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CP4 = Diseases of the GI Tract > Pathology of the GI Tract 2 > Flashcards

Pathology of the GI Tract 2 Flashcards

(64 cards)

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1
Q

Define: Diverticulum

A

Abnormal pouch/sac at weak point in intestinal wall.

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2
Q

What type of diverticulum is sigmoid diverticulosis?

A

Acquired

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3
Q

What type of diverticulum is diverticulosis of the right colon?

A

Either congenital or acquired.

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4
Q

What layers of the bowel protrude in a diverticulosis?

A

> Mucosa

> Submucosa

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5
Q

In which part of the colon are diverticula commonly found?

A

Sigmoid Colon

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6
Q

Where are colon diverticuli located between?

A

Mesenteric and anti-mesenteric coli.

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7
Q

What is the pathogenesis of Colon diverticulosis?

A

> Increases intra-luminal pressure

> Increases relative weakness points in the bowel wall.

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8
Q

What is pre-diverticular disease?

A

Thickening of the muscular propria

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9
Q

What pathological changes occur in diverticulosis?

A

> Mucosal folds/ridges become useless
Sacculations/Diverticulations
Taenia coli –> elastic –> shorten

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10
Q

What are the clinical features of Diverticular disease?

A 
MOSTLY ASYMPTOMATIC (90-99%) 
> Abdominal pain
> Alternating constipation/diarrhoea
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11
Q

What are the acute complications of Diverticular disease?

A

> Haemorrhage
Perforation
Diverticulitis

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12
Q

What are the chronic complications of Diverticular disease?

A

> Polypoid prolapsing mucosal folds
Colitis
Fistula
Intestinal obstruction

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13
Q

What can chronic idiopathic inflammatory bowel disease be divided into?

A

Ulcerative Colitis or Crohn’s Disease.

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14
Q

What is the incidence of Ulcerative Colitis?

A

20 - 40 years old.
M = F
Increase in urban areas

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15
Q

What are the risk factors for UC?

A 
> Smoking
> Oral contraceptives
> Childhood infections
> MMR
> Domestic Hygiene 
> Appendicectomy
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16
Q

What is the clinical presentation for Ulcerative Colitis?

A 
> Diarrhoea
> Constipation ( Rectal bleeding
> Abdominal pain
> Anorexia
> Weight loss
> Anaemia
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17
Q

What is the incidence of Chrons disease?

A

F:M = 3:1

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18
Q

What is the clinical presentation of Crohn’s disease?

A 
> Diarrhoea
> Fever
> Weight loss
> Colicky abdominal pain
> Palpable abdominal mass
> Anorexia
> Anaemia
> Oral ulcers
> Peri-anal disease
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19
Q

Where is Crohn’s disease primarily distributed?

A

Ileocolic

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20
Q

Where is Crohn’s disease least distributed?

A

Gastro-duodenal

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21
Q

Which disease affects the colon only?

A

UC

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22
Q

Which disease affects any part of the GI tract?

A

Crohns

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23
Q

Which disease always involves the rectum?

A

UC

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24
Q

Which disease involves more of the terminal ileum?

A

Crohns

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25
Which disease has a granular red mucosa with flat, undermining ulcers?
UC
26
Which disease has a cobblestoned appearance?
Crohns
27
What disease has serousitis?
Crohns
28
In what disease are strictures rare?
UC
29
In what disease are there no spontaneous fistulae?
UC
30
In what disease are there more than 75% anal lesions?
Crohns
31
In what disease are crypt abcesses common ?
UC
32
In what disease is crypt distortion severe?
UC
33
In which disease are granulomas absent?
UC
34
In which disease are inflammatory polyps less common?
Crohns
35
What are the liver manifestations of IBD?
> Fatty change > Granulomas > Primary Sclerosing Cholangitis > Bile duct carcinoma
36
What are the skeletal manifestations of IBD?
> Ankylosing Spondylitis > Sacro-ileitis > Polyarthritis
37
What are the muco-cutaneous manifestations of IBD?
> Oral apthoid ulcers > Pyoderma gangrenosum > Erythema nodosum
38
What are the ocular manifestations of IBD?
> Iritis/uveitis | > Episcleritis (retinitis)
39
What are the renal manifestations of IBD?
Kidney and bladder stones
40
What are the haematological manifestations of IBD?
> Anaemia > Leucocytosis > Thrombocytosis > Thrombo-embolic disease.
41
What are the systemic manifestations of IBD?
> Amyloid | > Vasculitis
42
What is the step by step process from inflamed mucosa to colorectal cancer?
Inflamed mucosa --> Low grade dysplasia --> High grade dysplasia --> Colorectal cancer.
43
What are colorectal polyps?
Mucosal protrusions
44
What causes colorectal polyps?
>Submucosal/mucosal pathology | > Lesion deeper in bowel wall
45
What are the two types of hamartomatous polyps in the colorectum?
> Peutz-Jeghers polyps | > Juvenile polyps
46
Where are hyper plastic polyps located?
Rectum and Sigmoid colon
47
What is Peutz- Jeghers syndrome?
GI polyps mainly in small bowel
48
What is the inheritance pattern of Peutz-Jeghers syndrome?
Autosomal dominant
49
What is the mutation causing Peutz-Jeghers?
SKT11 on Cr 19.
50
What is the appearance of Peutz-Jeghers syndrome?
1 in 50,000- 1 in 200,000
51
What are the symptoms of Peutz-Jeghers?
> Abdo pain > GI bleeding > Anaemia
52
What are adenomas?
Benign epithelial tumours.
53
In whom do adenomas present in?
~30% of population >50 years
54
What is the distribution of adenomas?
> Even in colon | > Larger in recto-sigmoid and caecum.
55
What type of adenomas have more of a chance becoming cancerous?
> Flat | > >10mm
56
What is the main pre-disposer to colorectal cancer?
Sporadic
57
What are the risk factors for Colorectal cancer?
``` > Diet - Red meat, calcium, folate, fibre, fat > Obesity > Alcohol > NSAIDs > Oral contraceptives and HRT > Schistosomiasis > Pelvic radiation > UC and Crohns ```
58
Describe: Familial Adenomatous Polyposis
> Makes up Autosomally dominant inheritance pattern - mutation in APC tumour suppressor gene. > Assc: Multiple colon benign adenomatous polyps > Large bowel lifetime risk : 100%
59
Describe: Hereditary Non-polyposis Colorectal cancer
> Mutation in DNA mismatch repair gene > Large bowel lifetime risk : 50-70% > Inc risk of other bowel cancers - endometrial, gastric, ovarian etc
60
What is the most common type of colorectal cancer?
Adenocarcinoma - glandular epithelial tissue.
61
What type of adenocarcinoma makes up 10-20% of Colorectal adenocarcinomas?
Mucinous adenocarcinoma.
62
What type of differentiation makes up the majority of CRC grading?
> Moderately well differentiated.
63
How does colorectal cancer spread?
``` > Directly invades adjacent tissues > Iatrogenic spread > Transcoelomic - metastasis through body cavity. > Lymphatic > Haematogenous metastasis ```
64
What are the different dukes staging of Adenocarcinomas?
``` A = Confined to bowel wall B = Invade through bowel wall C = Regional Lymph node invasion D = Distant metastasis ```

CP4 = Diseases of the GI Tract (5 decks)

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