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pathology 2 > non-neoplastic disease of the colon > Flashcards

non-neoplastic disease of the colon Flashcards

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1
Q

function of the colon

A

water and electrolyte absorption
transport, storage and evacuation of faeces
nutrient and vitamin absorption

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2
Q

colon begins as the

A

caecum

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3
Q

between the ascending and the transverse colon

A

hepatic flexure

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4
Q

between the traverse and the descending colon

A

splenic flexure

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5
Q

layers of the colon

A

mucosa
submucosa
musculares externa

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6
Q

inflammatory bowel disease

A

chronic inflammatory condition arising from inappropriate mucosal immunologic activation
chronic illness - punctuated by relapses and remission

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7
Q

inflammatory bowel disease Is composed of 2 major disorders

A

ulcerative colitis

Crohn disease

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8
Q

trends in inflammatory bowel disease

A

increasing incidence
more common in jews and caucasians
more common in urban areas
more common in colder climate regions

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9
Q

peak ages for inflammatory bowel disease

A

2nd - 4th decide and 6th-7th decade

equal proportion in males and females

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10
Q

risk factors for inflammatory bowel disease

A

smoking, diet and exercise

family history is a strong risk factor

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11
Q

clinical features of ulcerative colitis

A

diarrhoea, rectal bleeding, passage of mucus
tenesmus and urgency
abdominal pain, fever and weight loss

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12
Q

clinical features of crohn disease

A

abdominal pain
constitutional symptoms, weight loss and fever, growth retardation, anal fissure/perianal disease
diarrhoea with or without blood
extra intestinal manifestations

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13
Q

skip lesions

A

more characteristic of crohns but can be present in ulcerative colitis
peri-appendiceal inflammation and caecal patch

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14
Q

microscopic pathology of ulcerative colitis

A

confined tp mucosa archetectyral distortion and mucosal metaplasia
lamina propria chronic inflammation
cry-titis and crypt abscesses
erosions, ulcers

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15
Q

gross pathology of crohns disease

A 
mouth to anus 
predilection for distal small bowel and proximal colon 
skip lesson and discontinuous lesions 
rectal sparing 
sinuses, fistulas, anal fissure and perianal disease 
cobblestone mucosa 
thickening of the wall 
creeping fat
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16
Q

Crohn microscopic pathology

A

patchy and focal inflammation
transmural inflammation and lymphoid aggregates
granulomas - well defined aggregates
connective tissue changes - fibrosis, neural hypertrophy

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17
Q

wall appearance in UC vs CD

A

thin in ulcerative colitis and thick in Crohn disease

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18
Q

inflammation in UC vs CD

A

superficial in UC and transmural and patchy in CD

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19
Q

distribution in UC vs CD

A

mainly colon and rectum in UC and mouth to anus in CD

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20
Q

ulcers in UC vs CD

A

shallow in UC and deep, fissuring, knife like in CD

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21
Q

granulomas in UC vs CD

A

none in UC and appearing in 30% of cases in CD

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22
Q

lymphoid reaction in UC vs CD

A

moderate in UC and marked in CD

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23
Q

pseudopolyps in UC vs CD

A

marked in UC and moderate in CD

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24
Q

features of CD

A

strictures, fistulae/sinuses, fat creeping

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25
complications of ulcerative colitis
toxic megacolon, perforation dysplasia and colorectal adenocarcinoma orchitis extra intestinal manifestations
26
complications of crohns disease
``` fistula or sinuses stenosis/stricture abscesses malabsorption and nutritional deficiency toxic megacolon and perforation dysplasia and adenocarcinoma extra intestinal manifestation ```
27
management of ulcerative colitis
surgical
28
management of crohns disease
surgical
29
microscopic colitis
macroscopically normal colonic mucosa with microscopic inflammation
30
microscopic colitis encompasses two entities
collagenous colitis | lymphocytic colitis
31
age and gender in microscopic colitis
typically older adults 50-70yr children may be affected female predominance, less pronounced in lymphocytic colitis with some studies reporting similar rates among males and females
32
associated diseases and conditions
coeliac disease, diabetes, autoimmune or lymphatic gastritis | drugs
33
aetiopathogenesis of microscopic colitis
inflammatory disorder arising from epithelial immune responses to intraluminal antigens
34
clinical features of microscopic colitis
chronic non-bloody diarrhoea radiology and colonoscopy normal abdominal pain, fatigue, weight loss, arthralgia
35
microscopic colitis pathology
``` normal architecture increased intraepithelial lymphocytes epithelial injury lamina propria chronic inflammation thickening of sub epithelial collagen distinguishes collagenous colitis from lymphocytic colitis ```
36
how to distinguish collagenous colitis from lymphocytic colitis
thinking of the sub epithelial collagen
37
prognosis of microscopic colitis
good prognosis most patients répond to cessation of risk factors eg. NSAID anti-inflammatory therapy and surgery may be needed for those patients that relapse
38
infectious colitis
inflammation of the colon
39
infectious colitis often occurs in people
extremes of age - children and the elderly | those with impaired immunity
40
agents responsible for infectious colitis
campylobacter, salmonella, shigella, E coli, clostridia, yersinia, aeromonas
41
pathogenesis of infectious colitis
adherence, enterotoxin production, cytotoxin production, mucosal invasion
42
clinical features of infectious colitis
diarrhoea, nausea voliting abdominal pain, tenesmus, urgency fevers/chills, malaise, arthralgia/myalgia
43
prognosis of infectious colitis
self limiting | 1-2 weeks
44
complications of infectious colitis
dehydration sepsis and shock toxic megacolon entra intestinal manifestations eg. guillan barre syndrome
45
management of infectious colitis
specific antimicrobial therapy
46
antibiotic associated diarrhoea
diarrhoea illness or colitis following antibiotic therapy
47
psuedomembranous colitis
characterised by formation of pseudomembranes and associates with toxin producing C difficile
48
AAD AND PMC epidemiology
diarrhoea is a common side effect of antibiotics increasing incidence PMC may be nosocomial or community acquired
49
risk factors for PMC
age, antibiotics, hospitalisation, Gi procedures, chemotherapy, acid suppression therapy, surgery, immunosuppressed
50
clinical features of AAD and PMC
history of antibiotic use - previous episodes of diarrhoea with antibiotics diarrhoea with abdominal pain
51
pathology of AAD
normal or minor changes | colitis
52
gross pathology of PMC
yellow-white pseudomembranes that bleed when scraped off
53
microscopic pathology of PMC
volcano lesion with intercrypt necrosis and ballooned crypts pseudomembrane composed of fibrin, mucin and neutrophils
54
AAD natural history and prognosis
mild and self limiting
55
PMC complications
fulminating colitis with toxic megacolon or perforation dehydration systemic sepsis
56
management of AAD
withdrawal of implicated antibiotic | supportive symptomatic treatment and anti peristaltic agents
57
management og PMC
``` cessation of culprit antibiotic supporting and symptomatic treatment specific therapy binding resins, probiotics microbiota transplntation ```
58
ischaemic colitis
colitis due to reduced blood flow to the colon leading to ischaemic injury
59
epidemiology of ischameic colitis
most common manifestation of ischaemia to the GIT | most common in the elderly and in females
60
occlusive causes of ischaemic colitis
arterial - thromboembolism, cholesterol emboli | venous - venous thrombosis, strangulated hernia, volvulus, obstruction, external compression
61
non-occlusive causes if ischameic colitis
``` hypotension haemorrhahic shock heart failure sepsis medications ```
62
acute clinical features if ischameic colitis
sudden inset of abdominal pain and tenderness urgent desire to defecate nausea and vomiting blood diarrhoea loss of bowel sounds, abdominal rigidity shock, vascular collapse
63
subacute/chronic clinical features of ischaemia colitis
non-specific symptoms, episodes of blood diarrhoea, blood loss, sepsis, symptomatic strictures, weight loss
64
prognosis of ischaemic colitis
symptoms resolve 2-3 days | colon heals 1-2 weeks
65
complications of ischaemic colitis
perforation massive haemorrhage sepsis stricture
66
diverticulum
acquired pseudodiverticular out pouching of mucosa and submucosa
67
diverticular disease
any clinical state caused by colonic diverticula eg. haemorrhage, inflammation
68
diverticulitis
implies an inflammatory process associated with diverticula
69
epidemiology of diverticular disease
prevalence increases with age sigmoid colon affected in 95% of cases seen predominately in western nations
70
diverticular disease - aetiopathogenesis
genetic factors environmental factors age, geography, life style, ethnicity
71
environmental/lifestyle factors associated with diverticular disease
``` low fibre diet obesity decreased physical activity corticosteroids NSAIDS alcohol caffeine intake cigarette smoking polycystic kidney disease ```
72
clinical features of diverticular disease
``` asymptomatic alternating constipation and diarrhoea mimic IBS intermittent cramping, continuous lover abdominal discomfort, diarhhea, tenets fever chronic ir intermittent blood loss inflammatory mass massive haemorrhage ```
73
iatrogenic types of colitis
diversion colitis radiation proctitis graft versus host disease drug induced
74
diversion colitis
inflammation in diverted segment of bowel
75
radiation proctors
following radiation injury to the rectum
76
graft versus host disease
organ transplant
77
drug induced
eg. NSAID - ulcers, strictures, focal active colitis, microscopic colitis immunomodular therapy

pathology 2 (47 decks)

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