Colon

Question 1

What are the 2 types of colonic polyps?

Answer 1

Neoplastic and non-neoplastic

Question 2

What is the main neoplastic polyp

Answer 2

Adeno

Question 3

What are the 3 types of non-neoplastic polyps

Answer 3

Hamartoma
Metaplastic
Inflammatory

Question 4

Where do all colonic adenocarcinomas originate from

Answer 4

Colonic adenomas

Question 5

How long does it take for an adenoma to progress into a carcinoma

Answer 5

10years (average)

Question 6

What is the gold standard for polyps

Answer 6

Colonoscopy and removal of polyps

Question 7

What is Familial adenomatous polyposis (FAP) characterised by

Answer 7

Multiple colonic adenomas which invariably progress to colorectal cancer unless colectomy is performed in the second or third decade of life

Question 8

What type of disorder is Hereditary non-polyposis colorectal cancer

Answer 8

Autosomal dominant

Question 9

In what 3 syndromes do hamartomas occur

Answer 9

Peutz-Jeghers syndrome
Cowden’s disease
Cronkhite-Canada syndrome

Question 10

Where are metaplastic polyps usually found

Answer 10

In the rectum

Question 11

What is another term for inflammatory polyps

Answer 11

Pseudo-polyps

Question 12

What type of cancer is the second most common cancer in the UK

Answer 12

Colorectal adenocarcinoma

Question 13

What are the main risk factors for developing colorectal cancer

Answer 13

Genetic
Dietary - red meat, saturated animal fats
Protective - dietary fibre
Cbronic inflammaiton - IBD
Medical conditions (primary sclerosing cholangitis, acromegaly, obesity)
Smoking

Question 14

Where in the colon are most adenocarcinomas located

Answer 14

Rectosigmoid
Right colon
Left and transverse colon

Question 15

How does spread of colonic adenocarcinoma

Answer 15

Through the bowel wall into lymphatics

Portal and systemic circulations later

Question 16

What are the clinical features of colorectal adenocarcinoma

Answer 16

Rectal bleeding 
Altered bowel habit 
Anorexia 
weight loss 
abdominal mass 
intestinal obstruction or perforation is rare 
Tenesmus 
Abdominal pain

Question 17

What are the investigations carried out in suspected colorectal adenocarcinoma

Answer 17

Rigid sigmoid
Flexible sigmoid (for fresh bleeding) 
Colonoscopy (altered bowel habit, polyps seen in sigmoidoscopy, FHx, surveillance of IBD or polyps

Question 18

What is typically seen in a barium enema for colorectal carcinoma

Answer 18

Apple core stricture

Question 19

What staging system is used for staging colorectal adenocarcinoma

Answer 19

Duke’s

Question 20

At what stage is surgery suitable in colorectal adenocarcnoma

Answer 20

Dukes stage A and B

Question 21

What is colonic diverticular disease

Answer 21

symptomatic diverticula

Question 22

What is diverticulitis

Answer 22

Refers to diverticula causing complications (bleeding, inflammation, stricturing and perforation

Question 23

Where in the GI tract is diverticula most common in the Western Wordl

Answer 23

In the sigmoid and the left colon

Question 24

Where in the GI tract is diverticula most common in Oriental populations and rare under 40

Answer 24

right sided disease is more common

Question 25

What explains the geographical variability of the diverticulosis problem

Answer 25

A diet, especially in early life

Question 26

What does a lack of fibre mean for the GI tract

Answer 26

More pressure for propulsion is required | Inflammation from impacted faeces

Question 27

What are the symptoms of uncomplicated diverticulosis

Answer 27

Symptoms of colicky left iliac fossa pain eased by defecation passage of pellet stools abdominal bloating

Question 28

What is the treatment for uncomplicated diverticulosis

Answer 28

Increase in dietary fibre and dietary fluids

Question 29

What is the treatment for Diverticular bleeding

Answer 29

Most settle with simple observation

Question 30

What side of the colon does bleeding come from in diverticular bleeding

Answer 30

The right side

Question 31

What is diverticulitis characterised by

Answer 31

Pain fever raised white count raised inflammatory markers

Question 32

What is contraindicated for investigation of diverticulitis

Answer 32

Colonoscopy

Question 33

What is the treatment for mild cases of diverticulitis

Answer 33

Oral antibiotics (metronidazole and ciprofloxacin) and analgesia

Question 34

What is the treatment for severe cases

Answer 34

Possible need for IV antibiotics

Question 35

What is the treatment for complicated attacks of diverticulitis

Answer 35

Surgery - structure, perforation, fistula or abscess

Question 36

What are the two types of megacolon

Answer 36

Congenital (Hirschsprung's disease) and acquired (idiopathic megacolon and megarectum)

Question 37

What are some of the common presentations of Hirschsprung's disease?

Answer 37

Constipation abdominal distension comiting

Question 38

How is a diagnosis of Hirschsprung's disease made

Answer 38

by demonstrating the absence of the rectoanal inhibitory reflex on physiological testing

Question 39

What is the treatment for Hirschsprung's disease

Answer 39

Surgical resection of the localised segment

Question 40

What are the common presentations for patients with Idiopathic megacolon and megarectum

Answer 40

``` Constipation with infrequent urge to defaecate Faecal soiling (in children) ```

Question 41

What might be found on digital examination in Idiopathic megacolon and megarectum

Answer 41

Presence of stool

Question 42

What is the management for idiopathic megacolon and megarectum

Answer 42

Titrated use of osmotic laxative with or without enemas to empty the rectum What is Acute colonic pseudo-obstruction (Ogilvie's syndrome)

Question 43

What would be found on examination of Acute colonic pseudo-obstruction

Answer 43

Increased bowel sounds and abdominal distension

Question 44

What is characteristic of acute colonic pseudo-obstruction

Answer 44

Sudden, painless distension of the colon in the absence of mechanical obstruction

Question 45

How is Ogilvie's syndrome confirmed

Answer 45

By a plain abdominal Xray showing the dilated gut and contrast study will exclude a mechanical cause of obstruction

Question 46

What is the management plan for Ogilvie's syndrome

Answer 46

Deoebds on reversing the cause if possible - deflate the colon and ease symptoms Decompression if urgent due to the risk of perforation