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HistoPath > Histopathology 16: Lower GI > Flashcards

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 features of Crohn’s disease ?

A
  • ENTIRE GIT affected (mainly terminal ileum and large bowel)
  • Transmural inflammation (all the way through the wall)
  • Skip lesions
  • Non-caseating granulomas
  • Cobblestone mucosa
  • Can affect anus to mouth
  • Fistula formation

Extra-intestinal (NB also get these in UC):

  • Arthritis
  • Uveitis
  • Stomatitis/ cheilitis
  • Skin lesions: erythema multiforme, nodosum
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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 (NOT transmural like Crohn’s)
  • Inflammation is continuous, no skip lesions
  • Backwash ileitis- terminal ileum gets involved
  • Can cause toxic megacolon
  • ULCERS
  • mucosa regenerates forming pseudopolyps
  • Crypt abscesses
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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

Gardner’s syndrome: pathological and aetiological features of FAP with a high cancer risk

  • 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 adenocarcinoma?

A

Duke’s staging

  • A= confined to bowel wall
  • B= through wall of bowel
  • C= lymph node metastases
  • D= distant metastases
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15
Q

Which tumour marker identifies colorectal cancer ?

A

CEA

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16
Q

where do 90% of diverticuli occur

A

left colon

17
Q

therapy for pseudomembranous colitis

A

metronidazole or vancomycin

18
Q

at what sites do ischaemic colitis/ infarction occur

A
  • segments in ‘watershed’ zones
  • such as splenic flexure (SMA and IMA), rectosigmoid (IMA and IIA)
19
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
20
Q

list 3 complications of UC

A
  • severe haemorrhage
  • toxic megacolon
  • adenocarcinoma
21
Q

list some extra-intestinal features of UC (5)

A

arthritis
myositis
uveitis/iritis
Erythema Nodosum, PG
PSC

22
Q

list 3 non neoplastic polyps of the colon and rectum

A

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

23
Q

list 3 neoplastic polyps (increase R of cancer) of the colon and rectum

A

tubular adenoma
tubulovillous adenoma
villous adenoma

24
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 (more villousy = more R)
degree of dysplastic change within the polyp

25
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

26
Q

What is Hereditary Non-Polyposis Colorectal Cancer (HNPCC)?

A
  • autosomal DOMINANT condition (uncommon)
  • Numerous DNA replication errors
  • Get Onset of colorectal cancer at an early age
  • High frequency of carcinomas proximal to the splenic flexure
  • Multiple synchronous cancers (also endometrium, prostate, breast, stomach)
  • Do NOT necessarily get polyps
27
Q

Is UC or Crohn’s more common?

A

UC (slightly more)

28
Q

Mutation causing Familial Adenomatous Polyposis (FAP)

A

APC tumour suppressor gene on Chromosome 5q21 (FAP gene)

29
Q

Where is high frequency of carcinomas in HNPCC found?

A

proximal to the splenic flexure

30
Q

Most colon cancers are what type?

Sx

A

adenocarcinoma (98%) - means they come from the glands

  • Bleeding
  • Change in bowel habit
  • Anaemia
  • Weight loss
  • Pain
  • Fistula
31
Q

Big RF for diverticular disease

A

low-fibre diet

High intraluminal pressure leads to herniation of the bowel mucosa through weak points in the bowel wall

32
Q

How to detect C. difficile toxin in Pseudomembranous Colitis

A

toxin stool assay

33
Q

Most common vascular disorder of the intestinal tract

A

Ischaemic Colitis/ Infarction

34
Q

What are GIT adenomas?

A
  • excessive epithelial proliferations with dysplasia (moving towards cancer)
  • has lost control but it has NOT invaded yet so it is not cancer
35
Q

Histology of Tubular Adenoma

A

Has stalk + not invaded basement membrane

36
Q

On histology, difference between pink and purple

A

Pink = good

Purple = bad

37
Q

Progression of normal cells to carcinoma in GIT

A
  • Normal -> adenoma -> carcinoma
  • Adenomas tend to appear about 10 years before carcinoma
  • Risk of cancer is proportional to the number of the adenomas
  • Screening and removal of adenoma reduces risk of carcinoma

HistoPath (21 decks)

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