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Gastroenterology > Colon and rectum > Flashcards

Colon and rectum Flashcards

1
Q

which layer involved in colorectal polyp?

A

mucosal layer

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2
Q

appaearances of Colo polpys?

A

sessile, pedunculated, flat, depressed, elevated

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3
Q

types of colo polyp

A

neopastic
non neoplastic

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4
Q

Name of non neoplastic polyp

A

hamartoma
inflammatory
hyperplastic

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5
Q

name of neoplastic polyp

A

conventional adenoma
traditional serrated adenoma
sessile serrated

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6
Q

commonest type of colorectal polyp
found in where?

A

hyperplastic polyp
distal colon

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7
Q

subclassification of adenomas

A

tubular
villous
tubulovillous

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8
Q

features of adenomas

A

asymptomatic
bleeding
anaemia
diarrhoea
hypokalaemia

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9
Q

Mckittrick willock syndrome

A

large villous adenoma causing diarrhoea and hypokalaemia

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10
Q

investigation for colorec polyp

A

colonoscopy
sigmoidoscopy

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11
Q

Mx of colorec polyp

A

segmental colonic resection
submucosal resection
endoscopic submucosal dissection

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12
Q

third most common cancer in males
second most common cancer in females
which one?

A

Colorectal cancer

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13
Q

what are the factors important in colorec cancer?
sporadic=
genetic=
hereditary=

A

Factors are genetic and environmental
sporadic= 75%
genetic= 20%
hereditary= 5%

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14
Q

risk factors for malignant change in colonic polyps

A

large size >2cm
multiple polyps
serrated polyps( excluding small rectal hyperplastic polyps
villous architecture
high grade dysplasia

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15
Q

pathways of genetic involvement in colorectal cancer?

A

chromosomal instability
microsattelite instability
CIMP (CpG island methylated phenotype)

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16
Q

what are the two distinct pathways of carcinogenesis of colorectal cancer?
and there precursor lesions

A

the adenoma carcinoma pathway
serrated neoplasia pathway
precursor lesions: adenoma, serrated polyps

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17
Q

Risk factors for colorectal cancer?

A

genetic
diet
medical conditions
others

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18
Q

diet factor increased risk in colorectal cancer

A

red meat
saturated animal fat

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19
Q

diet factors decreased risk of CC

A

dietary fiber
fruits and vegetables
calcium
folic acid
omega 3 fatty acids

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20
Q

medical conditions causing risk of CC

A

colocrectal neoplastic polyps
long standing UC or Chrons colitis
uterosigmoidoscopy
acromegaly
pelvic radiopathy

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21
Q

other factors increase risk of CC
decrease risk

A

obesity
sedentary lifestyle
smoking
alchohol
cholecystectomy
t2 Dm

aspirin
nsaids
statins

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22
Q

gene involvement of colorectal carcinogenesis
early:
intermediate:
late adenoma:
carcinoma

A

early: APC
intermediate: KRAS
late adenoma: DCC, SMAD4
carcinoma: TP53

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23
Q

clinical features of left colon
and right colon
rectum CC

A

left colon: fresh rectal bleeding and obstruction early
right colon: anemia and altered bowel habit and obstruction (late)
rectum: early bleeding, mucus discharge or feeling of incomplete emptying

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24
Q

common features of colorectal cancer?

A

colicky abdominal pain
rectal bleeding
features of obstruction and perforations

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25
Q

complications of CC

A

obstruction
perforation
peritonitis
localised abscess
fistula

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26
Q

investigation of CC

A

colonoscopy: 1st choice
if not possible: CT colonography

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27
Q

after diagnosis of CC which inv?
why?

A

CT chest, abdomen and pelvis
or MRI
for staging

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28
Q

for follow up and checking recurrence which investigation should be done in CC?

A

CEA

29
Q

which is the most important determinants of CC?

A

TNM staging at diagnosis.

30
Q

mx of CC

A

endoscopy:
EMR, ESMD, EFTR
surgery
adjuvant therapy:
decrease the risk of recurrence
palliative treatment:
surgical resection for symptoms
palliative chemotherapy
prevention and screening

31
Q

which is the cornerstone of rx for CC

A

surgery

32
Q

what are the hereditary syndromes predisposing to colorec cancer

A

Non- polyposis
polyposis
familial adenomatous polyposis
peutz jeghers syndrome
juvenile polyposis

33
Q

other name of HNPCC

A

lynch syndrome

34
Q

what is the commonest hereditary cancer syndrome

A

HNPCC/lynch syndrome

35
Q

HNPCC
mode of inheritance
which age groups involved
mean age for cancer development

A

Autosomal dominant
young age
45 years

36
Q

name of the criteria for HNPCC?
what are the criterias?

A

Modified Amsterdam criteria

criteria:
FAP excluded
3 or more relatives with CC (atleast 1 1st degree relative)
CC in 2 or more generations
at-least 1 members before 50 years of age

37
Q

after criteria of HNPCC what should be done?

A

pedigree assessment
genetic testing
colonoscopy

38
Q

prevention of HNPCC

A

colonoscopy every 2 years
aspirin for reduce CC risk

39
Q

✳️what are the GIT polyposis syndromes?

A

Neoplastic
-FAP
-PJS
non neoplastic
-juvenile
-cronkhite canada
-cowden syndrome

40
Q

mode of inheritance of FAP
mutation of which gene?
type of mutation and resulting protein name?
what does this protein do?

A

Autosomal dominant
germline mutation of tumour suppressor APC gene
loss of function mutation resulting truncated APC protein
bind and sequester B- catenin

41
Q

what is the second gene that is involved in FAP?
disease name with this?

A

MUTYH
MAP

42
Q

FAP+CNS tumours (astrocytoma, medulloblastoma)
Congenital hypertrophy of the retinal pigment epithelium? associated with?
FAP in mesentery or abdominal wall, name?

A

Turcot syndrome
FAP
Desmoid tumours

43
Q

Extra intestinal features of FAP
5⭐️

A

CHRPE= 70-80%
Epidermoid cyst (extremities, face and scalp)= 50%
Benign osteomas esp, skull and angle of mandibles= 50-90%
Dental abnormalities= 15-25%
Desmoid tumors= 10-15%
other malignancies (brain, thyroid, liver adenoma)= 1-3%

44
Q

5⭐️
Epidermoid cyst
benign osteoma
dental abnormalities

which syndrome?

A

Gardner syndrome

45
Q

colorectal cancer+ bleeding+ extra intestinal features
colonic polyps

A

FAP

46
Q

pigmentation+bleeding+ intusucception+ bowel and other cancers
small bowel polyps

A

PJS

47
Q

hair loss+ pigmentation+ nail dystrophy+ malabsorption
gastric polyps and colorectal polyps

A

Cronkhite canada syndrome

48
Q

many congenital anomalies+ oral and cutaneous hamartomas+ thyroid+ breast tumuors
gastric polyps

A

Cowden disease

49
Q

investigation for FAP

A

sigmoidoscopy
genetic testing if diagnosed
genetic testing to all 1st degree relatives

50
Q

Rx for FAP

A

total proctocolectomy with ileal pouch anal anastomosis

51
Q

Multiple hamartomatous polyps in small intestine and colon + melanin pigmentation of the lips, mouth and digits

other features?

A

PJS
anaemia, bleeding, intusuception

52
Q

mode of inheritance
gene mutation in pjs?? 🌟🌟

A

Autosomal dominant
serine-threonine kinase gene on chromosome 19p (STK11)

53
Q

investigation for PJS

A

genetic testing
upper gi endoscopy
colonoscopy
small bowel and pancreatic imaging

54
Q

Diverticulosis site??

A

Sigmoid
Descending colon

55
Q

Common age group for diverticulosis

A

Middle age group

56
Q

name the laxatives class

A

bulk forming: ishapgula husk, methylcellulose
stimulants: Bisacodyl, denton, decusate, senna
faecal softeners: docusate, arachis oil enema
osmotic laxatives: lactulose, lacitol, magnesium sulphate
serotogenic agents: prucalopride
prosecretory agents: linaclotide, lubipristone, plecanatide
others: polyethylene glycol, phosphate enema

57
Q

melanosis coli
specific mucosa finding?
rx

A

long term consumption of stimulants laxatives leads to accumulation of liposfuscin pigment in macrophages of lamina propria

tiger skin

stop laxatives

58
Q

complication of melanosis coli
and their barium enema finding

A

megacolon or cathartic colon

featureless mucosa, loss of haustra, shortening of the bowel.

59
Q

✳️
hirschprung’s disease
cause

A

Constipation and colonic dilatation
congenital absence of ganglion cells in the large intestine

60
Q

✳️Hirschprung disease mode of inheritance
affecting genes
type of mutation

A

autosomal dominant
RET- proto oncogene
loss of function mutation

61
Q

pathogenesis of hirschprung disease
rectal finding during DRE

A

ganglion cell are absent from nerve plexuses, most commonly in a short segment of the rectum and/or sigmoid colon causing internal anal sphincter fails to relax

rectum is empty

62
Q

✳️investigation for hirschprung disease
findings

A

plain abdominal xray
barium enema
full thickness biopsy
anorectal manometry

a small rectum and colonic dilatation above the narrowed segments

to confirm the absence of ganglion cell

failure to internal sphincter to relax with balloon dilatation

63
Q

✳️Rx of hirchprung disease

A

resection of the affected segments

64
Q

causes of acute colonic pseudo obstruction

A

trauma, burn,
recent surgery
drugs: opiates and phenothiazines
respiratory failure
electrolytes and acid base disorders (hypokalaemia, hypomagnesesimea)
DM- automic dysfunction
uraemia

65
Q

what is haemorrhoids
cause
degrees of piles
S/S
treatment

A

congestion of internal and external anal sphincters
unknown, constipation, straining, first time in pregnancy
1st degree: bleed
2nd degree: prolapse but retract spontaneously
3rd degree: manual replacement after prolapse
bright red rectal bleed +pain+ pruritus ani+ mucus discharge+ thrombosis which is very painful
Band ligation, haemorroidectomy, HALO

66
Q

causes of pruritus ani??

A

piles, fistula, fissures, poor hygiene
threadworms, candidiasis
contact dermatitis, psoriasis, LP
Diarrhoea or any incontinence, IBS, anxiety

67
Q

anal fissure
S/S
✳️Rx

A

traumatic and ischemic damage to the anal mucosa causing superficial mucosal tear and spasm of the anal sphincters

severe pain on defecation+ minor bleeding+ mucus discharge+ pruritus+ oedematous skin tag or sentinel pile

bulk forming laxatives
plenty of water intake
NO and 0.2% gtn: relax sphincter, alt: diltiazem cream
inj botulinum toxin: resistant case
surgery: lateral int anal sphincterectomy
or advanced anoplasty

68
Q

causes of faecal incontinece

A

obstetric trauma
severe diarrhoea
faecal impaction
cong anorectal anomaly
anorectal disease
neurological disease

Gastroenterology (4 decks)

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