Histopathology 16: Lower GI Flashcards

1
Q

A 2 year old boy with down syndrome presents with symptoms of constipation with overflow diarrhoea and vomiting. There are signs of abdominal distension.

What is the most likely diagnosis ?

A

Hirschsprung’s disease

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2
Q

Where does Volvulus tend to occur in children? Where does it occur in adults ?

A
Children= small bowel 
Adults = Sigmoid colon
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3
Q

Which organism causes pseudomembranous colitis ?

A

C.difficile

antibiotics kill commensal bacteria and allow C.diff to flourish. It’s endotoxins cause Pseudomembranous colitis

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4
Q

List 5 features of Crohn’s disease ?

A
Transmural inflammation 
Skip lesions 
Non-caseating granulomas 
Cobblestone mucosa 
Can affect anus to mouth
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5
Q

List 5 features of Ulcerative colitis ?

A

Involves rectum and Colon but not small bowel
Inflammation confined to the mucosa
Inflammation is continuous, no skip lesions
Backwash ileitis- terminal ileum gets involved
Can cause toxic megacolon

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6
Q

List 3 skin lesions seen in Crohn’s ?

A

Erythema multiforme
Erythema nodosum
Pyoderma gangrenosum

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7
Q

List 3 familial syndromes characterised by polyps ?

A

Familial adenomatous polyposis
Peutz-jeghers syndrome
Hereditary non polyposis colorectal cancer (HNPCC)

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8
Q

Name 2 subtypes of FAP ?

A

Gardner’s syndrome

Turcot syndrome

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9
Q

List 5 extra-intestinal manifestations of Gardner’s syndrome ?

A

Multiple Osteomas of the skull and mandible
Epidermal cysts
Desmoid tumours
Dental carries/ unerrupted supernumerary teeth
Post surgical mesenteric fibromatoses

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10
Q

List 3 features seen in carcinoid syndrome ?

A
  • Flushing
  • Diarrhoea
  • Bronchoconstriction / tachycardia
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11
Q

Which test is used to diagnose carcinoid syndrome ?

A
  • 24 hour urine 5-HIAA
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12
Q

Which paediatric disease presents with up to 100 hamartomatous polyps in children <5 years old ?

A

Juvenile polyposis

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13
Q

List 3 features of peutz-jeghers syndrome ?

A
  • multiple hamartomatous polyps
  • freckles around mouth
  • mucocutaenous hyperpigmentation
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14
Q

Which staging system is used to stage colorectal cancer ?

A

-Duke’s staging

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15
Q

Which tumour marker identifies colorectal cancer ?

A

CEA

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16
Q

list 3 congenital disorders of the lower GI tract

A

atresia/ stenosis
duplication
imperforate anus

17
Q

where do 90% of diverticuli occur

A

left colon

18
Q

therapy for pseudomembranous colitis

A

metronidazole or vancomycin

19
Q

at what sites do ischaemic colitis/ infarction occur

A
segments in 'watershed' zones 
splenic flexure (SMA and IMA), rectosigmoid (IMA and IIA)
20
Q

list causes of ischaemic colitis

A

arterial occlusion
venous occlusion
small vessel disease - DM, cholesterol, emboli, vasculitis
low flow states - shock, haemorrhage
obstruction - hernia, intussusception, adhesions

21
Q

list some extra-intestinal features of crohns disease

A

arthritis
uveitis
stomatitis
skin - PG, EM, EN

22
Q

list 3 complications of UC

A

severe haemorrhage
toxic megacolon
adenocarcinoma

23
Q

list some extra-intestinal features of UC

A
arthritis 
myositis 
uveitis/iritis 
EN, PG
PSC
24
Q

list 3 polyps - non neoplastic tumours of the colon and rectum

A

hyperplastic
inflammatory (pseudo-polyps)
hamartomatous (juvenile, peutz jeghers)

25
Q

list 3 neoplastic polyps of the colon and rectum

A

tubular adenoma
tubulovillous adenoma
villous adenoma

26
Q

list risk factors for the development of cancer from a polyp

A

size of polyp (>4cm - 455 have invasive malignancy)
proportion of villous component
degree of dysplastic change within the polyp

27
Q

what is FAP/APC

A
AD
average age of onset = 25 yrs 
minimum 100 polyps 
average 1000 
chromosome 5q21, APC TS gene 
nearly 100% develop cancer within 10 years
28
Q

list features of HNPCC

A
uncommon AD 
1 of 4 DNA MM repair genes involved 
numerous DNA replication errors 
early age CC 
mainly proximal to splenic flexure 
poorly differentiated and mucinous more common 
multiple synchronous cancers 
extra-colonic cancers - endometrium, prostate, breast, stomach