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Flashcards in Colon Deck (46):
1

What are the 2 types of colonic polyps?

Neoplastic and non-neoplastic

2

What is the main neoplastic polyp

Adeno

3

What are the 3 types of non-neoplastic polyps

Hamartoma
Metaplastic
Inflammatory

4

Where do all colonic adenocarcinomas originate from

Colonic adenomas

5

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

10years (average)

6

What is the gold standard for polyps

Colonoscopy and removal of polyps

7

What is Familial adenomatous polyposis (FAP) characterised by

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

8

What type of disorder is Hereditary non-polyposis colorectal cancer

Autosomal dominant

9

In what 3 syndromes do hamartomas occur

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

10

Where are metaplastic polyps usually found

In the rectum

11

What is another term for inflammatory polyps

Pseudo-polyps

12

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

Colorectal adenocarcinoma

13

What are the main risk factors for developing colorectal cancer

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

14

Where in the colon are most adenocarcinomas located

Rectosigmoid
Right colon
Left and transverse colon

15

How does spread of colonic adenocarcinoma

Through the bowel wall into lymphatics
Portal and systemic circulations later

16

What are the clinical features of colorectal adenocarcinoma

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

17

What are the investigations carried out in suspected colorectal adenocarcinoma

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

18

What is typically seen in a barium enema for colorectal carcinoma

Apple core stricture

19

What staging system is used for staging colorectal adenocarcinoma

Duke's

20

At what stage is surgery suitable in colorectal adenocarcnoma

Dukes stage A and B

21

What is colonic diverticular disease

symptomatic diverticula

22

What is diverticulitis

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

23

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

In the sigmoid and the left colon

24

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

right sided disease is more common

25

What explains the geographical variability of the diverticulosis problem

A diet, especially in early life

26

What does a lack of fibre mean for the GI tract

More pressure for propulsion is required
Inflammation from impacted faeces

27

What are the symptoms of uncomplicated diverticulosis

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

28

What is the treatment for uncomplicated diverticulosis

Increase in dietary fibre and dietary fluids

29

What is the treatment for Diverticular bleeding

Most settle with simple observation

30

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

The right side

31

What is diverticulitis characterised by

Pain
fever
raised white count
raised inflammatory markers

32

What is contraindicated for investigation of diverticulitis

Colonoscopy

33

What is the treatment for mild cases of diverticulitis

Oral antibiotics (metronidazole and ciprofloxacin) and analgesia

34

What is the treatment for severe cases

Possible need for IV antibiotics

35

What is the treatment for complicated attacks of diverticulitis

Surgery - structure, perforation, fistula or abscess

36

What are the two types of megacolon

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

37

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

Constipation
abdominal distension
comiting

38

How is a diagnosis of Hirschsprung's disease made

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

39

What is the treatment for Hirschsprung's disease

Surgical resection of the localised segment

40

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

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

41

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

Presence of stool

42

What is the management for idiopathic megacolon and megarectum

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

43

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

Increased bowel sounds and abdominal distension

44

What is characteristic of acute colonic pseudo-obstruction

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

45

How is Ogilvie's syndrome confirmed

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

46

What is the management plan for Ogilvie's syndrome

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