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Colon > Colon > Flashcards

Colon Flashcards

1
Q

Length?

A

1.5 meters

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2
Q

Widest part?

A

Cecum – 8cm diameter

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3
Q

The 3 bundles of teniae coli?

A

1) Mesocolic 2) Omental 3) Free

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4
Q

Average length of appendix?

A

10cm

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5
Q

Rectum anatomy

A 
Fixed.
Retroperitoneal.
No haustra.
Has 3 tenia coli.
Valves of Houston (3 horizontal folds - superior/middle/inferior)
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6
Q

Where does the Meissner’s plexus reside?

A

Submucosa layer

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7
Q

Auerbach’s myenteric plexus resides?

A

Between the circular and longitudinal muscular layer.

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8
Q

Width of sigmoid colon?

A

2.5cm

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9
Q

Descending colon

A

Fixed part of GI.

Retroperitoneal (including flexure).

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10
Q

Most narrowest and mobile part of GI?

A 
Sigmoid colon
(Makes for most common site for volvulus and obstruction)
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11
Q

Double Contrast Enema used for what?

A

Visual polyps

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12
Q

Most common location of colon atresia?

A

Right hepatic flexure

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13
Q

Best views to observe imperforate anus?

A

Up-side-down films (invertograms) OR lateral prone films

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14
Q

Fistulas from imperforate anus to bladder/urethra will show what?

Who do these occur in?

A

Air in bladder.

50% of males with high atresia.

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15
Q

Colonic duplication usually seen where in GI tract?

A

Sigmoid or rectum

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16
Q

Colonic duplications are usually seen along what side of the colon?

A

Mesenteric border

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17
Q

How much does the colon rotate during fetal development and in which direction?

A

90 counterclockwise 1st stage; 180 counterclockwise 2nd stage = 270 counterclockwise TOTAL

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18
Q

Failure of last 180 deg rotation (complete failure)?

A

Asymtomatic & infrequent
Jejunum & ileum – right side of abdomen
Colon – left side of abdomen
Iliocecal valve reversed.

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19
Q

Incomplete failure (malrotation)?

A

Common

Defect in peritoneal attachment - VOLVULUS common finding.

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20
Q

Reversal of rotation?

A

Clockwise rotation = rare

Transverse colon behind the duodenum

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21
Q

AKA for aganglionic megacolon

A

Hirschsprung disease

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22
Q

What population does aganglionic megacolon occur in?

A

Neonates (most common cause of colonic obstruction at this age 15-20%)
M>F (3-4 to 1)

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23
Q

Aganglionic megacolon pathology?

A

Absence of ganglion cell in DISTAL colon and RECTUM –> functional obstruction develops as result of spasm in denervated colon.
NO PERISTALSIS in this region.

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24
Q

What condition is 10% of Hirschsprung cases associated with?

A

Down’s syndrome

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25
Q

Contrast emema presentation of Hirschsprung?

A

Saw-tooth irregularity of agangliontic segment with proximal DILATION and thickened walls
No gas/feces in rectosigmoid.

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26
Q

Hepatic flexure between liver and diaphragm called…

A

Chilaiditi’s Sign

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27
Q

RLQ Sigmoid colon seen in what population?

A

Infants and young children

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28
Q

Redundant colon predisposes to…?

A

Constipation or volvulus

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29
Q

TB affects what part of GI most often (location & percentage)?

A

Ileocecal region 85-90%

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30
Q

Colonic TB pathology?

A

Healing in chronic stage with fibrosis –> rigidity and narrowing of lumen
(Should be considered when person originates from an endemic area)

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31
Q

Colonic TB image findings

A

Narrowing –> small bowel obstruction
Loss of haustrations
Ulceration of mucosa
~ Multiple mass-like lesions

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32
Q

Abnormal terminal ileum in Europe =

A

Crohns

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33
Q

Abnormal terminal ileum in Asia =

A

TB

34
Q

Areas most commonly affected by Amebiasis?

A

Cecum
Appendix
Ascending colon

35
Q

What is the organism involved in Amebiasis?

A

Entamoeba histolytica

36
Q

Amebiasis x-ray findings?

A
  • Superficial ulcers (serrated appearance)
  • Possible deformity of the cecum –> CONE SHAPED
  • Ileocecal valve is thickened, incompetent, open & fixed
37
Q

Ulcerative Colitis location?

A

Rectum (30%), Rectum + colon (40%), Pancolitis (30%)

38
Q

Ulcerative Colitis incidence?

A

1st degree relative = 30-100X greater
F>M
15-25yr (again 55-65yr)

39
Q

Layers of the wall most affected in UC?

A

Mucosa and submucosa

40
Q

What % of UC is associated with arthritis?

A

25%

41
Q

UC Radiographic Findings (General)

A
  • Continuous segments
  • Thickened folds of haustra
  • Deep ulcers
  • TOXIC MEGACOLON >6cm
    ~ Cobblestone appearance
  • Increased presacral space (m/c/c)
42
Q

UC Radiographic Findings (Acute)

A
  • Colorectal narrowing + incomplete filling
  • Haustra edematous & thickened
  • Polyps
43
Q

UC Radiographic Findings (Chronic)

A
  • Shortening of colon
  • “LEAD-PIPE” colon –> rigid + narrowing
  • Haustra blunted or lost
  • BACKWASH ILEITIS (10-40%)
  • Widened presacral space
  • Strictures (10%)
44
Q

UC complications?

A

75-80% of pancolitis cases –> Colon cancer

45
Q

Crohn’s colitis (Granulomatous colitis) location?

A

Right sided (spares rectum)

46
Q

Crohn’s colitis’s clinical hallmark?

A

Diarrhea

47
Q

Crohn’s colitis’s radiographic findings?

A
  • Discrete, superficial ulcers
  • Thickened wall & narrow lumen
  • COBBLESTONE appearance
  • SKIP LESIONs
48
Q

Crohn’s colitis pathological features?

A
  • Hyperplasia of lymphoid in submucosa (transmural extension)
49
Q

Crohn’s vs. UC

A

CROHN’S

  • transmural inflammation
  • affects terminal ileum mostly (proximal colon)
  • ulcers random & asymmetric
  • skip lesions
  • granulomas seen in colon
  • anal lesions

UC

  • inflammation of mucosa and submucosa
  • affects sigmoid and rectum mostly
  • ulcers monotonous & uniform
  • continuous lesion
50
Q

Cathartic Colon pathology?

A

Prolonged stimulation of colon by irritant laxatives cause meuromuscular incoordination (inability of colonic musculature to produce adequate contractile force)

51
Q

Cathartic colon demographics?

A

Women, middle aged, +15yrs of laxative use

52
Q

Cathartic Colon radiographic appearance?

A

Lack of haustral saculations (smooth)
Lumen distends or narrows
Ileocecal valve flattens and gaps – backwash ileitis appearance

53
Q

Organism seen most in Pseudomembranous colitis?

A

Clostridium difficile

54
Q

Pseudomembranous colitis etiology?

A

Chronic use of antibiotics – high numbers of drug resistant clostridia

55
Q

Pseudomembranous colitis x-ray findings?

A
  • Thumbprinting
  • Shaggy appearance of colon
  • Minimal distention
56
Q

Pseudomembranous colitis ddx?

A

ISCHEMIC COLITIS

57
Q

Ischemic colitis demographics?

A

+50yrs (prior hx of CVD)

58
Q

Ischemic colitis pathology?

A 
Hypotensive episode (eg. trauma, drugs etc.) --> focal or diffuse
20% colonic ischemia proximal to obstruction
59
Q

Ischemic colitis Location?

A
  1. Splenic flexure (Griffith point – junction of SMA & IMA)
  2. Rectosigmoid (Sudeck point – junction of IMA & hypogastric artery)
  3. Left-side colon – elderly w/ dec. perfusion
  4. Right side colon – young patients
60
Q

Ischemic colitis radiographic features?

A
  • Thumbprinting (submucosal edema & bleeding) 75%
  • Luminal narrowing 13%
  • Ulceration 46-60%
  • Bowel wall thickening
61
Q

Common location for diverticula in colon?

A
  • Sigmoid (between taenia coli)
62
Q

Colonic diverticuli demographics?

A

Western society
50-80yrs
30-50% (above 50yrs)
+50% (above 80yrs)

63
Q

Colonic Diverticular pathology?

A

Herniation of mucosa and submucosa through muscular layers of bowel

64
Q

Colonic diverticulitis vs. diverticulosis?

A

With vs. without inflammation

65
Q

Colonic polyps location?

A

Rectum & lower sigmoid (60-75%)

66
Q

Colonic polyp presentation?

A
  • Sessile or pedunculated

- Reach 4-5cm in length

67
Q

Colonic polyp x-ray finding?

A
  • Barium filling defect
  • SMOOTH margins (sharply defined)
  • Minimum size to see = 0.7 to 1cm
68
Q

Colonic polyp malignancy characteristics?

A
  • Size over 1-1.5cm
  • Irregular contour & surface
  • Growth rate quick
69
Q

Familial multiple polyposis complication in colon?

A

Colorectal cancer (67%) by age 50

70
Q

Familial multiple polyposis general age onset?

A

2nd decade of life (but can be seen early childhood)

71
Q

Peutz-Jeghers presentation?

A 
Multiple polyposis of s. bowel; 
Mucocutaneous pigmentation (melanin) of lips and mouth
72
Q

Peutz-Jeghers complication?

A

Mild inc incidence of colonic cancer.

Greater occurrence of ovarian tumors (female).

73
Q

Gardner’s syndrome triad?

A

1) Colonic polyposis
2) Osteomas
3) Soft tissue tumors

74
Q

Gardner’s syndrome complication?

A

These adenomas are extremely malignant.

75
Q

Cronkhite-Canada Syndrome presentation?

A

RARE.
Alopecia & Atrophy (AA in CC) of nails
Hyperpigmentation

76
Q

Cronkhite-Canada Syndrome major concern?

A

Protein losing disease – dangerous for females.

77
Q

Turcot’s Syndrome presentation in colon?

A

Polyps & central nervous system glioblastomas (supratentorial).

78
Q

Turcot’s Syndrome demographics?

A

Children and young adults

79
Q

Turcot’s Syndrome demographics?

A

Children and young adults

80
Q

Turcot’s Syndrome demographics?

A

Children and young adults

Colon (1 decks)

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