Small and Large Intestine Pathology 2

Question 1

What are the microscopic features of Crohn’s disease?

Answer 1

Transmural inflammation
Infiltration of
- Lymphocytes
- Histiocytes
- Plasma cells
Granulomas

Question 2

What are the macroscopic features of Crohn’s disease?

Answer 2

Thickening of bowel wall
Lumen narrowing
Cobblestone appearance

Question 3

Why is there separation of bowel loops on x-ray in Crohn’s disease?

Answer 3

Rubber hose rigidity

Question 4

What is the course of Crohn’s disease?

Answer 4

Chronic

Relapsing-remitting

Question 5

What are the complications of Crohn’s disease?

Answer 5

Lower risk of cancer than ulcerative colitis, but higher than normal
Obstruction
Perforations
B12 deficiency
Fistula
Bleeding
Amyloidosis
Toxic megacolon, but less common than in ulcerative colitis
Perianal fissures

Question 6

What are the extra-intestinal manifestations of Crohn’s disease?

Answer 6

Scleritis
Uveitis
Arthritis
Erythema nodosum
Ankylosing spondylitis
Sclerosing cholangitis
Kidney stones

Question 7

What are the proportions of varying lengths of the colon being involved in ulcerative colitis?

Answer 7

10% - entire colon involved

80% - rectum and recto-sigmoid colon involved

Question 8

What is toxic megacolon?

Answer 8

Enlargement of colon
Fever
Pain
Shock

Question 9

What are the macroscopic features of ulcerative colitis?

Answer 9

Hyperaemia
Irregular, broad-based ulcers
Pseudopolyps

Question 10

What are the microscopic features of ulcerative colitis?

Answer 10

Limited to mucosa
Hyperaemia
Oedematous
Chronic lymphocytic infiltrate

Question 11

What is the course of ulcerative colitis?

Answer 11

Variable

Relapsing-remitting

Question 12

What are the complications of ulcerative colitis?

Answer 12

Toxic megacolon
Colorectal cancer
Perforation
Obstruction less likely than in Crohn's disease
Haemorrhage
Inflammatory stricture

Question 13

What factors influence the risk of dysplasia in ulcerative colitis?

Answer 13

Duration

Extent

Question 14

What are the extra-intestinal manifestations of ulcerative colitis?

Answer 14

Primary sclerosing cholangitis
Iritis
Erythema nodosum
Pyoderma gangrenosum
Seronegative arthritides; eg: ankylosing spondylitis
Clubbing

Question 15

What do most left-sided colon cancers look like?

Answer 15

Constricted annular region

Question 16

What do most right-sided colon cancers look like?

Answer 16

Fungated, polypoid region

Question 17

What do left-sided colon cancers commonly present as?

Answer 17

Bowel obstruction

Question 18

What do right-sided colon cancers common present as?

Answer 18

Fe deficiency anaemia

Tiredness

Question 19

What are the predisposing factors for colorectal carcinoma?

Answer 19

Genetics
Smoking
Ulcerative colitis
FAP
Lynch syndrome
Age
Alcohol
Radiation
Past benign polyps
High red meat, low fibre diet
Little exercise
Obesity

Question 20

What is the cell of origin of an adenocarcinoma?

Answer 20

Superficial glandular cells

Question 21

What is the most important prognostic predictor for patients with colorectal cancer?

Answer 21

Detection

Question 22

What other factors are important in the prognosis of patients with colorectal cancer?

Answer 22

Site
Lymph node involvement
Metastasis

Question 23

What is the mode of inheritance of Lynch syndrome?

Answer 23

Autosomal dominant