Pathology of the large bowel Flashcards Preview

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Flashcards in Pathology of the large bowel Deck (34):
1

What causes variation in the pathology of the large bowel

Age
Culture
Diseases

2

Name the 5 most common diseases of the large bowel

Diverticular Disease
Ischaemia
Antibiotic induced colitis
Microscopic colitis
Radiation colitis

3

Describe the appearance of an endoscopic image of the large bowe in diverticular disease

Lots of little holes and outpouches

4

Why might outpouches appear blue?

They may be filled with blood

5

Why are the holes often arranged in rows?

Due to the muscle layers - there are points of weakness in between the straps of the longitudinal muscle

6

What is the most cause of a benign tumour

Diverticular disease

7

Describe the pathology of diverticular disease

Reduced lumen
Thick muscle band
further small lumina
High presence of inflammatory cells in diverticulitis

8

Describe diverticular disease

Very common
often assymptomiatic
related to low fibre in the diet
increased intralumenal pressure

9

List 5 complications of diverticular disease

Inflammation
Rupture
Abscess
Fistula
Massive bleeding

10

How does the inflammation occur

Outpouches contain static faecal material - microorganisms develop a niche with them and expand in number

11

What could happen if the inflammation goes unchecked

Body forms an abscess - surgical emergency

12

What happens if the abscess goes unchecked

It can rupture, cause sepsis, shock and death

13

How can a patient experience a massive haemorrhage

If the abscess lies next to a blood vessel, the vessel can rupture through perforation

14

Who is most likely to present with ischaemia of the large bowel

Elderly

15

What side is affected in ischemia

Left side - at the splenic flexture and the sigmoid colon

16

What is the most common cause of ischaemia of the large bowel

Atherosclerosis of the abdominal aorta and the mesenteric vessles

17

Describe the histology of Ischaemia of the large bowel

Withering and damage of the crypts and pink smudging of the lamina propria
Fewer chronic inflammatory cells

18

What are the 3 main complications of ischaemic colitis

Massive bleeding
Rupture
Stricture

19

What do small white dots significant of in an endoscopy

pseudomembranes

20

Describe the histology of pseudomembranes

Explosive fibrinopurulent exudate on the surface of the epithelium

21

Describe the stool from a patient with pseudomembranes

Blood filled and loose

22

What causes pseudomembranes

Patients who are on a broad spectrum of Antibiotics - especially in the elderly

23

How do we treat pseudomembranes

Flagyl and Vancomycin

24

What patient would usually present with watery diarrhoea

A female in their 50s or 60s

25

Is there usually rectal bleeding in collagenous colitis

No

26

What category does collagenous colitis fit into

Microscopic colitis

27

How do we treat collagenous colitis

Immunosuppresion

28

What are the histological findings of collagenous colitis

Increase in the thickness of subepithelial collagen
Thickened basement membrane
Disease is patchy

29

Describe the findings in an endoscopy of a patient with microscopic colitis

Nothing - appears normal

30

What is a key question to ask when investigating the possibility of

Radiation in the past
e.g. Radiotherapy for a pelvic tumours

31

Describe the appearance of the crypts in radiation collitis

No irregularity

32

What is the commonest cause of colitis

Radiational collitis

33

After a patient is discharged, what happens

They need to be followed up cloesly

34

What are 3 other causes of abnormal pathology in the large bowel

mycophenylate
Graft versus host disease
CMV

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