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Flashcards in Pathology Deck (62):
1

What are the common diseases of the large bowel? (5)

Diverticular disease
Ischaemia
Antibiotic reduced colitis
Microscopic colitis
Radiation colitis

2

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

3

What are the causes of diverticular disease?

It is related to a low fibre diet and increased interlumenal pressure

4

What are the complications of Diverticular disease? (5)

inflammation
rupture
abscess
fistula
massive bleeding

5

What can cause ischaemia of the large bowel? (6)

CVS disease
Atrial fibrillation
Embolus
Atherosclerosis of the mesenteric vessels
Shock
Vasculitis

6

Histopathological signs of ischaemic colitis

withering of crypts
pink smudgy lamina propria
fewer chronic inflammatory cells

7

Complications of ischaemic colitis?

massive bleeding
rupture
stricture

8

What is colitis?

Inflammation of the lining of the colon

9

Who gets antibiotic induced colitis?

Patients on broad spectrum antibiotics and is caused by C. Diff

10

What does the bacteria in antibiotic colitis produce?

Produces toxins which attack the endothelium and epithelium causing mini-infarcts

11

What are the symptoms of antibiotic induced colitis?

massive diarrhoea and bleeding

12

what is the treatment for antibiotic induced colitis?

flagyl or vancomycin
May need colectomy if complications arise

13

How does collagenous colitis present?

watery diarrhoea

14

What histopathological changes are present in collagenous colitis?

thickened basement membrane i.e. between 2-3 microns
It is associated with intraepithelial inflammatory cells

15

How is collagenous colitis diagnosed?

A biopsy must be taken and clinical history will include watery diarrhoea and a normal endoscopy

16

what is the histopathology of lymphocytic colitis?

there are no cjronic changes in the crypts but have raised intraepithelial lymphocytes

17

How does lymphocytic colitis present?

Watery diarrhoea with no blood and normal mucosa on endoscopy

18

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.

19

What would be seen in radiation colitis?

bizarre stroma cells and bizarre vessels

20

What is a polyp?

A protrusion above an epithelial surface (tumour)

21

what are the differential diagnoses of a colonic polyp? (4)

adenoma
serrated polyp
polypoid carcinoma
other

22

Are adenomas benign or malignant?

benign - they don't invade or metastasise

23

What is the sequence of events which leads to an adenoma becoming a carcinoma?

Normal mucosa
Dysplastic adenoma
Invasive adenomacarcinoma

24

Which gene must acquire mutations in the most common pathway for the development of a colorectal carcinoma?

APC

25

What is the treatment for adenomas?

removal endoscopically or surgically as they are all premalignant

26

Do all colorectal carcinomas have the same genetic origins?

No - there are separate pathways for inherited tumours and serrated adenomas

27

What is the treatment for an adenocarcinoma?

Surgery - the colon or rectum is removed and sent to pathology for staging

28

What is the criteria for Dukes staging A?

Confined by muscularis propria

29

What is the criteria for Dukes staging B?

Through muscularis propria

30

What is the criteria for Dukes staging C?

Metastatic to lymph nodes

31

which parts of the colon would be affected in left sided colorectal cancer?

rectum
sigmoid
descending colon

32

which parts of the colon would be affected in right sided colorectal cancer?

caecum
ascending colon

33

what are the common presenting complaints in patients with left sided colorectal cancer?

post rectal blood
altered bowel habits
obstruction

34

what are the common presenting complaints in patients with right sided colorectal cancer?

anaemia
weight loss

35

Describe the gross appearance of colorectal cancer

It can be varied - may be polyploid, stricturing and ulcerating

36

where does colorectal carcinomas spread during local invasion?

mesorectum
peritoneum
other organs

37

How does colorectal cancer spread through the lymphatics

mesenteric nodes - lie between the layers of the mesentery

38

where does colorectal cancer spread when it metastasises haematogeniously?

liver
distant sites

39

Is HNPCC late or early onset

late - usually around 60s

40

Is FAP late or early onset?

early - usually around 20s

41

Wha is the inherited mutation in HNPCC?

Mutation in MLH-1, MSH-2, PMS-1 or MSH-6

42

what is the inherited mutation in FAP?

mutation in the FAP gene

43

Name two types of inherited colorectal carcinomas

HNPCC and FAP

44

where do the tumors present in HNPCC?

right side of the colon

45

where do tumours present in FAP?

throughout the colon

46

which other carcinomas is HNPCC related to

gastric
endometrial

47

which other carcinoma is associated with FAP

desmoid tumours
thyroid tumours

48

what are the three zones of the liver?

Zone 1: Periportal
Zone 2: Mid acing
Zone 3: Pericentral

49

what kind of necrosis can liver insult produce and is this reversible?

Parenchymal necrosis - heals by resolution

50

what occurs after insult to hepatocytes?

Inflammation - fibrosis - cirrhosis

51

What causes acute liver failure?

Viruses
Alcohol
Drugs
Bile duct obstruction

52

what are the three classifications of jaundice?

Pre-hepatic
Hepatic
Post-hepatic

53

What are the pre-hepatic causes of jaundice?

Haemolysis
Haemolytic anaemia
unconjugated bilirubin

54

what are the hepatic causes of jaundice?

Acute liver failure
Alcoholic hepatitis
Cirrhosis
Bile duct loss
Pregnancy

55

what are the post-hepatic causes of jaundice?

congenital biliary atresia
galstone blocked common bile duct
Strictures of the common bile duct
Tumours

56

what is cirrhosis pathologically defined by?

Bands of fibrosis separating regenerative nodules of hepatocytes

57

what are the causes of cirrhosis?

Alcohol
Hepatitis B
Iron overload
Gallstones
Autoimmune liver disease

58

What are the complications of cirrhosis?

Portal hypertension
Ascites
Liver failure

59

what are the clinical presentations of portal hypertension?

Caput medusa
Oesophageal varices
Haemorrhoids

60

what is the outcome of alcoholic liver disease?

Cirrhosis
Portal hypertension
Malnutrition
Hepatocellular carcinoma
Social disintegration

61

what is the difference between NASH and NAFLD?

NASH is a more serious progression of NAFLD

62

In what patients does NASH occur?

Diabetics
Obese patients
Hyperlipidaemic patients