Colonic Disease

Question 1

What is a polyp?

Answer 1

A protrusion of an epithelial surface

Question 2

What is an adenoma?

Answer 2

A benign epithelial tumour that produces glands

Question 3

All polyps are adenomas. True/False?

Answer 3

False

Question 4

What are the 3 types of polyp?

Answer 4

Pedunculated (stalks)
Serrated (from villous)
Flat

Question 5

All adenomas are dysplastic and may form adenocarcinoma. True/False?

Answer 5

True

Question 6

What is the primary treatment of adenocarcinoma of the colon?

Answer 6

Surgical excision - colectomy, colostomy and/or resection

Question 7

Colorectal carcinoma is found most commonly on which side - right or left?

Answer 7

Left (75%)

Question 8

What is a diverticulum?

Answer 8

Outpouching of epithelial lining

Question 9

What is the difference between diverticulosis and diverticulitis?

Answer 9

Diverticulosis = diverticular disease = the presence of diverticula
Diverticulitis = inflammation of diverticula

Question 10

What is the proposed aetiology of diverticular disease?

Answer 10

Low fibre diet, high fatty diet

Reduces motility and increases colonic pressure

Question 11

List some investigations for diverticular disease

Answer 11

Sigmoidoscopy
Barium enema
CT ABDOMEN - DIVERTICULITIS

Question 12

Which part of the colon is most susceptible to diverticular disease?

Answer 12

Sigmoid colon

Question 13

What is a fistula?

Answer 13

Pathological connection/link between two epithelial surfaces

Question 14

What would a fistula between the colon and the bladder be called?

Answer 14

Colovesical fistula

Question 15

What are the main management for diverticular disease?

Answer 15

IV fluids, bowel rest, IV antibiotics, increased fibre in diet
Percutaneous drainage
Hartmann procedure

Question 16

Describe Hartmann procedure

Answer 16

Remove sigmoid colon and connect colostomy bag to descending colon

Question 17

What are the most common organisms that cause infective colitis?

Answer 17

C. difficile
Campylobacter
E. coli

Question 18

Name some symptoms of acute and chronic colitis

Answer 18

Diarrhoea with/without blood
Cramping pain
Dehydration
Weight loss

Question 19

List investigations for acute and chronic colitis

Answer 19

AXR
Stool culture
Sigmoidoscopy
Barium enema

Question 20

Name some causes of large bowel obstruction

Answer 20

Colonic cancer
Volvulus
Faecal impaction
Pseudo-obstruction

Question 21

Which part of the colon is most commonly affected by ischaemic colitis?

Answer 21

Sigmoid colon (diverticular disease too - it just gets all the shit…)

Question 22

What is the most common cause of ischaemic colitis?

Answer 22

Atherosclerosis of mesenteric vessels

Question 23

Which organism is mostly behind antibiotic-induced colitis?

Answer 23

C. difficile

Question 24

How does C. difficile cause colitis?

Answer 24

Produces toxin A and B in response to broad-spectrum antibiotics which attack epithelium

Question 25

What is the classic presentation of collagenous colitis?

Answer 25

Watery diarrhoea | Normal endoscopy

Question 26

Familial adenomatous polyposis is a type of CRC caused by mutation in which gene?

Answer 26

APC (tumour suppressor) gene

Question 27

Hereditary nonpolyposis colorectal cancer is caused by mutation in which gene?

Answer 27

DNA mismatch repair gene

Question 28

HNPCC is more common than FAP. True/False?

Answer 28

True

Question 29

What are the symptoms of colorectal carcinoma?

Answer 29

Pain, anaemia, cachexia, lymphadenopathy Abdominal mass, abdominal distension (ascites) Rectal mass, PR bleeding, tenesmus, change in bowel habit

Question 30

How is CRC diagnosed?

Answer 30

Barium enema CT colography Sigmoidoscopy Colonoscopy

Question 31

What is the screening test for CRC?

Answer 31

Faecal occult blood testing

Question 32

What is colonic volvulus? Where is it most common? How is it diagnosed? How is it treated?

Answer 32

Part of colon twists on mesentery, causing obstruction - typically elderly people Sigmoid colon AXR - COFFEE BEAN SHAPE Sigmoidectomy

Question 33

What is colonic angiodysplasia? What are the signs? How is it diagnosed? How is it treated?

Answer 33

Small vascular malformation of gut, leading to bleeding and anaemia Fresh PR bleeding in elderly PR exam, colonoscopy, angiography Embolization

Question 34

List some features of diverticular disease

Answer 34

LIF pain/ tenderness Altered bowel habit Nausea/ vomiting Septic

Question 35

What classification system do we use for diverticulitis?

Answer 35

Hinchey's classification

Question 36

What is the treatment for colitis?

Answer 36

IV fluids IV steroids (NOT IN ISCHAEMIC) GI rest Surgery if failure to settle

Question 37

Name the four main types of colitis

Answer 37

Infective Ulcerative Crohns Ischaemic

Question 38

List the main causes of PR bleeding

Answer 38

``` Diverticulitis Colorectal cancer Haemorrhoids Crohns/ UC Angiodysplasia ```

Question 39

What are the symptoms of large bowel obstruction? How is it treated?

Answer 39

``` Vomiting Colicky pain Constipation Distension Catheter, NGT, IV fluids, surgical stenting ```

Question 40

Mechanical GI onstruction with no cause found is known as... | What are the types?

Answer 40

Pseudoobstruction ACUTE: Ogilves syndrome CHRONIC: Weight loss due to malabsorption

Question 41

What staging method is used for CRC?

Answer 41

Duke's Criteria