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Colon Flashcards

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1
Q

Length?

A

1.5 meters

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2
Q

Widest part?

A

Cecum – 8cm diameter

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3
Q

The 3 bundles of teniae coli?

A

1) Mesocolic 2) Omental 3) Free

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4
Q

Average length of appendix?

A

10cm

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5
Q

Rectum anatomy

A 
Fixed.
Retroperitoneal.
No haustra.
Has 3 tenia coli.
Valves of Houston (3 horizontal folds - superior/middle/inferior)
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6
Q

Where does the Meissner’s plexus reside?

A

Submucosa layer

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7
Q

Auerbach’s myenteric plexus resides?

A

Between the circular and longitudinal muscular layer.

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8
Q

Width of sigmoid colon?

A

2.5cm

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9
Q

Descending colon

A

Fixed part of GI.

Retroperitoneal (including flexure).

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10
Q

Most narrowest and mobile part of GI?

A 
Sigmoid colon
(Makes for most common site for volvulus and obstruction)
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11
Q

Double Contrast Enema used for what?

A

Visual polyps

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12
Q

Most common location of colon atresia?

A

Right hepatic flexure

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13
Q

Best views to observe imperforate anus?

A

Up-side-down films (invertograms) OR lateral prone films

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14
Q

Fistulas from imperforate anus to bladder/urethra will show what?

Who do these occur in?

A

Air in bladder.

50% of males with high atresia.

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15
Q

Colonic duplication usually seen where in GI tract?

A

Sigmoid or rectum

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16
Q

Colonic duplications are usually seen along what side of the colon?

A

Mesenteric border

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17
Q

How much does the colon rotate during fetal development and in which direction?

A

90 counterclockwise 1st stage; 180 counterclockwise 2nd stage = 270 counterclockwise TOTAL

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18
Q

Failure of last 180 deg rotation (complete failure)?

A

Asymtomatic & infrequent
Jejunum & ileum – right side of abdomen
Colon – left side of abdomen
Iliocecal valve reversed.

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19
Q

Incomplete failure (malrotation)?

A

Common

Defect in peritoneal attachment - VOLVULUS common finding.

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20
Q

Reversal of rotation?

A

Clockwise rotation = rare

Transverse colon behind the duodenum

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21
Q

AKA for aganglionic megacolon

A

Hirschsprung disease

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22
Q

What population does aganglionic megacolon occur in?

A

Neonates (most common cause of colonic obstruction at this age 15-20%)
M>F (3-4 to 1)

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23
Q

Aganglionic megacolon pathology?

A

Absence of ganglion cell in DISTAL colon and RECTUM –> functional obstruction develops as result of spasm in denervated colon.
NO PERISTALSIS in this region.

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24
Q

What condition is 10% of Hirschsprung cases associated with?

A

Down’s syndrome

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25
Contrast emema presentation of Hirschsprung?
Saw-tooth irregularity of agangliontic segment with proximal DILATION and thickened walls No gas/feces in rectosigmoid.
26
Hepatic flexure between liver and diaphragm called...
Chilaiditi's Sign
27
RLQ Sigmoid colon seen in what population?
Infants and young children
28
Redundant colon predisposes to...?
Constipation or volvulus
29
TB affects what part of GI most often (location & percentage)?
Ileocecal region 85-90%
30
Colonic TB pathology?
Healing in chronic stage with fibrosis --> rigidity and narrowing of lumen (Should be considered when person originates from an endemic area)
31
Colonic TB image findings
Narrowing --> small bowel obstruction Loss of haustrations Ulceration of mucosa ~ Multiple mass-like lesions
32
Abnormal terminal ileum in Europe =
Crohns
33
Abnormal terminal ileum in Asia =
TB
34
Areas most commonly affected by Amebiasis?
Cecum Appendix Ascending colon
35
What is the organism involved in Amebiasis?
Entamoeba histolytica
36
Amebiasis x-ray findings?
- Superficial ulcers (serrated appearance) - Possible deformity of the cecum --> CONE SHAPED - Ileocecal valve is thickened, incompetent, open & fixed
37
Ulcerative Colitis location?
Rectum (30%), Rectum + colon (40%), Pancolitis (30%)
38
Ulcerative Colitis incidence?
1st degree relative = 30-100X greater F>M 15-25yr (again 55-65yr)
39
Layers of the wall most affected in UC?
Mucosa and submucosa
40
What % of UC is associated with arthritis?
25%
41
UC Radiographic Findings (General)
- Continuous segments - Thickened folds of haustra - Deep ulcers - TOXIC MEGACOLON >6cm ~ Cobblestone appearance - Increased presacral space (m/c/c)
42
UC Radiographic Findings (Acute)
- Colorectal narrowing + incomplete filling - Haustra edematous & thickened - Polyps
43
UC Radiographic Findings (Chronic)
- Shortening of colon - "LEAD-PIPE" colon --> rigid + narrowing - Haustra blunted or lost - BACKWASH ILEITIS (10-40%) - Widened presacral space - Strictures (10%)
44
UC complications?
75-80% of pancolitis cases --> Colon cancer
45
Crohn's colitis (Granulomatous colitis) location?
Right sided (spares rectum)
46
Crohn's colitis's clinical hallmark?
Diarrhea
47
Crohn's colitis's radiographic findings?
- Discrete, superficial ulcers - Thickened wall & narrow lumen - COBBLESTONE appearance - SKIP LESIONs
48
Crohn's colitis pathological features?
- Hyperplasia of lymphoid in submucosa (transmural extension)
49
Crohn's vs. UC
CROHN'S - transmural inflammation - affects terminal ileum mostly (proximal colon) - ulcers random & asymmetric - skip lesions - granulomas seen in colon - anal lesions UC - inflammation of mucosa and submucosa - affects sigmoid and rectum mostly - ulcers monotonous & uniform - continuous lesion
50
Cathartic Colon pathology?
Prolonged stimulation of colon by irritant laxatives cause meuromuscular incoordination (inability of colonic musculature to produce adequate contractile force)
51
Cathartic colon demographics?
Women, middle aged, +15yrs of laxative use
52
Cathartic Colon radiographic appearance?
Lack of haustral saculations (smooth) Lumen distends or narrows Ileocecal valve flattens and gaps -- backwash ileitis appearance
53
Organism seen most in Pseudomembranous colitis?
Clostridium difficile
54
Pseudomembranous colitis etiology?
Chronic use of antibiotics -- high numbers of drug resistant clostridia
55
Pseudomembranous colitis x-ray findings?
- Thumbprinting - Shaggy appearance of colon - Minimal distention
56
Pseudomembranous colitis ddx?
ISCHEMIC COLITIS
57
Ischemic colitis demographics?
+50yrs (prior hx of CVD)
58
Ischemic colitis pathology?
``` Hypotensive episode (eg. trauma, drugs etc.) --> focal or diffuse 20% colonic ischemia proximal to obstruction ```
59
Ischemic colitis Location?
1. Splenic flexure (Griffith point -- junction of SMA & IMA) 2. Rectosigmoid (Sudeck point -- junction of IMA & hypogastric artery) 3. Left-side colon -- elderly w/ dec. perfusion 4. Right side colon -- young patients
60
Ischemic colitis radiographic features?
- Thumbprinting (submucosal edema & bleeding) 75% - Luminal narrowing 13% - Ulceration 46-60% - Bowel wall thickening
61
Common location for diverticula in colon?
- Sigmoid (between taenia coli)
62
Colonic diverticuli demographics?
Western society 50-80yrs 30-50% (above 50yrs) +50% (above 80yrs)
63
Colonic Diverticular pathology?
Herniation of mucosa and submucosa through muscular layers of bowel
64
Colonic diverticulitis vs. diverticulosis?
With vs. without inflammation
65
Colonic polyps location?
Rectum & lower sigmoid (60-75%)
66
Colonic polyp presentation?
- Sessile or pedunculated | - Reach 4-5cm in length
67
Colonic polyp x-ray finding?
- Barium filling defect - SMOOTH margins (sharply defined) - Minimum size to see = 0.7 to 1cm
68
Colonic polyp malignancy characteristics?
- Size over 1-1.5cm - Irregular contour & surface - Growth rate quick
69
Familial multiple polyposis complication in colon?
Colorectal cancer (67%) by age 50
70
Familial multiple polyposis general age onset?
2nd decade of life (but can be seen early childhood)
71
Peutz-Jeghers presentation?
``` Multiple polyposis of s. bowel; Mucocutaneous pigmentation (melanin) of lips and mouth ```
72
Peutz-Jeghers complication?
Mild inc incidence of colonic cancer. | Greater occurrence of ovarian tumors (female).
73
Gardner's syndrome triad?
1) Colonic polyposis 2) Osteomas 3) Soft tissue tumors
74
Gardner's syndrome complication?
These adenomas are extremely malignant.
75
Cronkhite-Canada Syndrome presentation?
RARE. Alopecia & Atrophy (AA in CC) of nails Hyperpigmentation
76
Cronkhite-Canada Syndrome major concern?
Protein losing disease -- dangerous for females.
77
Turcot's Syndrome presentation in colon?
Polyps & central nervous system glioblastomas (supratentorial).
78
Turcot's Syndrome demographics?
Children and young adults
79
Turcot's Syndrome demographics?
Children and young adults
80
Turcot's Syndrome demographics?
Children and young adults

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