Diseases of Colon & Rectum

Question 1

aetiology of colorectal cancer?

Answer 1

old age, low fibre intake, high fat & sugar intake, obesity, smoking, lack of exercise, long standing inflammatory disease e.g. Crohn’s

Question 2

modes of cancer spread?

Answer 2

direct, lymphatic, blood (liver, lung)

Question 3

presentation of colorectal cancer?

Answer 3

anaemia, tiredness, bowel changes, wt loss, rectal bleeding, pain or lump, tenesmus

Question 4

what is tenesmus?

Answer 4

recurrent need to empty bowels

Question 5

hx for colorectal cancer?

Answer 5

changes in bowel habits, bleeding from back passage, wt loss, abdominal pain, swelling in abdomen, previous operations?

Question 6

ix for colorectal cancer?

Answer 6

FOBT (screening), barium enema, rigid sigmoidoscopy/ colonoscopy, CT colonography

Question 7

how to stage for colorectal cancer using radiology

Answer 7

CT abdo, MRI rectum

Question 8

what must be done before colonoscopy?

Answer 8

bowel prep, CO2 insufflation, buscopan IV

Question 9

tx for colorectal cancer?

Answer 9

surgery- right hemicolectom, extended right hemicolectomy, transferase colectomy, sigmoid colectomy, anterior resection, APR
post-op staging
chemo 
imaging 
palliative

Question 10

what surgical technique is recommended and why?

Answer 10

laproscopy- smaller wound site and faster recovery

Question 11

what type of palliative care is carried out for colorectal cancer?

Answer 11

stenting, palliative chemo/radio

Question 12

what are adenomas also known as?

Answer 12

polyps

Question 13

what is an adenoma?

Answer 13

a protrusion above an epithelial surface

Question 14

true/false…

polyps are benign

Answer 14

false…

they can be malignant or benign

Question 15

what are the classes of polyp?

Answer 15

adenoma, serrated polyp, polypoid adenocarcinoma, other

Question 16

what is an adenoma?

Answer 16

benign tumour but can cause local invasion hence should all be removed

Question 17

pathophysiology of an adenoma?

Answer 17

normal mucosa > adenoma > large adenoma > adenocarcinoma

Question 18

what is the tx for polypoid adenocarcinoma?

Answer 18

surgical removal of colon/rectum, radio & chemo

Question 19

where does polypoid adenocarcinoma usually invade into?

Answer 19

muscularis propria

Question 20

what is the staging of polypoid adenocarcinoma?

Answer 20

Dukes Criteria

Question 21

go through Dukes Criteria…

Answer 21

Dukes A: confined by muscularis propria
Dukes B: spread into muscularis propria
Dukes C: metastasis to LNs

Question 22

recap of TNM staging…?

Answer 22

T: T1 (submucosa), T2 (into muscle), T3 (through muscle), T4 (adjacent structures)
N: N0 (no LNs), N1 (<3LNs) N2 (>3 LNs)
M: M0 (no mets), M1 (mets)

Question 23

where site is polypoid adenocarcinoma usually found at?

Answer 23

left sided- rectum, sigmoid, descending

Question 24

what are the common mutations that cause polypoid adenocarcinoma?

Answer 24

APC & K-ras

Question 25

what nodes are invaded with polypoid adenocarcinoma?

Answer 25

mesenteric

Question 26

local invasion of polypoid adenocarcinoma?

Answer 26

mesorectum, peritoneum, etc

Question 27

what is the hereditary cancer causing syndrome?

Answer 27

non polyposis coli (HNPCC)

Question 28

true/false... | HNPCC presents with <100 polyps

Answer 28

True

Question 29

describe HNPCC...

Answer 29

right sided, crohn's like inflammation, late onset

Question 30

what is the familial cancer causing symptom?

Answer 30

adenomatous polyposis (FAP)

Question 31

how many polyps does FAP have?

Answer 31

>100

Question 32

describe FAP...

Answer 32

early onset, defect in APC tumour suppression gene, throughout colon

Question 33

what is diverticular disease?

Answer 33

small sacs form in wall of large intestine

Question 34

why do diverticula form?

Answer 34

high luminal pressure caused by low fibre

Question 35

what is the epidemiology of diverticular disease?

Answer 35

>50yo

Question 36

what is difference between diverticulosis and diverticulitis

Answer 36

diverticulosis: having diverticula (sacs) diverticulitis: when diverticula become inflamed

Question 37

aetiology of diverticulitis?

Answer 37

low fibre intake, fatty food, Marfan's

Question 38

symptoms of diverticulitis?

Answer 38

LIF pain/tenderness, septic, altered bowel habits

Question 39

ix for diverticulitis?

Answer 39

exam, barium enema*, sigmoidoscopy*, CT

Question 40

what is the diverticulitis scoring system for acute disease?

Answer 40

Hinchey Classification

Question 41

describe the Hinchey Classification

Answer 41

1. para colic abscess 2. pelvic abscess 3. purulent peritonitis 4. faecal peritonitis

Question 42

tx for uncomplicated diverticulitis

Answer 42

IV antibiotics and inc fibre

Question 43

tx for complex diverticulitis

Answer 43

Hartmann's procedure, 1y resection/ anastomosis, percutaneous drainage, laparoscopic lavage and drainage, antibis

Question 44

what is hartmann's procedure?

Answer 44

remove sigmoid colon and attach colostomy bag to descending colon

Question 45

complications of diverticulitis?

Answer 45

pericoli abscess, perforation*, haemorrhage, fistula*, stricture

Question 46

what is meckel's diverticulum?

Answer 46

a result of the incomplete regression of Vitelli-intestinal duct

Question 47

symptoms of Meckel's?

Answer 47

asymptomatic

Question 48

tx for Meckel's?

Answer 48

laparoscopic resection

Question 49

when does Meckel's present?

Answer 49

before 2 years of age- usually incidental finding

Question 50

what does Meckel's usually mimic?

Answer 50

appendicitis

Question 51

complications of Meckel's?

Answer 51

bleed, perforation, ulceration, diverticulitis, malignant change

Question 52

what are the types of colitis?

Answer 52

acute or chronic

Question 53

aetiology of colitis?

Answer 53

infective colitis, ulcerative, crohn's, ischaemic

Question 54

what organisms cause infective colitis?

Answer 54

c.dif, campylobacter, shigella, e.coli 0157

Question 55

what is colitis?

Answer 55

inflammation of colon

Question 56

symptoms of colitis?

Answer 56

diarrhoea +-blood, cramps, dehydration, sepsis, wt loss & anaemia

Question 57

ix for colitis?

Answer 57

barium enema*, sigmoidoscopy & biopsy, stool cultures, X-ray

Question 58

tx for colitis

Answer 58

fluids, IV steroids, GI rest, surgery

Question 59

who does ischaemic colitis usually affect

Answer 59

elderly and arteriopaths

Question 60

infection of which artery may result in ischaemic colitis?

Answer 60

infected mesenteric artery

Question 61

what is colonic angiodysplasia?

Answer 61

submucosal lakes of blood

Question 62

where does colonic angiodysplasia usually affect?

Answer 62

right side of colon

Question 63

tx for angiodysplasia?

Answer 63

embolisation, ablation, surgical resection

Question 64

what are 3 less common bowel diseases?

Answer 64

large bowel obstruction sigmoid volvulus pseudomembranous colitis

Question 65

causes and tx of large bowel obstruction?

Answer 65

colorectal cancer, benign stricture, volvulus. | tx- resuscitate, operate, stent

Question 66

causes, ix and tx of sigmoid volvulus?

Answer 66

bowel twist on mesentery. ix- X-ray, rectal contrast tx- flatus tube, surgical resection

Question 67

what is most common presentation for pseudomembranous colitis?

Answer 67

massive diarrhoea & vomit

Question 68

tx for pseudomembranous colitis?

Answer 68

metronidazole/ vancomycin