Year 3 - Met3a > Lower GI pathology > Flashcards

Lower GI pathology Flashcards

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1
Q

where do the colon start for

A
  • Extends from the terminal ileum to the anal canal
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2
Q

How long is the colon

A

1-1.5m long

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3
Q

What does the colon include

A
  • caecum
  • ascending colon
  • hepatic flexure
  • transverse colon
  • splenic flexure
  • descending colon
  • rectum
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4
Q

What is the blood supply of the colon

A
  • Superior mesenteric artery (caecum - splenic flexure)

- inferior mesenteric artery (remainder of colon - rectum)

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5
Q

What are the two types of polyps

A
  • Bengin v malignant

- non-neoplastic v neoplastic

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6
Q

What do the symptoms of polyps depend on

A
  • size and site
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7
Q

What are the symptoms if the polyps are on the left side of the colon

A
  • frank blood
  • constipation
  • diarrhoea
  • obstruction
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8
Q

What are the symptoms if the polyps are on the right side of the colon

A
  • less overt blood
  • intussuscpetion (rare)
  • constipation
  • diarrhoea
  • obstruction
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9
Q

what are inflammatory polyps

A
  • non-neoplastic

- mix of epithelial and stromal elements

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10
Q

What conditions are inflammatory polyps associated with

A
  • inflammatory bowel disease

- surgical anastomosis or with other causes of inflammation such as ischaemic colitis, infection

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11
Q

What is the incidence of patients with inflammatory polyps

A
  • incidence of 10-20% in patients with ulcerative colitis
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12
Q

What does the histology of inflammatory polyps look like

A
  • may be relatively normal with a polypoid shape
  • may have ulceration, erosion and distortion of the normal crypt architecture
  • differential diagnosis: juvenile polyp, pyogenic granuloma
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13
Q

What are hyperplastic polyps

A
  • this is a serrated polyp
  • not dysplastic
  • asymptomatic
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14
Q

what is the most common polyp

A
  • hyperplastic polyps (up to 90% of polyps in the colon)
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15
Q

Where are the hyperplastic polyps and what side of the colon are they in

A
  • up to 5mm in size, rarely greater than 10mm
  • left sided
  • may occur as part of syndromes
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16
Q

What are sessile serrated lesions, polyps, adenomas

A
  • neoplastic polyps with premalignant features
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17
Q

describe sessile serrated lesions, polyps, adenomas

A
  • greater than 10mm in size

- serrated architecture with crypt dilatation and may have low grade or high grade dysplasia

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18
Q

what mutation are sessile serrated lesions, polyps, adenomas associated with

A
  • they are associated with BRAF mutation and microsatellite instability
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19
Q

describe a traditional serrated adenoma

A
  • tubulovilour architetcutre

- often left sided

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20
Q

Describe a hamartomatous polyps

A
  • rare
  • tend to occur in children and young adults
  • normal tissue in abnormal location
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21
Q

Name a type of hamartomatous polyps

A

peutz jegher

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22
Q

describe peutz-jegher polyp

A

hamartomatous polyp with characteristic features; absorbing smooth muscle
- can have dysplasia and adenocarcinoma

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23
Q

What is the WHO criteria for peutz-jegher polyps

A
  • 3 or more PJ polyps
  • any number of PJ polyps with family history of PJS
  • characteristic mucocutaneous pigmentation with family history of PJS
  • any number of PJ polyps and mucocutaenous pigmentation
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24
Q

What is the most common polyp in children

A

Juvenile polyps

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25
What is the definition of juvenile polyposis syndrome
- 5 or more juvenile polyps in colorectum - juvenile polyps throughout GI tract - any number of polyps and family history
26
What is the genetics of juvenile polyposis syndrome
autosomal dominant
27
describe the histology of juvenile polyposis syndrome
- sessile or pedunculated - 5-50mm in size - histology - similar to inflammatory polyps but usually have a cystically dilated crypt
28
describe adenoma polyps
- common, i ndice increases with age - usually sporadic but can be familial - premalignant lesions
29
what is the most common adenoma polyps
tubular adenoma
30
Name two types of adenoma polyps
- tubular adenoma | - villous adenoma
31
What is tubular adenoma polyps risk factors that increase the chance of getting them
- smoking - high BMI - red meat
32
what increases risk of invasion of tubular adenoma polyps
- size = less than 1% if less than 1cm versus 10% if they are greater than 2cm - 3 or more - villous component - high grade dysplasia
33
what are follow ups dependent on
- presence of invasive carcinoma - number of polyps - size of polyps - presence of villous architecture, high grade dysplasia
34
what is the most common type of colorectal cancer
98% is adenocarcinoma
35
who is colorectal more common in
men
36
What is the peak age of incident of colorectal cancer
- Peak age is 60-79 - less than 20% beofre age 50 - if before age 40 probably related to syndrome
37
what side is colorectal cancer more on
left side more than right
38
What are the risk factors for colorectal cancer
- older age - obesity - physical inactivity - alcohol consumption - IBD - family history - polyposis syndromes - FAP, Lynch, juvenile polyposis, PJS - dietary risk factors - low fibre and increased beef consumption
39
What is the presentation of colorectal cancer
- colonscopy | - faecal occult blood test
40
What are the symptoms of colorectal cancer
Right - aneamia - pain Left - change in bowel habit - rectal bleeding may be asymptomatic
41
What are common metastasise of colorectal cancer
- lymph nodes - liver - peritoneum - lung - ovaries
42
What is the prognosis of colorectal cancer
- 5 year survival 40-60% | - most recurrences are within 2 years
43
What are the poor prognostic features of colorectal cancer
- high stage - positive margins - poor differentiation - tumour budding - tumour perforation - involvement of peritoneal cavity
44
Describe the staging of colorectal cancer
TX - primary tumour cannot be assessed T0 - no evidence of primary tumour T1- tumour invades submucosa T2 - tumour invades muscularis propria T3 - tumour invades through muscularis propria T4a - tumour invades serosa/visceral peritoneum T4b- tumour directly invades or aderes to adjacent organs or structures NX - nodes cannot be assessed N1 - metastasis in 1-3 nodes N2 - metastasis in 4 or more nodes
45
what are the subtypes of colorectal cancer
- adenocarcinoma - adenosquamous carcinoma - squamous cell carcinoma - neuroendocrine carcinoma
46
What are the types of inflammatory bowel disease
- Ulcerative colitis | - Crohn's disease
47
describe ulcerative colitis
- relapse, remitting - inflammation limited to the mucosa - involves large bowel only
48
describe crohn's disease
- recurrent granulomatous - transmural inflammation - can cause pain - involves any part of the GI tract
49
What disease can you see angular stomatitis in
crohns disease
50
What age does UC occur in
Peak onsets 20-25 or 70-80 | - 60% have mild disease, 97% have one relapse per 10 years
51
What is the peak onset of crohn's disease
- peak onset - teens/twenties and 50-69
52
What is the concordance rate in Crohn's disease
30-50% monozygotic in twins
53
where is ulcerative colitis
- start in rectum and spreads proximally - continuous - can be patchy due to treatment invovlement
54
Where is crohn's disease
- usually involves the small intestine - 40% of patients have colon involvement - discontinous involvement (skip lesions)
55
What are the symptoms of ulcerative colitis
- relapsing bloody mucoid diarrhoea - pain, cramps = but this is relieved by defecation - lasts for months to days
56
describe the symptoms of crohns disease
- episodic mild diarrhoea - fever and pain - anaemia - growth failure - 20% have abrupt onset of symptoms resembling acute appendicitis
57
What are the macroscopic features of UC
Active - red - friable - granular - oedematous mucosa Quiescent - atrophic/featureless mucsoa
58
What are the macroscopic features of Crohn's disease
- thickened rigid bowel - granular, scarred serosa - apthoid, fissuring and serpiginous ulcers with cobblestoning
59
What are the complications of ulcerative colitis
- acute fulminant colitis - acute dilatation of transverse colon - increase in extensive ulceration, transmural inflammation and perforation - malignant change
60
what are the complications of Crohn's disease
- Strictures - that lead to obstruction - fistula formation - between the bowel and abdominal viscera, between bowel and skin - malabsorption - perianal disease
61
Name the systemic complications of UC
ULCERATIVE COLITIS - SKIN: Erythema nodosum, pyoderma gangrenosum - JOINTS: Seronegative polyarthritis - EYE: Iritis, episcleritis - KIDNEY: Calculi, pyelonephritis - LIVER: Sclerosing cholangitis
62
Name the systemic complications of Crohn's disease
- SKIN: Erythema nodosum, pyoderma gangrenosum - JOINTS: Seronegative polyarthritis - EYE: Iritis, episcleritis - KIDNEY: Calculi, pyelonephritis - AMYLOIDOSIS
63
what IBD condition are you more likely to get carcinoma from
Ulcerative colitis
Year 3 - Met3a
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