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GIHEP > L28: Diverticular Disease + Colorectal Cancer > Flashcards

L28: Diverticular Disease + Colorectal Cancer Flashcards

1
Q

What is the most common type of colorectal cancer?

A

Adenocarcinoma

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2
Q

List the 4 macroscopic types of colorectal cancer

A
  1. Fungating Polypoid Tumour
  2. Annular Constricting Tumour
  3. Flat Ulcerated
  4. Mucinous
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3
Q

List the common tumour sites of colorectal cancer for most common to least

A
  1. Descending + Sigmoid
  2. Rectum
  3. Right-Sided
  4. Transverse
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4
Q

What is the most common site for colorectal cancer?

A

descending + sigmoid colon

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5
Q

What is CEA and what is it used for?

A

Carcinoembryonic Antigen

- used to monitor colorectal cancer + if treatment is working

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6
Q

What is the gold standard investigation to diagnose colorectal cancer?

A

Endoscopy

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7
Q

Which classification system is used to rate the severity of colorectal cancer? (hint: not TNM)

A

Dukes’ Classification

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8
Q

What is Dukes’ Classification?

A

used to rate severity of colorectal cancer + gives prognosis

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9
Q

What does Dukes A classification mean?

A

CRC confined to bowel wall

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10
Q

What does Dukes B classification mean?

A

CRC invades through muscularis propria

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11
Q

What does Dukes C classification mean?

A

CRC invaded regional lymph nodes

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12
Q

What does Dukes D classification mean?

A

CRC has distant mets

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13
Q

When is a right hemicolectomy done?

A

for right-sided CRC tumours

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14
Q

When is a left hemicolectomy done?

A

for left-sided CRC tumours

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15
Q

If there is CRC as well as positive lymph nodes and evidence of vascular invasion, what adjuvant therapy may be given?

A

adjuvant chemotherapy

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16
Q

If there is a rectal tumour in the upper 1/3 of the rectum, what surgery may be done?

A

a high anterior resection

17
Q

If there is a rectal tumour in the middle and lower 1/3 of the rectum, what surgery may be done?

A

a low anterior resection

abdomino-perineal resection (APR)
- removes anus, rectum + sigmoid colon

18
Q

If a kit test for faecal occult blood is positive, what should be done?

A
  • kit screens for occult blood in faeces
  • screening for CRC
  • pt referred for full colonoscopic evaluation
19
Q

What is diverticular disease mainly caused by?

A

constipation + increased colonic pressure

20
Q

Which part of the colon does diverticular disease predominantly affect?

A

the sigmoid colon

21
Q

What are the 2 types of diverticular disease?

A
  1. Diverticulosis

2. Diverticulitis

22
Q

What is diverticulosis?

A
  • presence of outpouchings in colon
  • asymptomatic
  • incidental finding
23
Q

What is diverticulitis?

A
  • presence of outpouchings in colon

- has associated inflammation

24
Q

List some of the symptoms and signs of diverticulitis

A
  • fever
  • lower inguinal fossa pain
  • diarrhea/constipation
  • bleeding
  • nausea + vomiting
  • tachycardia
  • guarding of area
25
Q

List some of the complications of diverticular disease

A
  • inflammation (diverticulitis)
  • bleeding
  • perforation ± peritonitis
  • obstruction
  • fistula (e.g. colovesical/enterovesical)
  • stricture formation
  • pericolic or paracolic abscess
26
Q

How is inflammation of a diverticula managed?

A

with antibiotics

27
Q

What is the Hinchey Classification used for?

A

acute diverticulitis

  • is used to describe perforations of the colon due to diverticulitis
  • helps in determining treatment
28
Q

What is Hinchey Classication 1A?

A

paracolic phlegmon

29
Q

What is Hinchey Classification 1B?

A

pericolic/mesenteric abscess

30
Q

What is Hinchey Classification 2?

A

diverticulitis w/ walled-off abscess

31
Q

What is Hinchey Classification 3?

A

purulent peritonitis (perforated abscess cavity)

32
Q

What is Hinchey Classification 4?

A

faeculent peritonitis

- indication for surgery

33
Q

According to the Hinchey Classification, what is considered UNCOMPLICATED diverticulitis?

A

Hinchey 1, 2 and 3

34
Q

According to the Hinchey Classification, what is considered COMPLICATED diverticulitis?

A

Hinchey 4

35
Q

What is the main treatment for UNCOMPLICATED diverticulitis?

A

IV antibiotics

36
Q

What is the main treatment for COMPLICATED diverticulitis?

A

surgery

37
Q

In regards to diverticular disease, when may an End Colostomy (Hartmann’s Procedure) be done?

A

if complicated diverticulitis + a complication (such as perforation)

  • otherwise, affected parts removed and rest of colon anastomosed together

GIHEP (24 decks)

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