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JazGI > Colorectal + anal pathologies > Flashcards

Colorectal + anal pathologies Flashcards

1
Q

Colorectal polyps are always pathological

benign =

A

epithelial: adenoma, inflammatory, Peutz-Jegher’s
mesenchymal: lipoma, fiboma, leiomyoma

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2
Q

Malignant colorectal polyps

A 
epithelial = adenocarcinomas/carcinoid
mesenchymal = sarcoma
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3
Q

3 types of polyp by appearance

A

pedunculated - on a stalk
sessile - like a carpet
flat - not noticably protruding

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4
Q

polyp defintion

A

protrusion above an epithelial surface

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5
Q

All ____ of the colon should removed as may becomes adenocarcinoma if acquire ___ mutation

A

adenoma

p53

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6
Q

staging and treatment of adenocarcinoma of colon

A

biopsy

surgery

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7
Q

Duke A stage for adenoca of colon =

A

confined to muscularis propria

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8
Q

Duke B stage for adenoca of colon =

A

through muscularis propria

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9
Q

Duke C stage for adenoca of colon =

A

metastasis to lymph nodes

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10
Q

most common type of colorectal cancer

most common in R/LHS of colon

A

adenocarcinoma

75% LHS - desc, sigmoid and rectum

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11
Q

RHS colorectal cancers present with ___

A

more likely to be incidental finding
wt loss
anaemia

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12
Q

LHS colorectal cancers present with

A

blood PR, obstruction, altered bowel habit

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13
Q

HNPCC = ___/___
have ___ polyps
caused by a ____ defect in ____

A

Hereditary Non-polypsosis Colorectal cancer/ Lynch syndrome
less than 100
auto dom
mismatch repair genes

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14
Q

HNPCC causes ___ tumours
has a early/late onset
has a Crohn’s-like ___
associated with __+__ cancers

A

mucinous/LHS colon cancers
late onset
inflammatory response
endometrial and gastric

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15
Q 
FAP =
have \_\_\_ polyps
early/late onset
\_\_\_\_ fault in \_\_\_ gene
has no specific \_\_\_\_
causes \_\_\_\_\_ (cancer)
associated with \_\_+\_\_ (cancers)
A 
familial adenomatous polyposis
more than 100
early
auto dom ; APC
no inflammatory response
adenocarcinoma
ass. with desmoid tumours and thyroid carcinoma
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16
Q

APC gene is a ___

A

tumour suppressor

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17
Q

HNPCC/ FAP causes an inflammatory response

A

HNPCC

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18
Q

Diverticula definition =

A

mucosal herniation through the muscle wall

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19
Q

diverticular disease is most common in ___

A

sigmoid colon

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20
Q

True diverticula definition

eg.

A

all layers of gut wall

Meckel’s

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21
Q

majority of diverticula are ___

definition =

A

false - only serosa and mucosal layers

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22
Q

Tests to diagnose diverticulosis/itis

A

contrast enema
clincial findings
sigmoidoscopy
CT

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23
Q

colovesicular fistula presents with:

A

recurrent UTIs, cloudy urine, pneumaturia, dysuria

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24
Q

Treatment for complicated diverticular disease =

A

Hartmanns (remove sigmoid and have stoma)
IV antibiotics
percutaneous drainage
laparoscopic lavage and drainage

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25
Causes of colitis:
Crohn's, UC, bac. infections, ischaemia
26
Colitis findings on an AXR
lead piping | thumbprinting
27
diagnosis of colitis by:
``` AXR, sigmoidoscopy + biopsy (finds out what type) stool cultures (if have IBD then if bac. -ve only then start steroids) ```
28
Treatment of IBD colitis (if no bacteria present)
IV fluids and steroids | if present after 3-4days then more IS/surgery resection
29
Ischaemic colitis treatment =
sntiplatelets and statins
30
Colonic angiodysplasia =
submucosal lakes of blood usually RHS of colon => malaena
31
diagnosis of colonic angiodysplasia
CT, angiography, colonoscopy, endoscopy (exclude upper GI bleed)
32
Treatment of colonic angiodysplasia
injection embolyse endoscopic ablation surgical resection
33
Absolute constipation indicates ___ | 1st sign in ___
colonic obstruction | distal obstruction
34
1st sign in proximal colonic obstruction
vomiting
35
Ischaemic colon appearance =
segmental erythematous+/ulcerated appearance withered crypts w. lamina propria smudging fewer chronic inflam cells than other colitises
36
Ischaemia affects the ___ colon more
LHS
37
Pseudomembranous colitis is caused by | appearance
C. diff toxins A+B patchy yellow membranous exudate on mucosal surface microscopic = explosive fibrinopurulent exudate mucosal lesions
38
Treatment of pseudomembranous colitis
flagyl/vancomycin | may need colectomy
39
Microscopic colitis = | 2 types =
normal macroscopically but biopsies classify as microscopically altered collagenous lymphocytic
40
``` Collagenous colitis is a ____ colitis Causes increased thickness of ___ is continuous/patchy associated with ___ causes __ due to __ ```
``` microscopic subendothelial collagen patchy intraepithelial inflammatory cells watery diarrhoea drugs usually ```
41
Lymphocytic colitis is a __ colitis there is no ____ large increase in ___ raises the possibility of ___
microscopic no thickening of basement membrane intraepithelial lymphocytes coeliacs
42
radiation colitis is caused by ___ | leads to _
radiotherapy chronic active/inactive colitis telangectasia bizarre stromal cells and vessels
43
Acute (infective) colitis looks like: | acute can rarely be caused by:
no crypt irregularity but neutro.s in crypts | drugs ischaemia endoscopy prep IBD onset
44
Polyps can be ___, ___, ___ or ___
inflammatory, hamartomatous, metaplastic, neoplastic
45
Colorectal cancer shapes can be __/__/__
polypoidal ulcerative annular
46
colorectal cancer locations commonest to least common
rectal>sigmoid> caecum and ascending
47
Duke stage D for colorectal cancer =
metastasis
48
Protective lifestyle factors against colorectal cancers
veg, fruits | exercise - > AMPK>glucose uptake by muscle and decreased cell turnover
49
Rectal cancer main signs =
PR blood and tenesmus
50
Investigations for colorectal cancer:
``` FOBT colonoscopy Sigmoidoscopy CT colonography Barium enema Rectal staged by MRI ```
51
Rectal cancer is staged by __ imaging
MRI
52
If colorectal ca obstructs then treatment =
stent colonostomy resect w. colonostomy/anastamosis
53
Radiotherapy is used in colorectal ca in which cases
adjuvant pre and post op | palliative - recurrent/ inoperable cancers
54
chemotherapy agents used for colorectal ca | adjuvant therapy for __ and ___
5-FU (5-fluorouracil), capecitabine post op for Stage C advanced - roughly 5 month survival - disease
55
Haemorrhoids cause ___ bleeding | typically found in _+_+_ o'clock postitions when supine
painless | 3, 7, 11
56
Investigations for haemorrhoids
``` PR rigid sigmoidoscopy (flexible if >50yo) US if internal to find route and arterial branches that supply ```
57
Treatment for symptomatic haemorrhoids =
sclerotherapy band ligation open/stapled haemorrhoidectomy HALO/THD (for internal haemorrhoids - shrink in wks)
58
Rectal prolapses can be ___/___
partial (anterior mucosal prolapse) | complete (full thickness)
59
Presentation of rectal prolapse =
protruding anal mass esp during defaecation, poor anal tone, blood and mucus PR
60
Management of complete rectal prolapse =
surgery - delorme's (stitch back in), rectoplexy, anterior resection too frail = bulking agent + manual reduction
61
Management of incomplete rectal prolapse =
kids - diet and treat constipation | adults - similar to haemorrhoid therapy
62
A tear in the anal margin (usually posteriorly) due to constipation/multiple in Crohn's =
anal fissure
63
Shitting glass pain for 30mins after defaection follows episode of constipation
anal fissure
64
Anal fissures also often have ___ which is a ___ that looks like external haemorrhoids
sentinel tag | hypertrophic skin tag at distal edge
65
treatment of anal fissures
``` diiet stool softeners GTN/diltiazem ointment spincterotomy (6wks) botox injection ```
66
Internal opeing in anal canal connecting to 1/more openings on perianal skin =
fistula in ano
67
majority of fistula in ano arise due to __
delay/inadequate treatment of anorectal abscess
68
Rare causes of fistula in ano =
tb carcinoma Crohn's
69
Fistula in ano 4 types =
intersphincteric transphincteric extrasphincteric suprasphincteric
70
Investigations for fistula in ano =
EUA (exam under anaesthesia) of anorectum rigid sigmoidoscope (flexible if over 50) MRI - outlines course, extent and shows abscesses
71
Management of fistula in ano =
``` open seton stitch LIFT (ligation of intersphincteric fistula) + stitch to drain glue/permacol defunctioning(end) colonostomy ```

JazGI (26 decks)

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