Pathology of the large bowel Flashcards

(34 cards)

1
Q

What causes variation in the pathology of the large bowel

A

Age
Culture
Diseases

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2
Q

Name the 5 most common diseases of the large bowel

A
Diverticular Disease 
Ischaemia 
Antibiotic induced colitis
Microscopic colitis 
Radiation colitis
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3
Q

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

A

Lots of little holes and outpouches

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4
Q

Why might outpouches appear blue?

A

They may be filled with blood

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5
Q

Why are the holes often arranged in rows?

A

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

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6
Q

What is the most cause of a benign tumour

A

Diverticular disease

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7
Q

Describe the pathology of diverticular disease

A

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

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8
Q

Describe diverticular disease

A

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

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9
Q

List 5 complications of diverticular disease

A
Inflammation
Rupture 
Abscess 
Fistula 
Massive bleeding
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10
Q

How does the inflammation occur

A

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

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11
Q

What could happen if the inflammation goes unchecked

A

Body forms an abscess - surgical emergency

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12
Q

What happens if the abscess goes unchecked

A

It can rupture, cause sepsis, shock and death

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13
Q

How can a patient experience a massive haemorrhage

A

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

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14
Q

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

A

Elderly

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15
Q

What side is affected in ischemia

A

Left side - at the splenic flexture and the sigmoid colon

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16
Q

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

A

Atherosclerosis of the abdominal aorta and the mesenteric vessles

17
Q

Describe the histology of Ischaemia of the large bowel

A

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

18
Q

What are the 3 main complications of ischaemic colitis

A

Massive bleeding
Rupture
Stricture

19
Q

What do small white dots significant of in an endoscopy

A

pseudomembranes

20
Q

Describe the histology of pseudomembranes

A

Explosive fibrinopurulent exudate on the surface of the epithelium

21
Q

Describe the stool from a patient with pseudomembranes

A

Blood filled and loose

22
Q

What causes pseudomembranes

A

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

23
Q

How do we treat pseudomembranes

A

Flagyl and Vancomycin

24
Q

What patient would usually present with watery diarrhoea

A

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