Large Bowel

Question 1

Diverticulosis definition

Answer 1

Presence of diverticular

Question 2

Diverticular disease definition

Answer 2

Presence of diverticular and

• intermittent lower abdomen pain and bloating
• may be eased by passing stool
• new IBS in older people
• rectal bleeding, fresh

Question 3

Diverticulitis definition

Answer 3

Presence of diverticular and

• infection and inflammation of diverticular
• constant abdo pain
• fever
• constipation or diarrhoea
• bleeding
• n+v

Question 4

Diverticular aetiology

Answer 4

• thickend colonic muscle wall due to excess elastic tissue
• functional hypersegmentation -> increased pressure
• pockets of mucosa herniate through weak points in the bowel wall
• between the taeniae coli
• sigmoid most common

Question 5

Complications of diverticular pericolic abcess

Answer 5

Severe diverticulitis which fails to resolve with antibiotics
Pain and tenderness
Fever
Incomplete obstruction 
Purulent diarrhoea 
-> CT scan and antibiotics

Question 6

Complications of diverticular disease, perforation

Answer 6

Acute abdomen and sepsis

-> colonic resection and temporary stoma

Question 7

Diverticular disease complications, fistula

Answer 7

Inflammation-> adhesions-> rupture
Bubbles in wee/infections
Uterus

Question 8

Diverticular disease complications, haemorrhage

Answer 8

> 50 years
Spontaneous
Fresh blood
Most common cause of large volume

Question 9

Diverticular disease investigations

Answer 9

CT scan

Colonoscopy

Question 10

Diverticular disease management

Answer 10

Increase dietary fibre
Resection if severe/repeated attacks
Antibiotics

Question 11

Colorectal adenomas

Answer 11

Most common type of polyp
Glandular epithelium of large bowel
Have malignant potential so all need to be removed
Often asymptomatic and found on screening
-unexplained anaemia/rectal bleeding
-mucous
-tenesmus

Question 12

Familial adenomatous polyps, what and how

Answer 12

Autosomal dominant -> rare-> APC gene
Commonly asymptomatic
Begin to develop in childhood and have hundreds by 30-40
Inevitably develop cancer by 45
Prevented by surveillance and removal of common
Also:
-desmoid tumours
-congenital hypertrophy of retinal pigment
-fibrous oesteomas
-sebaceous cysts

Question 13

Hereditary Non-polyposis what and how

Answer 13

Autosomal dominant -> DNA mismatch repair gene
Increased incidence of adeoncardinomas in the ovary, endometrium and stomach
90% develop cancer
Often poorly differentiated and aggressive

Question 14

Colon cancer epidemiology

Answer 14

6th decade
2/3 rectum
3rd commonest cause of cancer death in UK

Question 15

Colon cancer risk factors

Answer 15

Age
High red/processed meat intake
Low fibre 
T2DM
UC
Inherited syndromes

Question 16

Colon cancer pathophysiology

Answer 16

Adenocarcinoma
Initially exophytic-> protrudes in to lumen -> ulcerated
-> invade bowel wall
-stromatolites fibrosis-> obstruction
Lymph and blood mets-> para aortic and liver

Question 17

Colon cancer presentation

Answer 17

Anaemia 
Change in bowel habits 
Large bowel obstruction 
Rectal bleeding 
Abdo pain
Malaise
Wt loss 
Tenesmus 
Perforation

Question 18

Dukes staging

Answer 18

A-mucosa
B-muscle, no nodes
C- nodes
D-mets

Question 19

Primary caecal cancer specific symptoms

Answer 19

Painless
Iron deficient an email
RIF mass
Diarrhoea

Question 20

Primary descending cancer specific symptoms

Answer 20

Rectal blood loss
Change in bowel habit 
Colicky pain/obstruction 
Increased mucous 
Fistula perforation

Question 21

Sigmoid primary cancer specific symptoms

Answer 21

Tenesmus
Diarrhoea 
Hypokalemia 
Local pain 
Incontinence

Question 22

Colon cancer screening

Answer 22

60-70y
Test stools for blood
-> colonoscopy

Question 23

Colon cancer investigations

Answer 23

DRE
Colonscopy
Carcinogenoembryonic antigen
CT scan

Question 24

Colon cancer management

Answer 24

Colon-> surgical removal + adjuvant in higher stage

Rectum-> pre op chemo radio -> resection

Adjuvants

• nodes-> chemo
• palliative