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Flashcards in Colorectal + anal pathologies Deck (71):
1

Colorectal polyps are always pathological
benign =

epithelial: adenoma, inflammatory, Peutz-Jegher's
mesenchymal: lipoma, fiboma, leiomyoma

2

Malignant colorectal polyps

epithelial = adenocarcinomas/carcinoid
mesenchymal = sarcoma

3

3 types of polyp by appearance

pedunculated - on a stalk
sessile - like a carpet
flat - not noticably protruding

4

polyp defintion

protrusion above an epithelial surface

5

All ____ of the colon should removed as may becomes adenocarcinoma if acquire ___ mutation

adenoma
p53

6

staging and treatment of adenocarcinoma of colon

biopsy
surgery

7

Duke A stage for adenoca of colon =

confined to muscularis propria

8

Duke B stage for adenoca of colon =

through muscularis propria

9

Duke C stage for adenoca of colon =

metastasis to lymph nodes

10

most common type of colorectal cancer
most common in R/LHS of colon

adenocarcinoma
75% LHS - desc, sigmoid and rectum

11

RHS colorectal cancers present with ___

more likely to be incidental finding
wt loss
anaemia

12

LHS colorectal cancers present with

blood PR, obstruction, altered bowel habit

13

HNPCC = ___/___
have ___ polyps
caused by a ____ defect in ____

Hereditary Non-polypsosis Colorectal cancer/ Lynch syndrome
less than 100
auto dom
mismatch repair genes

14

HNPCC causes ___ tumours
has a early/late onset
has a Crohn's-like ___
associated with __+__ cancers

mucinous/LHS colon cancers
late onset
inflammatory response
endometrial and gastric

15

FAP =
have ___ polyps
early/late onset
____ fault in ___ gene
has no specific ____
causes _____ (cancer)
associated with __+__ (cancers)

familial adenomatous polyposis
more than 100
early
auto dom ; APC
no inflammatory response
adenocarcinoma
ass. with desmoid tumours and thyroid carcinoma

16

APC gene is a ___

tumour suppressor

17

HNPCC/ FAP causes an inflammatory response

HNPCC

18

Diverticula definition =

mucosal herniation through the muscle wall

19

diverticular disease is most common in ___

sigmoid colon

20

True diverticula definition
eg.

all layers of gut wall
Meckel's

21

majority of diverticula are ___
definition =

false - only serosa and mucosal layers

22

Tests to diagnose diverticulosis/itis

contrast enema
clincial findings
sigmoidoscopy
CT

23

colovesicular fistula presents with:

recurrent UTIs, cloudy urine, pneumaturia, dysuria

24

Treatment for complicated diverticular disease =

Hartmanns (remove sigmoid and have stoma)
IV antibiotics
percutaneous drainage
laparoscopic lavage and drainage

25

Causes of colitis:

Crohn's, UC, bac. infections, ischaemia

26

Colitis findings on an AXR

lead piping
thumbprinting

27

diagnosis of colitis by:

AXR, sigmoidoscopy + biopsy (finds out what type)
stool cultures (if have IBD then if bac. -ve only then start steroids)

28

Treatment of IBD colitis (if no bacteria present)

IV fluids and steroids
if present after 3-4days then more IS/surgery resection

29

Ischaemic colitis treatment =

sntiplatelets and statins

30

Colonic angiodysplasia =

submucosal lakes of blood usually RHS of colon => malaena

31

diagnosis of colonic angiodysplasia

CT, angiography, colonoscopy, endoscopy (exclude upper GI bleed)

32

Treatment of colonic angiodysplasia

injection embolyse
endoscopic ablation
surgical resection

33

Absolute constipation indicates ___
1st sign in ___

colonic obstruction
distal obstruction

34

1st sign in proximal colonic obstruction

vomiting

35

Ischaemic colon appearance =

segmental
erythematous+/ulcerated appearance
withered crypts w. lamina propria smudging
fewer chronic inflam cells than other colitises

36

Ischaemia affects the ___ colon more

LHS

37

Pseudomembranous colitis is caused by
appearance

C. diff toxins A+B
patchy yellow membranous exudate on mucosal surface
microscopic = explosive fibrinopurulent exudate mucosal lesions

38

Treatment of pseudomembranous colitis

flagyl/vancomycin
may need colectomy

39

Microscopic colitis =
2 types =

normal macroscopically but biopsies classify as microscopically altered
collagenous
lymphocytic

40

Collagenous colitis is a ____ colitis
Causes increased thickness of ___
is continuous/patchy
associated with ___
causes __
due to __

microscopic
subendothelial collagen
patchy
intraepithelial inflammatory cells
watery diarrhoea
drugs usually

41

Lymphocytic colitis is a __ colitis
there is no ____
large increase in ___
raises the possibility of ___

microscopic
no thickening of basement membrane
intraepithelial lymphocytes
coeliacs

42

radiation colitis is caused by ___
leads to _

radiotherapy
chronic active/inactive colitis
telangectasia
bizarre stromal cells and vessels

43

Acute (infective) colitis looks like:
acute can rarely be caused by:

no crypt irregularity but neutro.s in crypts
drugs ischaemia endoscopy prep IBD onset

44

Polyps can be ___, ___, ___ or ___

inflammatory, hamartomatous, metaplastic, neoplastic

45

Colorectal cancer shapes can be __/__/__

polypoidal
ulcerative
annular

46

colorectal cancer locations commonest to least common

rectal>sigmoid> caecum and ascending

47

Duke stage D for colorectal cancer =

metastasis

48

Protective lifestyle factors against colorectal cancers

veg, fruits
exercise - > AMPK>glucose uptake by muscle and decreased cell turnover

49

Rectal cancer main signs =

PR blood and tenesmus

50

Investigations for colorectal cancer:

FOBT
colonoscopy
Sigmoidoscopy
CT colonography
Barium enema
Rectal staged by MRI

51

Rectal cancer is staged by __ imaging

MRI

52

If colorectal ca obstructs then treatment =

stent
colonostomy
resect w. colonostomy/anastamosis

53

Radiotherapy is used in colorectal ca in which cases

adjuvant pre and post op
palliative - recurrent/ inoperable cancers

54

chemotherapy agents used for colorectal ca
adjuvant therapy for __ and ___

5-FU (5-fluorouracil), capecitabine
post op for Stage C
advanced - roughly 5 month survival - disease

55

Haemorrhoids cause ___ bleeding
typically found in _+_+_ o'clock postitions when supine

painless
3, 7, 11

56

Investigations for haemorrhoids

PR
rigid sigmoidoscopy (flexible if >50yo)
US if internal to find route and arterial branches that supply

57

Treatment for symptomatic haemorrhoids =

sclerotherapy
band ligation
open/stapled haemorrhoidectomy
HALO/THD (for internal haemorrhoids - shrink in wks)

58

Rectal prolapses can be ___/___

partial (anterior mucosal prolapse)
complete (full thickness)

59

Presentation of rectal prolapse =

protruding anal mass esp during defaecation, poor anal tone, blood and mucus PR

60

Management of complete rectal prolapse =

surgery - delorme's (stitch back in), rectoplexy, anterior resection
too frail = bulking agent + manual reduction

61

Management of incomplete rectal prolapse =

kids - diet and treat constipation
adults - similar to haemorrhoid therapy

62

A tear in the anal margin (usually posteriorly) due to constipation/multiple in Crohn's =

anal fissure

63

Shitting glass
pain for 30mins after defaection
follows episode of constipation

anal fissure

64

Anal fissures also often have ___ which is a ___ that looks like external haemorrhoids

sentinel tag
hypertrophic skin tag at distal edge

65

treatment of anal fissures

diiet
stool softeners
GTN/diltiazem ointment
spincterotomy (6wks)
botox injection

66

Internal opeing in anal canal connecting to 1/more openings on perianal skin =

fistula in ano

67

majority of fistula in ano arise due to __

delay/inadequate treatment of anorectal abscess

68

Rare causes of fistula in ano =

tb
carcinoma
Crohn's

69

Fistula in ano 4 types =

intersphincteric
transphincteric
extrasphincteric
suprasphincteric

70

Investigations for fistula in ano =

EUA (exam under anaesthesia) of anorectum
rigid sigmoidoscope (flexible if over 50)
MRI - outlines course, extent and shows abscesses

71

Management of fistula in ano =

open
seton stitch
LIFT (ligation of intersphincteric fistula) + stitch to drain
glue/permacol
defunctioning(end) colonostomy