Colonic Disease Flashcards
What is a polyp?
A protrusion of an epithelial surface
What is an adenoma?
A benign epithelial tumour that produces glands
All polyps are adenomas. True/False?
False
What are the 3 types of polyp?
Pedunculated (stalks)
Serrated (from villous)
Flat
All adenomas are dysplastic and may form adenocarcinoma. True/False?
True
What is the primary treatment of adenocarcinoma of the colon?
Surgical excision - colectomy, colostomy and/or resection
Colorectal carcinoma is found most commonly on which side - right or left?
Left (75%)
What is a diverticulum?
Outpouching of epithelial lining
What is the difference between diverticulosis and diverticulitis?
Diverticulosis = diverticular disease = the presence of diverticula Diverticulitis = inflammation of diverticula
What is the proposed aetiology of diverticular disease?
Low fibre diet, high fatty diet
Reduces motility and increases colonic pressure
List some investigations for diverticular disease
Sigmoidoscopy
Barium enema
CT ABDOMEN - DIVERTICULITIS
Which part of the colon is most susceptible to diverticular disease?
Sigmoid colon
What is a fistula?
Pathological connection/link between two epithelial surfaces
What would a fistula between the colon and the bladder be called?
Colovesical fistula
What are the main management for diverticular disease?
IV fluids, bowel rest, IV antibiotics, increased fibre in diet
Percutaneous drainage
Hartmann procedure
Describe Hartmann procedure
Remove sigmoid colon and connect colostomy bag to descending colon
What are the most common organisms that cause infective colitis?
C. difficile
Campylobacter
E. coli
Name some symptoms of acute and chronic colitis
Diarrhoea with/without blood
Cramping pain
Dehydration
Weight loss
List investigations for acute and chronic colitis
AXR
Stool culture
Sigmoidoscopy
Barium enema
Name some causes of large bowel obstruction
Colonic cancer
Volvulus
Faecal impaction
Pseudo-obstruction
Which part of the colon is most commonly affected by ischaemic colitis?
Sigmoid colon (diverticular disease too - it just gets all the shit…)
What is the most common cause of ischaemic colitis?
Atherosclerosis of mesenteric vessels
Which organism is mostly behind antibiotic-induced colitis?
C. difficile
How does C. difficile cause colitis?
Produces toxin A and B in response to broad-spectrum antibiotics which attack epithelium
What is the classic presentation of collagenous colitis?
Watery diarrhoea
Normal endoscopy
Familial adenomatous polyposis is a type of CRC caused by mutation in which gene?
APC (tumour suppressor) gene
Hereditary nonpolyposis colorectal cancer is caused by mutation in which gene?
DNA mismatch repair gene
HNPCC is more common than FAP. True/False?
True
What are the symptoms of colorectal carcinoma?
Pain, anaemia, cachexia, lymphadenopathy
Abdominal mass, abdominal distension (ascites)
Rectal mass, PR bleeding, tenesmus, change in bowel habit
How is CRC diagnosed?
Barium enema
CT colography
Sigmoidoscopy
Colonoscopy
What is the screening test for CRC?
Faecal occult blood testing
What is colonic volvulus? Where is it most common? How is it diagnosed? How is it treated?
Part of colon twists on mesentery, causing obstruction - typically elderly people
Sigmoid colon
AXR - COFFEE BEAN SHAPE
Sigmoidectomy
What is colonic angiodysplasia? What are the signs? How is it diagnosed? How is it treated?
Small vascular malformation of gut, leading to bleeding and anaemia
Fresh PR bleeding in elderly
PR exam, colonoscopy, angiography
Embolization
List some features of diverticular disease
LIF pain/ tenderness
Altered bowel habit
Nausea/ vomiting
Septic
What classification system do we use for diverticulitis?
Hinchey’s classification
What is the treatment for colitis?
IV fluids
IV steroids (NOT IN ISCHAEMIC)
GI rest
Surgery if failure to settle
Name the four main types of colitis
Infective
Ulcerative
Crohns
Ischaemic
List the main causes of PR bleeding
Diverticulitis Colorectal cancer Haemorrhoids Crohns/ UC Angiodysplasia
What are the symptoms of large bowel obstruction? How is it treated?
Vomiting Colicky pain Constipation Distension Catheter, NGT, IV fluids, surgical stenting
Mechanical GI onstruction with no cause found is known as…
What are the types?
Pseudoobstruction
ACUTE: Ogilves syndrome
CHRONIC: Weight loss due to malabsorption
What staging method is used for CRC?
Duke’s Criteria
