Large bowel pathology Flashcards
What do most polyps in the colon or rectum turn out to be?
Adenoma
What are the differential diagnoses of a polyp?
Adenoma
Serrated polyp
Polyploid carcinoma
Other
What are adenomas precursors to?
Adenocarcinoma
Why must all adenomas be removed?
They are all premalignant
What is the primary treatment for most adenocarcinoma?
Surgery
What is Dukes stage A?
Tumour is confined to submucosa or muscle layer
What is Dukes stage B?
Tumour has spread through muscle layer but does not involve lymph nodes
What is Dukes stage C?
Tumour has spread to lymph nodes
Where does colorectal carcinoma mist commonly occur?
Left-sided
Descending colon, sigmoid, rectum
How might a right sided colorectal carcinoma present?
Anaemia
Weight loss
How might a left sided colorectal carcinoma present?
Blood PR
Altered bowel habit
Obstruction
What is diverticular disease?
Mucosal herniation through muscle coat of the bowel
Where is diverticular disease most common?
Sigmoid colon
What are some of the clinical presentations of diverticulitis?
LIF pain/tenderness
Sepsis
altered bowel habit
How is the diagnosis of diverticulitis made?
History/examination
Barium enema
Sigmoidoscopy
What is the treatment of diverticulitis?
IV fluids
Bowel rest
IV antibiotics
What are some of the complications of diverticulitis?
Pericolic abscess Perforation Haemorrhage Fistula Stricture
When would surgery be indicated in diverticulitis?
No improvement with standard treatment
Complications
What are some of the causes of colitis?
Infective colitis
Ulcerative colitis
Crohn’s colitis
Ischaemic colitis
What are some of the symptoms of colitis?
Diarrhoea + blood Abdominal cramps Dehydration Sepsis Weight loss, anaemia
How is a diagnosis of colitis made?
Plain X-ray
Sigmoidoscopy + biopsy
Stool cultures
Barium enema
What is colonic angiodysplasia?
Submucosal lakes of blood
An obscure cause of rectal bleeding
Which side of the colon does colonic angiodysplasia tend to affect?
Right side
What are some of the causes of large bowel obstruction?
Colorectal cancer
Sigmoid or caecal volvulus
Pseudobstruction
Faecal impaction
How is the diagnosis of sigmoid volvulus made?
Plain AXR
Rectal contrast
What is the treatment for sigmoid volvulus?
Flatus tube
Surgical resection
