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MET3a > Lower GI Pathology > Flashcards

Lower GI Pathology Flashcards

1
Q

What are colorectal polyps

A

Growths of the mucosa into the luminal surface of the bowel

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2
Q

What is a colorectal carcinoma?

A

When colorectal polyps become invasive

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3
Q

Anatomical features of the colon?

A

Extends from terminal ileum to anal canal
1-1.5m
SMA supplies caecum to splenic flexure
IMA supplies remainder of colon to rectum
Caecum -> Ascending colon -> hepatic flexure -> transverse colon -> splenic flexure -> descending colon -> rectum

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4
Q

Ways of classifying colorectal polyps

A

Benign vs. malignant

Non neoplastic vs. neoplastic

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5
Q

Symptoms of left sided polyps

A

Frank blood
Constipation
Diarrhoea
Obstruction

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6
Q

Symptoms of right sided polyps

A 
Less overt blood
Intussusception (rare)
Constipation
Diarrhoea
Obstruction
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7
Q

Inflammatory Polyps features

A

Non-neoplastic
Mix of epithelial and stromal elements
May be associated with IBD, surgical anastomosis or other inflammation
- 10-20% of UC patients have them

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8
Q

Histology of inflammatory polyps

A
  • relatively normal
  • polypoid shape
  • ulceration/erosion/distortion of crypts
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9
Q

Differential diagnoses of inflammatory polyps

A

Juvenile Polyp

Pyogenic granuloma

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10
Q

Features of hyperplastic polyps

A
  • serrated!
  • not dysplastic
  • asymptomatic
  • most common polyp
  • up to 5mm in size
  • left sided
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11
Q

Features of sessile serrated lesions/adenomas

A
  • neoplastic
  • premalignant features
  • > 10mm in size
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12
Q

What mutation are sessile serrated lesions/adenomas associated with?

A

BRAF mutation

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13
Q

Histology of sessile serrated lesions/adenomas?

A
  • serrated
  • crypt dilatation
  • may have low or high grade dysplasia
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14
Q

Features of traditional serrated adenomas?

A
  • left sided often

- tubulovillous archiecture

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15
Q

Features of hamartomatous polyps

A

Rare

Tend to occur in children and young adults

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16
Q

What is an example of hamartomatous polyp?

A

Peutz-Jegher

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17
Q

Feature of Peutz-Jegher polp?

A

Hamartomatous polyps

  • aborising/tree like SM
  • can have dysplasia and adenocarcinoma
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18
Q

What is the criteria for Peutz-Jegher syndrome?

A
  • 3 or more PJ polyps
  • any number of PJ polyps with a FH of PJS
  • characteristic mucocutaneous pigmentation with FH of PJS
  • any number of PJ polyps and mucocutaneous pigmentation
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19
Q

Features of juvenile polyps

A
  • most common type in children
  • sessile or pedunculated
  • 5-50mm in size
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20
Q

Histology of juvenile polyps

A

Similar to inflammatory polyps but usually have cystically dilated crypts

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21
Q

Juvenile polyps syndrome criteria

A 
- 5 or more juvenile polyps in colorectum
or
- juvenile polyps throughout GI tract 
or
- any number of juvenile polyps + FH
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22
Q

Inheritance of juvenile polyps syndrome

A

Autosomal dominant

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23
Q

Features of adenomas

A
  • common
  • dysplastic polyps
  • sporadic mostly but can be familial
  • premalignant lesion
24
Q

What is the most common adenoma type?

A

Tubular adenoma

25
Q

What are tubular adenomas associated with?

A

Smoking
High BMI
Red meat

26
Q

Risks of invasion of tubular polyps

A

Villous component
High grade dysplasia
1cm to 2cm in size risk goes from 1% to 10%
More than 3 of them

27
Q

What does a follow up of polyps depend upon?

A

Presence of invasive carcinoma
Number of polyps
Size of polyps
Presence of villous architecture, high grade dysplasia

28
Q

Adenoma to Carcinoma sequence

A

5-20 years for progression
Various mutations = APC, beta catenin, KRAS, TP53
Microsatellite instability

29
Q

What are the majority of colorectal cancers?

A

Glandular - adenocarcinoma

30
Q

Who is most likely to get colorectal cancer?

A

Men>women
60-79 years
Left side > right side
If before 40yrs then probably related to a syndrome = poor outcomes

31
Q

RF of colorectal cancer

A 
Older age
Obesity
Physical inactivity
Alcohol consumption
IBD
FH
Polyposis syndromes
Dietary - low fibre, increased beef consumption
32
Q

Polyposis syndrome examples

A

Juvenile polyposis
PJS
FAP
Lynch

33
Q

Presentation of adenocarcinoma right sided

A

Anaemia
Pain
Asymptomatic?

34
Q

Presentation of left sided adenocarcinoma

A

Change in bowel habits
Rectal bleeding
Asymptomatic?

35
Q

Screening for colorectal cancer

A

Colonoscopy

Faecal occult blood test

36
Q

Common sites of metastases

A 
Lymph nodes
Liver
Peritoneum
Lung
Ovaries
37
Q

Staging of colorectal cancer

A

TNM
T1-4
Infiltrates through the mucosa = perforated = T4

38
Q

Prognosis of colorectal cancer

A

5 year survival

Most recurrences within 2 years

39
Q

Poor prognostic features of colorectal cancer

A 
High stage
Positive margins
Poor differentiation
Tumour budding
Tumour perforation
involvement of peritoneal cavity
40
Q

Types of colorectal cancer

A

Adenocarcinoma & subtypes
Adenosquamous carcinoma
Squamous cell carcinoma
Neuroendocrine carcinoma

41
Q

Other forms of inflammatory bowel disease which are not IBD

A 
Infective colitis
Ischaemic colitis
Microscopic colitis
Diversion colitis
Diverticular disease
Radiation colitis
Drug related colitis
Eosinophilic colitis
42
Q

Features of UC

A

Relapsing remitting
Inflammation limited to the mucosa
Involves large bowel only

43
Q

Features of Crohn’s disease

A

Recurrent granulomatous
Transmural inflammation
Involves any part of GI tract

44
Q

Epidemiology of UC

A
  • common
  • any age but 20-25 then 70-80
  • mostly mild
  • 1 relapse every 10yrs for most
45
Q

Epidemiology of Crohns

A
  • Western
  • teens/twenties and 50-69
  • Caucasian
  • can have concordance in monozygotic twins
46
Q

Distribution of UC

A
  • starts in rectum and spreads proximally
  • continuous
  • may develop patchy involvement only due to treatment effect
  • ileal changes in 17%
47
Q

Distribution of Crohns

A
  • small intestine
  • 40% colonic
  • discontinous
48
Q

Presentation of UC

A
  • relapsing
  • bloody mucoid diarrhoea
  • pain, cramps
  • relieved by defecation
  • months-days
49
Q

Presentation of Crohns

A
  • episodic
  • mild diarrhoea
  • fever
  • pain
  • anaemia
  • GF
  • 20% abrupt onset
50
Q

Macroscopic features of UC

A
  • active = red, granular, friable, oedematous mucosa

- quiescent = atrophic, featureless mucosa

51
Q

Macroscopic feature of Crohns

A

Thickened rigid bowel
Granular scarred serosa
Apthoid, fissuring and serpiginous ulcers with cobblestoning

52
Q

Local complications of UC

A
  • malignant change
  • acute fulminant colitis = acute dilatation of transverse colon = extensive ulceration, transmural inflammation and perforation
53
Q

Local complications of Crohns

A

Strictures = obstruction
Fistula = between bowel and abdominal viscera or between bowel and skin
Malabsorption
Perianal disease

54
Q

Systemic complications of UC

A 
Skin = erythema nodosum, pyoderma gangrenosum
Joints = seronegative polyarthritis
Eye = iritis, episcleritis
Kidney = calculi, pyelonephritis
Liver = sclerosing cholangitis
55
Q

Systemic complications of Crohns

A 
Skin= erythema nodosum, pyoderma gangrenosum
Joints = seronegative polyarthritis
Eye = iritis, episcleritis
Kidney = calculi, pyelonephritis
Amyloidosis
NO LIVER
56
Q

Carcinoma in IBD

A
  • more in UC than Crohns
  • varied risk
  • depends on duration of disease, age of onset, extent of disease
  • poorly differentiated
  • poor prognosis

MET3a (38 decks)

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