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