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Gastrointestinal (LECTURE NOTES) > Colon > Flashcards

Colon Flashcards

1
Q

What are the 2 types of colonic polyps?

A

Neoplastic and non-neoplastic

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2
Q

What is the main neoplastic polyp

A

Adeno

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3
Q

What are the 3 types of non-neoplastic polyps

A

Hamartoma
Metaplastic
Inflammatory

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4
Q

Where do all colonic adenocarcinomas originate from

A

Colonic adenomas

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5
Q

How long does it take for an adenoma to progress into a carcinoma

A

10years (average)

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6
Q

What is the gold standard for polyps

A

Colonoscopy and removal of polyps

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7
Q

What is Familial adenomatous polyposis (FAP) characterised by

A

Multiple colonic adenomas which invariably progress to colorectal cancer unless colectomy is performed in the second or third decade of life

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8
Q

What type of disorder is Hereditary non-polyposis colorectal cancer

A

Autosomal dominant

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9
Q

In what 3 syndromes do hamartomas occur

A

Peutz-Jeghers syndrome
Cowden’s disease
Cronkhite-Canada syndrome

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10
Q

Where are metaplastic polyps usually found

A

In the rectum

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11
Q

What is another term for inflammatory polyps

A

Pseudo-polyps

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12
Q

What type of cancer is the second most common cancer in the UK

A

Colorectal adenocarcinoma

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13
Q

What are the main risk factors for developing colorectal cancer

A

Genetic
Dietary - red meat, saturated animal fats
Protective - dietary fibre
Cbronic inflammaiton - IBD
Medical conditions (primary sclerosing cholangitis, acromegaly, obesity)
Smoking

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14
Q

Where in the colon are most adenocarcinomas located

A

Rectosigmoid
Right colon
Left and transverse colon

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15
Q

How does spread of colonic adenocarcinoma

A

Through the bowel wall into lymphatics

Portal and systemic circulations later

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16
Q

What are the clinical features of colorectal adenocarcinoma

A 
Rectal bleeding 
Altered bowel habit 
Anorexia 
weight loss 
abdominal mass 
intestinal obstruction or perforation is rare 
Tenesmus 
Abdominal pain
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17
Q

What are the investigations carried out in suspected colorectal adenocarcinoma

A 
Rigid sigmoid
Flexible sigmoid (for fresh bleeding) 
Colonoscopy (altered bowel habit, polyps seen in sigmoidoscopy, FHx, surveillance of IBD or polyps
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18
Q

What is typically seen in a barium enema for colorectal carcinoma

A

Apple core stricture

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19
Q

What staging system is used for staging colorectal adenocarcinoma

A

Duke’s

20
Q

At what stage is surgery suitable in colorectal adenocarcnoma

A

Dukes stage A and B

21
Q

What is colonic diverticular disease

A

symptomatic diverticula

22
Q

What is diverticulitis

A

Refers to diverticula causing complications (bleeding, inflammation, stricturing and perforation

23
Q

Where in the GI tract is diverticula most common in the Western Wordl

A

In the sigmoid and the left colon

24
Q

Where in the GI tract is diverticula most common in Oriental populations and rare under 40

A

right sided disease is more common

25
Q

What explains the geographical variability of the diverticulosis problem

A

A diet, especially in early life

26
Q

What does a lack of fibre mean for the GI tract

A

More pressure for propulsion is required

Inflammation from impacted faeces

27
Q

What are the symptoms of uncomplicated diverticulosis

A

Symptoms of colicky left iliac fossa pain eased by defecation
passage of pellet stools
abdominal bloating

28
Q

What is the treatment for uncomplicated diverticulosis

A

Increase in dietary fibre and dietary fluids

29
Q

What is the treatment for Diverticular bleeding

A

Most settle with simple observation

30
Q

What side of the colon does bleeding come from in diverticular bleeding

A

The right side

31
Q

What is diverticulitis characterised by

A

Pain
fever
raised white count
raised inflammatory markers

32
Q

What is contraindicated for investigation of diverticulitis

A

Colonoscopy

33
Q

What is the treatment for mild cases of diverticulitis

A

Oral antibiotics (metronidazole and ciprofloxacin) and analgesia

34
Q

What is the treatment for severe cases

A

Possible need for IV antibiotics

35
Q

What is the treatment for complicated attacks of diverticulitis

A

Surgery - structure, perforation, fistula or abscess

36
Q

What are the two types of megacolon

A

Congenital (Hirschsprung’s disease) and acquired (idiopathic megacolon and megarectum)

37
Q

What are some of the common presentations of Hirschsprung’s disease?

A

Constipation
abdominal distension
comiting

38
Q

How is a diagnosis of Hirschsprung’s disease made

A

by demonstrating the absence of the rectoanal inhibitory reflex on physiological testing

39
Q

What is the treatment for Hirschsprung’s disease

A

Surgical resection of the localised segment

40
Q

What are the common presentations for patients with Idiopathic megacolon and megarectum

A 
Constipation with infrequent urge to defaecate 
Faecal soiling (in children)
41
Q

What might be found on digital examination in Idiopathic megacolon and megarectum

A

Presence of stool

42
Q

What is the management for idiopathic megacolon and megarectum

A

Titrated use of osmotic laxative with or without enemas to empty the rectum What is Acute colonic pseudo-obstruction (Ogilvie’s syndrome)

43
Q

What would be found on examination of Acute colonic pseudo-obstruction

A

Increased bowel sounds and abdominal distension

44
Q

What is characteristic of acute colonic pseudo-obstruction

A

Sudden, painless distension of the colon in the absence of mechanical obstruction

45
Q

How is Ogilvie’s syndrome confirmed

A

By a plain abdominal Xray showing the dilated gut and contrast study will exclude a mechanical cause of obstruction

46
Q

What is the management plan for Ogilvie’s syndrome

A

Deoebds on reversing the cause if possible - deflate the colon and ease symptoms
Decompression if urgent due to the risk of perforation

Gastrointestinal (LECTURE NOTES) (29 decks)

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