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Medicine Gastrointestinal > Colorectal pathology > Flashcards

Colorectal pathology Flashcards

1
Q

What is a polyp?

A

Protrusion above an epithelial surface

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2
Q

Types of polyps

A

Epithelial or mesenchymal

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3
Q

Types of benign epithelial polyps

A

Neoplastic - adenoma, hamartomatous - juvenile polyp, Peutz-jeghers, metaplastic

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4
Q

Types of malignant epithelial polyps

A

Polypoid (adenocarcinomas), carcinoid polyps

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5
Q

Benign mesenchymal polyps

A

Lipoma, Lymphangioma, Haemangiomas, Fibromas, Leiomyoma

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6
Q

Malignant mesenchymal polyps

A

Sarcoma, lymphotamous

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7
Q

Why must all adenomas be removed?

A

They are dysplastic - pre-malignant

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8
Q

Microscopic view of adenomas

A

Tubulovillous structures

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9
Q

Which staging predicts prognosis in colorectal carcinoma?

A

Duke’s staging

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10
Q

Dukes staging (A-C)

A

Dukes A - confined by muscularis propria
Dukes B - through muscularis propria
Dukes C - metastatic to lymph nodes

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11
Q

Which side does colorectal carcinoma most commonly affect?

A

Left side (75%)

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12
Q

Presenting complaint of colorectal carcinoma which affects the left side (rectum, sigmoid, descending colon)

A

Blood per rectum, altered bowel habit and obstruction

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13
Q

Presenting complaint of colorectal carcinoma which affects the right side (caecum, ascending colon)

A

Anaemia or weight loss

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14
Q

Patterns of spread of colorectal carcinoma

A

Local invasion, lymphatic spread, haematogenous

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15
Q

Hereditary non polyposis coli:

  • How many polyps?
  • Autosomal dominant or recessive?
  • Where is the defect?
  • Which tumours does it cause?
  • Which cancers is it related to?
A
  • <100 polyps
  • Autosomal dominant
  • Defect in DNA mismatch repair, mutation in MLH-1, MSH-2, PMS-1 or MSH-6 genes
  • Right sided tumours and mucocinos tumours
  • Gastric and endometrial carcinoma
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16
Q

Familial adenomatous polyposis:

  • How many polyps?
  • Autosomal dominant or recessive?
  • Where is the defect?
  • Which cancers is it related to?
A
  • > 100 polyps
  • Autosomal dominant
  • Tumour suppressor defect, inherited mutation in FAP gene
  • Desmoid tumours and thyroid carcinoma
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17
Q

What is diverticular disease?

A

Mucosal herniation through the muscle coat

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18
Q

Where does diverticular disease often occur?

A

Sigmoid colon

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19
Q

What can diverticular disease be due to?

A

Low fibre intake

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20
Q

Complications of diverticular disease

A
  • Pericolic abscess
  • Perforation
  • Haemorrhage
  • Fistula
  • Stricture
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21
Q

Diagnosis of diverticulosis

A

History and clinical examination, barium enema and sigmoidoscopy

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22
Q

Clinical features of diverticulitis

A

Left iliac fossa pain/tenderness, the patient may be septic, and there may be altered bowel habit

23
Q

Which classification is used for diverticulitis

A

Hinchey classification

24
Q

Hinchey classification

A
  • Stage 0 – clinically mild diverticulitis
  • Stage Ia – confined pericolic diverticulitis (beside the colon)
  • Stage Ib – abscess formation (<5cm) in the proximity of the primary inflammatory response
  • Stage II – intra-abdominal abscess, pelvic or retroperitoneal abscess, abscess distant from the primary inflammatory process
  • Stage III – generalised purulent peritonitis
  • Stage IV – faecal peritonitis
25
Q

Treatment for uncomplicated diverticulitis

A

Antibiotics

26
Q

Treatment for complicated diverticulitis

A

Percutaneous drainage, Hartmann’s procedure, laparoscopic lavage and drainage, primary resection/anastomosis

27
Q

Colitis

A

Inflammation of the colon

28
Q

Causes of colitis

A
  • Infective colitis
  • Ulcerative colitis
  • Crohn’s disease
  • Ischaemic colitis
29
Q

Symptoms of colitis

A

Diarrhoea +/- blood, abdominal cramps, dehydration, sepsis, weight loss and anaemia

30
Q

Diagnosis of colitis

A

X-ray, sigmoidoscopy + biopsy, stool cultures, barium enema

31
Q

Treatment of ulcerative colitis/Crohn’s colitis

A

IV fluids, IV steroids, GI rest

32
Q

In which patients is ischaemic colitis most common?

A

Elderly or arteriopaths

33
Q

Colonic angiodysplasia:

  • What is it?
  • Diagnosis
  • Management
A
  • Small vascular malformation of the gut which can cause submucosal lakes of blood
  • Angiography, colonoscopy
  • Embolisation, endoscopic ablation, surgical resection
34
Q

Causes of large bowel obstruction

A

Colorectal cancer, benign stricture, volvulus

35
Q

Volvulus

A

When a loop of intestine twists round itself

36
Q

Treatment for large bowel obstruction

A

Resuscitate, operate, stenting

37
Q

Diagnosis of sigmoid volvulus

A

Plain x-ray abdomen, rectal contrast

38
Q

Treatment for sigmoid volvulus

A

Flatus tube, surgical resection

39
Q

Risk factors for colorectal cancer

A
  • Older age
  • Low intake of fibre
  • High intake of fat, sugar, alcohol, red meat, processed meats
  • Obesity
  • Smoking
  • Lack of physical exercise
40
Q

Ways of presenting with colorectal cancer

A

Bowel screening programme, urgent - via surgical outpatient department or endoscopy, emergency (obstruction, rectal bleeding, palpable mass, perforation)

41
Q

Signs and symptoms of right sided cancers

A
  • Unexplained iron deficiency anaemia
  • Persistent tiredness
  • A persistent and unexplained change in bowel habit
  • Unexplained weight loss
  • Abdominal pain (colicky)
  • Lump in the abdomen
42
Q

Signs and symptoms of cancers in the left side and rectum

A
  • Rectal bleeding
  • Feeling of incomplete emptying
  • Worsening constipation
43
Q

Investigations for colorectal cancer

A

Sigmoidoscopy, colonoscopy, CT colonography

44
Q

Steps in transformation of polyp to cancer

A

Normal epithelium (via APC mutation and COX-2 overexpression) → Hyperproliferative epithelium. Aberrant cryptic foci → Small adenoma (via K-ras mutation) → Large adenoma (via p35 mutation and loss of 18q) → Colon carcinoma

45
Q

Surgery options for colorectal cancer

A

Right hemicolectomy, extended right hemicolectomy, transverse colectomy, sigmoid colectomy, anterior resection, APR

46
Q

Right hemicolectomy

A

Right colon removed and ileocolic anastomosis

47
Q

Extended right hemicolectomy

A

Right colon and part of transverse colon removed, anastomosis between parts of colon

48
Q

Transverse colectomy

A

Transverse colon removed and anastomosis between parts of colon

49
Q

Sigmoid colectomy

A

Part of sigmoid colon removed and anastomosis between parts of colon

50
Q

Anterior resection

A

Part of rectum removed, remaining parts anastomosed

51
Q

APR

A

Sigmoid colon divided, anus resected and perianal skin is closed, colonostomy

52
Q

Factors influencing enhanced recovery following surgery for colorectal cancer

A

No premed, no NGT, no bowel prep, avoid fluid overload, prevent hypothermia, no drains, small incision, early mobilisation, early removal of catheters, NSAIDs, no opiods

53
Q

Colorectal cancer treatment following surgery

A

Chemotherapy, radiotherapy depending on staging

54
Q

Palliation for colorectal cancer

A

Stenting, palliative chemotherapy/radiotherapy, defunctioning, bypass

Medicine Gastrointestinal (24 decks)

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