflammation of the lining
polypoid prolapsing mucosal folds.

13

common pathogens which cause acute colitis

campylobacter, salmonella, CMV.

14

what can cause acute colitis

infection, immunosuppressed people, antibiotics, drugs, ischameia, radiation, neutropenia.

15

what causes chronic colitis

ischemia, diverticular, chronic infections (TB), eosiniphils, radiation, collagen and lymphocytes

16

what 3 conditions fall under the category of idiopathic inflammatory disease

ulcerative colitis
crohns
intermediate colitis-( mix of crowns and UC)

17

crohns of ulcerative colitis- which one is more common in children and females

Crohns

18

risk factors for UC and crohns.

Oral contraceptives
Childhood infections
domestic hygiene
familial clustering

19

what 2 substances are protective against UC but are risk factors of crohns

smoking, appendicectomy.

20

clinical presentation of ulcerative colitis

diarrhoea
constipation
rectal bleeding
abdominal pain
anorexia
weight loss
anaemia.

21

complications of ulcerative colitis

toxic mega colon- – Bowel wall dilates and thins, gas and fluid accumulate and can perforate release it.
treatment is steroids and cephlasporin
haemorrhage
stricture
carcinoma

22

features macroscopically for ulcerative colitis

rectum and extends to rest of colon

23

define proctosigmoditus

sigmoid and rectum

24

define pan colitis

rectum to caecum

25

is ulcerative colitis continous throughout the affected region

YES.

26

freatures microscopically of ulcerative coltiis

inflammation of restrict mucosa
Crypt abscess typical of UC- contains neutrophils.

27

clinical features of crohns disease

chronic relapsing and flare ups.
mout to anus
diarrhoaea
colicky abdominal pain
palpable abdominal mass
weight loss/failure to thrive
anorexia
fever
oral ulcers
perinanal disease- strictures and fistulas
anaemia

28

which part of the colon does crowns disease typically affects

iliocolic region

29

features of a macroscopic crohns colon

illiocolic- thickened and inflamed bowel lumen
cobblestone appearance due to longitudinal and transverse strictures.
pathcy appearance- skip lesions
apthoid ulcer

30

features of a microscopic crohns colon

compact epitheliod cell granuloma- all layers of the bowel wall, found in liver and regional lymph nodes.

31

complications of crowns

toxic mega colon
perforation
fistula
stricture
haemorrhage
carcinoma
short bowel syndrome- from numerous resections

32

which condition is transmural crohn or ulcerative colitis

crohns

33

which condition only affect the mucosal layer

ulcerative colitis

34

which condition are granulomas present crohn or ulcerative colitis

crohns

35

which condition are crypt abcesseses common

ulcerative colitis.

36

what hepatic manifestations occur in IBD

Fatty chnage
granulomas
primary scleroising colongitis-inflammation and fibrosis scarring of the bile ducts.
bile duct carcinoma

37

what skeletal changes occur in IBD

polyarthritis
sacro-iletis
ankolysing spondylitis

38

what mucocutaneous changes occur in IBD

Oral apthoid ulcers
Pyoderma gangrenosum- ulcers
Erythema nodosum- skin inflammation

39

what ocular changes occur in IBD

• Iritis/uveitis
• Episcleritis
• Retinitis- inflammation of the retina.

40

what renal changes occur in IBD

• Kidney and bladder stones

41

what haematological changes occur in IBD

• Anaemia
• Leucocytosis
• Thrombocytosis
• Thrombo-embolic disease- DVT

42

what systemic changes occur in IBD

• Amyloid deposition.
• vasculitis

43

what are the risk factors for developing colorectal cancer

• Early age of onset
• Duration of disease
• Total or extensive colitis- how much colon is affecting.
• PSC
• Family History of cancer.
• Severity of inflammation (pseudopolyps)
• Presence of dysplasia (pre- malignant neoplasm).

44

how is colitis surveillance performed

• After 10 years UC colonscipic is offered to all patients every few years.
• Take a biopsy and use it to see if any dysplasia is present.
• The more active the disease the increased frequency of colonscopy.

45

what layer of the colon forms colorectal polyps

mucosal protrusion

46

3 types of colorectal polyps

sensile- no stalk
pedunculated- stalk
flat

47

How are polyps classified

• Neoplastic, harmartomatous (disorganised proliferation of normal bowel), inflammatory and reactive.
• Benign or malignant
• Epithelial or mesenchymal

48

the most common type of non-neoplastic polyp

hyperplastic polyp

49

is Harmartomtous polyp begin or malignant

beingin

50

2 conditions which result in harmartomtous polyps

Peutz-jeghers polyps
Juvenile polyps

51

most common site for hyper plastic polyp

rectum and sigmoid

52

are hyperplactic polyps malignant or benign

Small distal HP’s have NO malignant potential.

Large right sided hyperplastic (caecum) polyps sessile serrated (broad-based polypoid lesion without a clear stalk.) may give rise to microsatellite unstable carcinoma

53

commoest polyp in children

juvenille polyp

54

what shape is a juvenile polyp

spherical

55

most common site for juvenile polyps

rectum and distal colon

56

are juvenile polyps malignant or benign

Juvenile polyposis (lots of them) associated with increased risk of colorectal and gastric cancer- FH

Sporadic polyps have no malignant potential

57

what type of genetic condition is PEUTZ-JEGHERS SYNDROME

autosomal dominat

58

clinical presentation of PEUTZ-JEGHERS SYNDROME

abdominal pain (intussusception), gastro-intestinal bleeding and anaemia.
Muco-cutaneous pigmentation- brown patches lips, fingers toes and lining of cheeks.

59

where are PEUTZ-JEGHERS SYNDROME polyps found.

small bowel and stomach.
can form in the gallbladder, urinary bladder and nasopharynx.

60

what cancer do PEUTZ-JEGHERS SYNDROME predispose you to

colon, stomach and breast.

61

what are the different types of benign neoplastic polyps

• Adenoma
• Lipoma
• Leiomyoma
• Haemangioma
• Neurofibroma

62

what are the different types of malignant neoplastic polyps

• Carcinoma
• Carcinoid
• Leiomyoscarcoma
• GIST
• Lymphoma
• Metastatic tumour.

63

what type of tumours are adenomas

benign
epitheliod tumour

64

what shape are adenomas

polyp shape

65

what typeof cancer are adenomas precursors to

colorectal cancer.

66

which part of the colon has lager adenomas

recto-sigmoid and caecum

67

features of macroscopic adenomas

pedunculated(stalk), sessile(broad base) or flat.

Architectural Type : villous, Tubulo-villous or tubular- villi or smooth surface with tubules.

68

what types of adenoma are more likely to form cancer
(think about size and architecture)

larger
Flat adenomas- only raised above the mucosa and higher risk of dysplasia.
villious

69

risk factors for colorectal cancer.

sporadic- most common
FH- single gene, HNPCC, FAP
IBD,diet, obesity, alcohol, • Hormone replacement therapy and oral contraceptives, Schistosomiasis, Pelvic radiation

70

what form of medication id protective for colorectal cancer

NSAIDS

71

which inherited codlins predisposes 100% to colorectal cancer

FAP

72

what types of polyps does FAP cause

multiple benign adenomatous polyps

73

HNPPC an FAP are both what type of genetic condition

autosomal dominat

74

what condition does a mutation in a APC tumour suppressor gene cause

FAP

75

what condition does a mutation in a DNA mismatch repair gene cause

HNPCC

76

what cancers other than colorectal does HNPCC predispose to

endometrial, ovarian, gastric, small bowel, urinary tract and billary tract cancer.

77

where are most colorectal cancers located

2/3 of cancer’s are distal to the splenic flexure.

78

what are the different types of colorectal cancer in terms of different tumours

Adenocarcinoma-most common
Adenosquamous carcinoma
Squamous cell carcinoma
Neuroendocrine carcinoma
undiffrentaited carcinome
medually carcinoma

79

how are tumours graded

Well differentiated
Moderately well differentiated
Poorly differentiated - bad prognosis

80

how does colorectal cancer spread

• Direct invasion of adjacent tissues
• Lymphatic metastasis (lymph nodes)
• Haematogenous metastasis (liver and lung)
• Transoelomic (peritoneal) metasis
• Iatrogenic spread eg. Needle track recurrence, port site recurrence.

81

what 2 forms of staging are used for colorectal cancer

TNM
Duke's staging

82

what does the T part of TNM determine

tumour- what layers has the tumour crossed.
• T1-mucosa and some submucosa.
• T2- muscularis propria
• T3-connective tissue
• T4-ulcertive peritoneal lining perforation or invades another organ e.g. vagina etc.

83

what does the N part of TNM determine

nodes
➢ N0 no nodes involved
➢ N1 1 – 3 nodes involved
➢ N2 4 or more nodes involved

84

what does the M part of TNM determine

metastases
➢ M= distal metastases.
➢ M0= NO metastases
➢ M1=METASESES.

85

how many stages are there in duke's staging
and what defines in each stage

4
• Stage A : adenocarcinoma confined to the bowel wall with no lymph node metastasis
• Stage B : adenocarcinoma invading through the bowel wall with no lymph node metastasis
• Stage C : adenocarcinoma with regional lymph node metastasis regardless of depth of invasion
• Stage D : distant metastasis present

stage D worst.