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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
Q

Causes of colitis:

A

Crohn’s, UC, bac. infections, ischaemia

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26
Q

Colitis findings on an AXR

A

lead piping

thumbprinting

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27
Q

diagnosis of colitis by:

A 
AXR, sigmoidoscopy + biopsy (finds out what type)
stool cultures (if have IBD then if bac. -ve only then start steroids)
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28
Q

Treatment of IBD colitis (if no bacteria present)

A

IV fluids and steroids

if present after 3-4days then more IS/surgery resection

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29
Q

Ischaemic colitis treatment =

A

sntiplatelets and statins

30
Q

Colonic angiodysplasia =

A

submucosal lakes of blood usually RHS of colon => malaena

31
Q

diagnosis of colonic angiodysplasia

A

CT, angiography, colonoscopy, endoscopy (exclude upper GI bleed)

32
Q

Treatment of colonic angiodysplasia

A

injection embolyse
endoscopic ablation
surgical resection

33
Q

Absolute constipation indicates ___

1st sign in ___

A

colonic obstruction

distal obstruction

34
Q

1st sign in proximal colonic obstruction

A

vomiting

35
Q

Ischaemic colon appearance =

A

segmental
erythematous+/ulcerated appearance
withered crypts w. lamina propria smudging
fewer chronic inflam cells than other colitises

36
Q

Ischaemia affects the ___ colon more

A

LHS

37
Q

Pseudomembranous colitis is caused by

appearance

A

C. diff toxins A+B
patchy yellow membranous exudate on mucosal surface
microscopic = explosive fibrinopurulent exudate mucosal lesions

38
Q

Treatment of pseudomembranous colitis

A

flagyl/vancomycin

may need colectomy

39
Q

Microscopic colitis =

2 types =

A

normal macroscopically but biopsies classify as microscopically altered
collagenous
lymphocytic

40
Q 
Collagenous colitis is a \_\_\_\_ colitis
Causes increased thickness of \_\_\_
is continuous/patchy
associated with \_\_\_
causes \_\_
due to  \_\_
A 
microscopic
subendothelial collagen
patchy
intraepithelial inflammatory cells
watery diarrhoea
drugs usually
41
Q

Lymphocytic colitis is a __ colitis
there is no ____
large increase in ___
raises the possibility of ___

A

microscopic
no thickening of basement membrane
intraepithelial lymphocytes
coeliacs

42
Q

radiation colitis is caused by ___

leads to _

A

radiotherapy
chronic active/inactive colitis
telangectasia
bizarre stromal cells and vessels

43
Q

Acute (infective) colitis looks like:

acute can rarely be caused by:

A

no crypt irregularity but neutro.s in crypts

drugs ischaemia endoscopy prep IBD onset

44
Q

Polyps can be ___, ___, ___ or ___

A

inflammatory, hamartomatous, metaplastic, neoplastic

45
Q

Colorectal cancer shapes can be __/__/__

A

polypoidal
ulcerative
annular

46
Q

colorectal cancer locations commonest to least common

A

rectal>sigmoid> caecum and ascending

47
Q

Duke stage D for colorectal cancer =

A

metastasis

48
Q

Protective lifestyle factors against colorectal cancers

A

veg, fruits

exercise - > AMPK>glucose uptake by muscle and decreased cell turnover

49
Q

Rectal cancer main signs =

A

PR blood and tenesmus

50
Q

Investigations for colorectal cancer:

A 
FOBT
colonoscopy
Sigmoidoscopy
CT colonography
Barium enema
Rectal staged by MRI
51
Q

Rectal cancer is staged by __ imaging

A

MRI

52
Q

If colorectal ca obstructs then treatment =

A

stent
colonostomy
resect w. colonostomy/anastamosis

53
Q

Radiotherapy is used in colorectal ca in which cases

A

adjuvant pre and post op

palliative - recurrent/ inoperable cancers

54
Q

chemotherapy agents used for colorectal ca

adjuvant therapy for __ and ___

A

5-FU (5-fluorouracil), capecitabine
post op for Stage C
advanced - roughly 5 month survival - disease

55
Q

Haemorrhoids cause ___ bleeding

typically found in ++_ o’clock postitions when supine

A

painless

3, 7, 11

56
Q

Investigations for haemorrhoids

A 
PR
rigid sigmoidoscopy (flexible if >50yo)
US if internal to find route and arterial branches that supply
57
Q

Treatment for symptomatic haemorrhoids =

A

sclerotherapy
band ligation
open/stapled haemorrhoidectomy
HALO/THD (for internal haemorrhoids - shrink in wks)

58
Q

Rectal prolapses can be ___/___

A

partial (anterior mucosal prolapse)

complete (full thickness)

59
Q

Presentation of rectal prolapse =

A

protruding anal mass esp during defaecation, poor anal tone, blood and mucus PR

60
Q

Management of complete rectal prolapse =

A

surgery - delorme’s (stitch back in), rectoplexy, anterior resection
too frail = bulking agent + manual reduction

61
Q

Management of incomplete rectal prolapse =

A

kids - diet and treat constipation

adults - similar to haemorrhoid therapy

62
Q

A tear in the anal margin (usually posteriorly) due to constipation/multiple in Crohn’s =

A

anal fissure

63
Q

Shitting glass
pain for 30mins after defaection
follows episode of constipation

A

anal fissure

64
Q

Anal fissures also often have ___ which is a ___ that looks like external haemorrhoids

A

sentinel tag

hypertrophic skin tag at distal edge

65
Q

treatment of anal fissures

A 
diiet
stool softeners
GTN/diltiazem ointment
spincterotomy (6wks)
botox injection
66
Q

Internal opeing in anal canal connecting to 1/more openings on perianal skin =

A

fistula in ano

67
Q

majority of fistula in ano arise due to __

A

delay/inadequate treatment of anorectal abscess

68
Q

Rare causes of fistula in ano =

A

tb
carcinoma
Crohn’s

69
Q

Fistula in ano 4 types =

A

intersphincteric
transphincteric
extrasphincteric
suprasphincteric

70
Q

Investigations for fistula in ano =

A

EUA (exam under anaesthesia) of anorectum
rigid sigmoidoscope (flexible if over 50)
MRI - outlines course, extent and shows abscesses

71
Q

Management of fistula in ano =

A 
open
seton stitch
LIFT (ligation of intersphincteric fistula) + stitch to drain
glue/permacol
defunctioning(end) colonostomy

JazGI (26 decks)

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