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Pathology > H - Lower GI > Flashcards

H - Lower GI Flashcards

(72 cards)

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1
Q

6 General consequences of lower GI conditions

A

Change in bowel habits
Bleeding
Perforation
Fistula formation
Obstruction
Systemic illness

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2
Q

4 congenital disorders of lower GI

A

Atresia
Stenosis
Duplication
Agenesis

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3
Q

What is atresia

A

No communication between 2 bits of bowel

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4
Q

What is hirschprungs

A

Absence of ganglion cells in submucosal and myenteric plexus

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5
Q

Patterns of hirschprungs

A

Starts in rectum and extends proximally

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6
Q

RFs for hirschprungs

A

Male
Downs

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7
Q

What mutation is present to cause hirschprungs

A

RET proto oncogene

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8
Q

Tx of hirschprungs

A

Resection of affected segment with frozen section to identify any ganglion cells and where they end

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9
Q

PC of hirschprungs

A

Failure to pass meconium in first 24hrs

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10
Q

General causes of bowel obstruction

A

Adhesions
Hernias
Extrinsic mass
Volvulus

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11
Q

Where do infants vs elderly get volvulus

A

Infants = SB
Elderly = sigmoid colon

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12
Q

Pathogenesis of diverticular disease

A

Low fibre diet
High intraluminal pressure
Weak points of bowel
Diverticular formed

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13
Q

What makes a diverticular a true one vs pseudo

A

True has ALL bowel wall layers in them

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14
Q

Where are 90% of diverticular found

A

L colon esp sigmoid

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15
Q

Complications of diverticular disease

A

Pain
Diverticulitis
Gross perforation
Fistula - bowel / bladder / vagina
Obstruction

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16
Q

Broad causes of acute colitis

A

Infection
Drugs / toxins
Chemo / radio

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17
Q

Infections that cause acute colitis

A

Fungal - Candida
Viral - CMV
Bacteria - salmonella
Protozoa - entamoeba histolytica

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18
Q

Who gets CMV colitis

A

Imm supp

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19
Q

Causes of chronic colitis

A

Crohns
UC
TB

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20
Q

When do you get pseudomembranous colitis

A

After ABx Tx

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21
Q

What is pseudomembranous colitis

A

Pseudomembrane formation with acute colitis

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22
Q

Cause of pseudomembranous colitis

A

Protein exotoxins of c.diff

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23
Q

Histology of pseudomembranous colitis

A

Mushroom cloud appearance

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24
Q

Ix for pseudomembranous colitis

A

C.diff stool assay

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25
Where do you get ischaemic colitis
Watershed zones - splenic flexures (SMA/IMA) or rectosigmoid (IMA/int iliac)
26
Patterns of ischaemic colitis
Mucosal Mural Transmural
27
5 causes of ischaemic colitis with examples
Arterial - atheroma, thrombosis Venous - thrombus, hypercoagulation Small vessel disease - emboli, vasculitis Low flow states - CCF, haemorrhage, shock Obstruction - hernia, intussusception, volvulus, adhesions
28
Risk of transmural ischaemic colitis
Perforation
29
What is idiopathic chronic IBD
Diagnosis of exclusion that isn’t Crohns or UC
30
Potential RFs for idiopathic chronic IBD
Genetics - HLA Infection - measles, mycobacteria Abnormal host immunity Microbiome
31
RFs for Crohns
Western Young adult White Jewish Smoking
32
Features / patterns of IBD
Mouth to anus Skip lesions Non caseating granulomas Transmural inflammation - fistulae, fissures, sinuses Cobblestoned appearance
33
Extra intestinal features of Crohns
Arthritis Uveitis Stomatitis Cheilitis Skin lesions - erythema multiforme / nodosum
34
Which is the more common IBD
UC
35
RFs of UC
White 20-25
36
Patterns / features of UC
Rectum to colon in continuous fashion Mucosal inflammation not Transmural
37
Complications of UC
Severe haemorrhage Toxic mega colon Adenocarcinoma
38
Extra intestinal complications of UC
PSC Erythema nodosum, pyoderma gangrenosum Uveitis / iritis Myositis Arthritis
39
Which IBDs get crypt abscesses
BOTH
40
7 Types of tumour of large bowel
Non neoplastic polyps Neoplastic epithelial lesions - adenoma, adenocarcinoma, neuroendocrine Mesenchymal - lipoma, leiomyoma Lymphoma
41
Types of non neoplastic polyps
Hyperplastic Sessile serrated Pseudopolyps - inflammation Hamartomatous - juvenile, Peutz Jeghers
42
Peutz Jeghers has hamartomatous polyps and what other feature
Pigment around lips
43
Which type of polyp may be a risk factor for cancer
Sessile serrated lesions
44
Types of neoplastic polyps
Tubular adenoma Tubulovillous adenoma Villus adenoma
45
Tubular vs villous adenoma shape
Tubular = can be pedunculated (stalk), round, flat surface Villous = finger like projections, non flat surface
46
What colour do neoplastic polyps look and why
Dark - high nuclear:cytoplasmic ratio
47
RFs for cancer in individual polyps
Size Proportion of villous component Degree of dysplasia
48
When do adenomas come vs carcinoma
Adenomas come 10 years before carcinomas
49
Do adenomas affect the risk of carcinoma
YES - risk proportional to number of adenomas
50
Sx of adenomas
Often non - can bleed / anaemia Sx
51
3 familial syndromes of colorectal cancer
Peutz Jagher FAP - familial adenomatous polyposis HNPCC - Hereditary non polyposis colon cancer
52
Age peak of FAP
25
53
Inheritance of FAP
AD
54
Mutation of FAP
Chr 5q21 APC TSG
55
What % of FAP get cancer in 10 years
100%
56
Dx cut off for FAP
>100 polyps but usually ~1000
57
What other type of cancer is associated with FAP
5% get duodenal periampullary cancer
58
What is Gardeners syndrome
FAP + extra intestinal Sx eg osteomas / Desmoid tumours
59
What is Turcot syndrome
FAP + brain tumours
60
What is HNPCC aka
Lynch syndrome
61
Inheritance of HNPCC
AD
62
What % of colorectal cancers is HNPCC
3-5%
63
Cause of HNPCC
1 of 4 DNA mismatch repair genes involved - resulting in numerous DNA replication errors
64
Features of the cancer you get in HNPCC
in caecum (opposite to normal) Poorly differentiated Mucinous carcinoma Multiple synchronous cancers
65
Other extracolonic cancers associated with HNPCC
ENDOMETRIUM Prostate Breast Stomach
66
What % of bowel carcinomas are adenocarcinomas
98
67
Peak age of carcinoma of bowel
60-79
68
RFs for carcinoma of bowel
Familial Diet - low fibre, high fat Lack of exercise Obesity Adenomas IBD
69
Sx of bowel carcinoma
Change in bowel habit Anaemia PR bleed Weight loss
70
What guide is used for grade / stage
TNM not dukes
71
TNM T stage 1 of bowel carcinoma
Submucosa only
72
TNM T stage 4 of bowel carcinoma
Into peritoneum

Pathology (87 decks)

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