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Pathology ICSM COPY > Histopathology 16 - Lower GI > Flashcards

Histopathology 16 - Lower GI Flashcards

(55 cards)

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1
Q

what is the aetiology of Hirschprung disease?

A

absence of ganglion cells of myenteric plexus

→ distal colon fails to dilate

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2
Q

What condition is Hirsprung disease associated with?

A

Down’s

RET protooncogene Cr10 abnormality

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3
Q

How is Hirschsprung disease diagnosed?

A

Full thickness biopsy of affected segment - Hypertrophied nerve fibres but NO ganglia

AXR - dilated loop then constricted segment

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4
Q

Treatment for Hirschprung

A

resection of affected (constricted segment)

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5
Q

What is volvulus?

A

Complete twisting of bowel loop around mesenteric base, around a vascular pedicle → intestinal obstruction and infarction

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6
Q

which segment does volvulus affect in children and elderly?

A

children - small bowel

elderly - sigmoid colon

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7
Q

Aetiology of diverticular disease

A

↑ intraluminal pressure → herniation of bowel mucosa through weak points in bowel wall (usually at points of entry of nutrient vessels)

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8
Q

where do most diverticuli occur?

A

L colon

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9
Q

Diagnosis of diverticular disease

A

Barium enema

Endoscopy

Histology

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10
Q

Which drugs cause pseudomembranous colitis?

A

Abx - cipro/ceph’s kill commensals -> C diff allowed to flourish

Exotoxins -> pseudomembranous colitis

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11
Q

What is this?

A

wet cornflakes appearance - peusomembranous colitis

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12
Q

Diagnosis of pseudomembranous colitis

A

C diff toxin stool assay

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13
Q

What is this image showing?

A

volcanic eruption -> pseudomembranous colitis

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14
Q

management for pseudomembranous colitis

A

metronidazole or vancomycin PO>IV (gut absorption)

NO cipro/cef

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15
Q

Causes of chronic colitis

A

IBD, TB

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16
Q

Which IBD is more common

A

UC > Crohn’s

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17
Q

Which part of the bowel is affected in UC?

A

rectum and colon contiguously

backwash ileitis (terminal ileum also inflamed)

small bowel and proximal GI tract not affected

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18
Q

which layers are affected in UC?

A

confined to the mucosa

NOT transmural

superficial ulcers

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19
Q

In what condition are pseudoplyps seen?

A

UC - islands of regenerating mucosa bulge into lumen -> pseudopolyps

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20
Q

How do symptoms differ in IBD?

A

UC - more bloody diarrhoea

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21
Q

Extra intestinal manifestations of IBD

A
  • Malabsorption and Fe def -> anaemia, stomatitis
  • Eyes - uveitis, conjunctivitis
  • Skin - erythema nodosum/multiforme, pyoderma gangrenosum, clubbing
  • Joints - migratory asymmetrical polyarthropathy of large joints, sacroilitis, myositis, ankylosing spondylitis
  • Liver - pericholangitis, PSC (UC>CD), steatosis
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22
Q

Complications of UC

A

severe haemorrhage

toxic megacolon

adenocarcinoma

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23
Q

What is this?

Study These Flashcards
A

UC -> continuous - no skip lesions

24
Q

What will histology show in UC?

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A

confined to mucosa and inflammtory infiltrate

25
Which part is affected in Crohn's?
entire GI tract from mouth to anus most commonly large bowel and terminal ileum
26
What layers are affected in CD?
transmural
27
Which IBD are non-caeseatingn granulomas seen in?
Crohns
28
Histological features of CD
Skip lesiosn Cobblestone mucosa - areas of healthy mucosa above diseased apthous ulcers, rosethorn ulcers
29
Complications of CD
strictures fistulae abscess perforation
30
Causes of ischaemic colitis
arterial/venous occlusion, small vessel disease (DM, cholesterol, vasculitis), low flow states, obstruction
31
where does ischaemic colitis usually occur?
watershed zones (furthest from supply) splenic flexure - SMA + IMA rectosigmoid - IMA + internal iliac artery mucosal, mural or transmural (leading to perforation)
32
Name 3 types of non neoplastic polyps
hyperplastic inflammatory ('pseudo-polyps') hamartomatous
33
What is this?
**wiggly wobbly** Hyperplastic plyps
34
What are hyperplastic polyps?
shedding of epithelium -\> cell buildup
35
What are hamatomatous polyps?
found sporadically in some genetic/acquired syndromes * juvenile, * Peutz Jeghers (mucocutanous hyperpigmentation, freckles around mouth, palms and soles)
36
what are adenomas?
benign dysplastic lesions precursor to most adenocarcinomas (but most remain benign)
37
what familial syndromes are associated with adenomas?
* Peutz Jegher's * FAP * HNPCC/Lynch syndrome
38
Genetics of FAP
Chr5q21 - APC tumour suppressor gene AD inheritence
39
What is FAP?
\>100 adenomatous polyps, mostly colorectal virtually 100% → cancer (needs prophylactic colectomy)
40
What mutation is associated with FAP?
APC
41
What is Garner's syndrome?
Subtype of FAP - distinct extra intestinal manifestations * Multiple osteomas of skull and mandible * Epidermoid cysts * Desmoid tumours * Dental caries, unerrupted supernumerary teeth * Post-surgical mesenteric fibromatoses
42
Genetics of HNPCC
DNA mismatch repair genes mutated Numerous DNA replication errors (RER)
43
Presentation of HNPCC
early age onset coloCa Ca proximal to splenic flexure Poorly differentiated and mucinous carcinoma are more frequent Multiple synchronous cancers Can cause extra-colonic cancers -\> endometrium, prostate, breast, stomach
44
What does this show?
polyp on a stalk - adenoma villous
45
How are adenomas calssified?
* Tubular (pink = normal mucosa -\> stalk -\> purple =polyp) * Villous (flatter, no stalk) * tubulovillous
46
risk factors for adenoma carcinoma sequence
Size of polyp (\> 4 cm = 45% invasive risk) Proportion of villous component Degree of dysplastic change within polyp
47
What is the most common subtype of CRC?
adenocarcinoma (98%)
48
What blood marker can be used to monitor disease?
CEA - carcinoembryonic antigen
49
What staging system is used for CRC?
Prev Duke's A = confined to bowel wall B = through bowel wall C = lymph node metastases D = distant metastases Now use TNM
50
What is carcinoid syndrome?
enterochromaffin cell tumours - produce 5-HT
51
What are symptoms of carcinoid?
bronchoconstriction, flushing, diarrhoea
52
Investigation of carcinoid
24 hr urine 5-HIAA (main metabolite of serotonin)
53
Treatment of carcinoid
octreotide (somatostatin analogue)
54
What are some examples of mesenchymal lesions in the colon?
Stromal tumours Lipoma Sarcoma
55
S/S of CRC
R sided - Fe def anaemia, weight loss L sided - change in bowel habit, crampy LLQ pain

Pathology ICSM COPY (90 decks)

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