Flashcards in Pathology Deck (62):
What are the common diseases of the large bowel? (5)
Antibiotic reduced colitis
what is diverticular disease?
a condition in which muscle spasm in the colon (lower intestine) in the presence of diverticula causes abdominal pain and disturbance of bowel function without inflammation
What are the causes of diverticular disease?
It is related to a low fibre diet and increased interlumenal pressure
What are the complications of Diverticular disease? (5)
What can cause ischaemia of the large bowel? (6)
Atherosclerosis of the mesenteric vessels
Histopathological signs of ischaemic colitis
withering of crypts
pink smudgy lamina propria
fewer chronic inflammatory cells
Complications of ischaemic colitis?
What is colitis?
Inflammation of the lining of the colon
Who gets antibiotic induced colitis?
Patients on broad spectrum antibiotics and is caused by C. Diff
What does the bacteria in antibiotic colitis produce?
Produces toxins which attack the endothelium and epithelium causing mini-infarcts
What are the symptoms of antibiotic induced colitis?
massive diarrhoea and bleeding
what is the treatment for antibiotic induced colitis?
flagyl or vancomycin
May need colectomy if complications arise
How does collagenous colitis present?
What histopathological changes are present in collagenous colitis?
thickened basement membrane i.e. between 2-3 microns
It is associated with intraepithelial inflammatory cells
How is collagenous colitis diagnosed?
A biopsy must be taken and clinical history will include watery diarrhoea and a normal endoscopy
what is the histopathology of lymphocytic colitis?
there are no cjronic changes in the crypts but have raised intraepithelial lymphocytes
How does lymphocytic colitis present?
Watery diarrhoea with no blood and normal mucosa on endoscopy
What is telangiectasia?
a condition characterized by dilatation of the capillaries causing them to appear as small red or purple clusters, often spidery in appearance, on the skin or the surface of an organ.
What would be seen in radiation colitis?
bizarre stroma cells and bizarre vessels
What is a polyp?
A protrusion above an epithelial surface (tumour)
what are the differential diagnoses of a colonic polyp? (4)
Are adenomas benign or malignant?
benign - they don't invade or metastasise
What is the sequence of events which leads to an adenoma becoming a carcinoma?
Which gene must acquire mutations in the most common pathway for the development of a colorectal carcinoma?
What is the treatment for adenomas?
removal endoscopically or surgically as they are all premalignant
Do all colorectal carcinomas have the same genetic origins?
No - there are separate pathways for inherited tumours and serrated adenomas
What is the treatment for an adenocarcinoma?
Surgery - the colon or rectum is removed and sent to pathology for staging
What is the criteria for Dukes staging A?
Confined by muscularis propria
What is the criteria for Dukes staging B?
Through muscularis propria
What is the criteria for Dukes staging C?
Metastatic to lymph nodes
which parts of the colon would be affected in left sided colorectal cancer?
which parts of the colon would be affected in right sided colorectal cancer?
what are the common presenting complaints in patients with left sided colorectal cancer?
post rectal blood
altered bowel habits
what are the common presenting complaints in patients with right sided colorectal cancer?
Describe the gross appearance of colorectal cancer
It can be varied - may be polyploid, stricturing and ulcerating
where does colorectal carcinomas spread during local invasion?
How does colorectal cancer spread through the lymphatics
mesenteric nodes - lie between the layers of the mesentery
where does colorectal cancer spread when it metastasises haematogeniously?
Is HNPCC late or early onset
late - usually around 60s
Is FAP late or early onset?
early - usually around 20s
Wha is the inherited mutation in HNPCC?
Mutation in MLH-1, MSH-2, PMS-1 or MSH-6
what is the inherited mutation in FAP?
mutation in the FAP gene
Name two types of inherited colorectal carcinomas
HNPCC and FAP
where do the tumors present in HNPCC?
right side of the colon
where do tumours present in FAP?
throughout the colon
which other carcinomas is HNPCC related to
which other carcinoma is associated with FAP
what are the three zones of the liver?
Zone 1: Periportal
Zone 2: Mid acing
Zone 3: Pericentral
what kind of necrosis can liver insult produce and is this reversible?
Parenchymal necrosis - heals by resolution
what occurs after insult to hepatocytes?
Inflammation - fibrosis - cirrhosis
What causes acute liver failure?
Bile duct obstruction
what are the three classifications of jaundice?
What are the pre-hepatic causes of jaundice?
what are the hepatic causes of jaundice?
Acute liver failure
Bile duct loss
what are the post-hepatic causes of jaundice?
congenital biliary atresia
galstone blocked common bile duct
Strictures of the common bile duct
what is cirrhosis pathologically defined by?
Bands of fibrosis separating regenerative nodules of hepatocytes
what are the causes of cirrhosis?
Autoimmune liver disease
What are the complications of cirrhosis?
what are the clinical presentations of portal hypertension?
what is the outcome of alcoholic liver disease?
what is the difference between NASH and NAFLD?
NASH is a more serious progression of NAFLD