Colon Flashcards by Dana Bashara

The parts that are covered by Serosa (peritoneum):

Cecum 
Transverse 
Sigmoid 
Ant. Ascending 
Ant. Descending 
Rectosigmoid 
Upper 3rd and ant. Wall of middle third of rectum

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Parts without serosa :

Post. Ascending
Post. Descending
Lower 3rd of rectum

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IBD - inflamatory bowel disease

2 major disorders :

1) ulcerative colitis ( uc)

2) cronh’s disease

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Crohn’s disease :

Causes inflammation of the digestive system
-Can affect any area from the mouth to the anus , it often affects the ileum.
Its aspect feature is cobblestones , and it does not affect in a continuous way
-Smoking worsen the disease
-crohns disease usually affects the entire thickness
-bowel obstruction, fistulas can appear

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Etiologic theories of IBD:

genetic predisposition
mucosal immune system
enviromental triggers (bacteria , infection, NSAID, smoking)

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Sympts. Of ulcerative colitis ;

- altered bowel movements: 
⬆️stool frequency 
⬇️stool cosistency 
-abdominal pain: 
LLQ cramping , relieved with defecation 
Tenesmus ( the feeling of the need to pass stool even if its empty)
-blood 🩸 in stool

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Sympts. Of Crohn’s disease :

chronic or nocturnal diarrhea
abd. Pain
distension and postprandial RLQ abd. Pain
weight loss
fever
rectal bleeding

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Risk factors for a more severe Crohn’s disease:

early age at diagnosis <40
perisnal involvment
severe deep ulceration on endoscopy
multiple areas of involvement
current tabacco use

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Risk factors for severe ulcerative colitis:

early age at diagnosis <40
early steroid treatment
extensive colitis
hospitalization
elevated inflammatory markers ( CRP, ESR)
low serum albumin

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Anti- TNF agents are:

✅Infliximab
✅Adalimumab
Golimumab(uc)
Gertolizumab (cd)
Pegol (cd)

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Anti- integin Agents:

✅Vedolizumab

Natalizumab (cd)

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Medications for active disease (UC):

1) 5-Aminosalicylic acid derivatives:
Sulfasalazine, mesalamine, balsalazide, olsalazine
2) ANTBX: metronidazole, ciprofloxaxin,rifaximin
3)corticosteroids:
Hydrocortisone, prednisone, methylprednisolone, predinsolone , budesonide, dexamethasone
4)immunomodulators:
Azathioprine, 6-mercaptopurine, methotrexate, cyclosporine
5) TNF inhibitors:
Infliximab, adalimumab , certolizumab pegol , golimumab
6)anti-integrin agents:
Natalizumab, vedolizumab
7) Anti-IL12/23 agents:
Ustekinumab

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Drugs for sympt, relief :

-antidiarrheal : diphenoxylate and atropine, loperamide, cholysteramine
-Anticholinergic antispasmodic agents:
Dicyclomine, hyocyamine

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Dermatological manifestation in IBD:

▪️erythema nodosum:
CD>UC, most common manifes.
▪️skin cancer
▪️pyoderma gangrenosum: most common site is legs
▪️psoriasis, sweet’s syndrome, metastatic croh’s disease

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Musculoskeletal manifestations of IBD:

▪️peripheral arthritis
▪️spondylitis
▪️sacroilitis

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Ocular manifestation in IBD:

▪️Episcleritis (ant. Chamber)
▪️post chamber: uveitis
▪️cataract ( from steroid treatment

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Other manifestations in IBD:

▪️thrombosis (hypercoagulable state)
▪️primary sclerosing cholangitis , fatty liver , gallstones
▪️Aphthous stomatitis ( repeated formation of benign and non contagious mouth ulcers
▪️Nephrolithiasis , obst. Uropathy , urinary tract fistulization
▪️colorectal cancer risk ( >8 years duration of disease , family history of CRC, psc

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Toxic megacolon:
Ineffective peristalsis (paralysis of myenteric plexus)
Distention leads to perforation
Sepsis and death

-dilatation >5.5cm on roentgenography

+3/4 of : fever , tachcard, leukocytosis , anemia

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Management of toxic megacolon:

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*iv fluid support
*correcting electrolyte abnormalities
*complete bowel rest
*rule out infectious etiology
▪️decompression:
Rectal tube , nasogastric tube , repositioning maneuvers
▪️medical care:
Tr. for infections , iv corticosteroids (3-5 days) , broad spec. ANTBX
▪️radiology: assessment with plain films , CT scanning
▪️surgical intervention: signs of perforation, medical care failure

Predictors for colectomy:

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🔸 >8 stools per day
🔸increased CRP
🔸>3 stools per day after the 3rd day of admission

Complications of colon surgery:

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-UTI/ retention
-significant hypokalemia
-ileus
-GIT( abscess , leak , SBO)
-cardiac
-atelecstasis
Pneumonia

Tru diverticulum vs pseudo:

*diverticula commonly affect the sigmoid

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True-> is sacklike herniation of the entire bowel wall

Pseudo-> involves only a protrusion of mucosa through the muscularis propria of the colon

Complications of diverticular disease :

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diverticulitis
perforation or bleeding
> diverticula commonly affect the sigmoid

The most common cause of hatochezia in pts >60 is :

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Colonic diverticulum

Acute uncomplicated Diverticulitis:

``` Fever Anorexia LLQ abd. Pain Obstipation Localized or generalized peritonitis ```

Complicated diverticular disease :

Perforation Abscess Stricture Fistula

Following findings on CT of Diverticulitis :

Sigmoid diverticula Thickened colonic wall >4mm Inflammation within the pericolic fat -+the collection of contrast material or fluid

DDX with diverticulitis:

Ovarian cyst Endometriosis Acute appendicitis Pelvic inflammatory disease

Treatment of diverticular disease :

Asympt.: managed by fiber inriched diet , ****avoid nuts and popcorn Sympt.: should be treated initially with antbx and bowel rest TRIMETHOPRIM/ SULFAMETHOXAZOLE or Ciprofloxacin +metronidazole *addition of ampicillin to nonresponders *IV piperacillin or oral penicillin /cluvanic acid *rifixamin with fiber (7-10days)

Surgical treatment of Div. Disease :

Goals : Controls sepsis , eliminating complications, removing the diseased colonic segment , restoring intestinal continuity Options : -ileostomy or colostomy and sutured omental patch with drainage -resection with colostomy -resection with anastomosis -resection with anastomosis and diversion

Contraindication to percutaneous drainage :

No percutaneous access route Pneumoperitoneum Fecal peritonitis

Stage 3 of diverticular disease is managed by :

HARTMAN’s procedure Or Primary anastomosis and proximal diversion

No anastomosis of any type should be attempted in stage :

Stage 4/ Hinchey stage of diverticular disease

Etiology of colon cancer :

``` Heridetary: FAP (familial adenomatous polyposis) HNPCC (heridetary non polyposis colorectal cancer ) Sporadic : Environmental factors ```

Risk factors of colon cancer :

``` 🔸Age ( >50) 🔸previous polyp or bowel cancer 🔸chronic bowel inflamm.: uc or CD 🔸diet and exercise 🔸obesity 🔸smoking and alcohol 🔸family history ```

Sympts. Of colorectal cancer :

``` Ascending: Anemia , tumor , mass , fever Descending: Obstruction, altered bowel habit Tenesmus (feeling the need to pass stool although its empty) , pain ```

Examination for colorectal cancer :

*general appearance : Anemia , jaundice , weight loss , cachexia *abd.: Mass , hepatomegaly , ascitis , signs of obstruction or peritonitis *rectal examination

Investigation and staging of colorectal cancer :

``` Colonoscopy +biopsy Blood samples CXR Barium enema US , CT, MRI CEA ```

FAP:

- long arm of chromosome 5 - >100 adenomas * clectomy and IRA( ileorectal anastomosis * IAP( ileoand pouch ) * ileostomy

Colon cancer treatment :

🔸surgery is the only way to cure 🔸chemotherapy 🔸immunotherapy and other treatments 🔸support

Staging of colon cancer :

▪️Duke’s A : confined to the bowel wall ▪️Duke’s B: through the wall ▪️Duke’s C : spread to LNs ▪️Dukes D : spread to liver

Pathways for colon metastasis dissemination:

🔸direct invasion through the wall 🔸LN metastasis 🔸portal vein metastasis 🔸intraluminal seeding

Colon cancer surgeries:

``` ▪️radical - resections ▪️palliative- stomas , internal by pass Standard operations : 🔸right hemicolectomy 🔸extended right hemicolectomy 🔸left hemicolectomy 🔸high ant. Resection 🔸segmental resection ```

Treatment of advanced colon cancer disease :

- quality of life - effective palliation - chemo/radiotherapy - palliative care unit - hepatic resection in selected pts - palliative surgical resection

In obstructed colon cancer we can use as treatment:

Self expanding stent

Clinical features of CD:

1) Any segment 2) Rectal sparing 3) Skip lesions 4) Transmural 5) Fistulas 6) Garnulomas 7) Smoking

Colon Flashcards

(46 cards)