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COLORECTAL DISEASES

COLORECTAL DISEASES. I. Inflammatory Problems. 1. Complication of Inflammatory Bowel Disease Ulcerative Colitis Crohn’s Disease Ischaemic Colitis 2. Granulomas Tubercular Amoebic Non-specific. II. Diverticular Disease III. Angiodysplasias. IV. Mechanical Problems. Volvulous Megacolon.

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COLORECTAL DISEASES

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  1. COLORECTAL DISEASES www.smso.net

  2. I. Inflammatory Problems 1. Complication of Inflammatory Bowel Disease • Ulcerative Colitis • Crohn’s Disease • Ischaemic Colitis 2. Granulomas • Tubercular • Amoebic • Non-specific www.smso.net

  3. II. Diverticular DiseaseIII. Angiodysplasias www.smso.net

  4. IV. Mechanical Problems • Volvulous • Megacolon www.smso.net

  5. V. Neoplastic Disease • Colo-rectal tumours www.smso.net

  6. Blood supply Of the Midgut

  7. Coronal Section Of the Rectum & Anal Canal

  8. Colo-Rectal Tumours Benign Tumours – Polyps • Inflammatory – hyperplastic and pseudopolyp • Hamartomatous polyps, Peutz-Jeghers Syndrome • Adenomatous polyps: - tubular - Villous – very high malignant potential • Familial polypsis and Gardner’s syndrome – very high malignant potential www.smso.net

  9. Colo-Rectal Carcinoma • Epidemiology, prevalence • Etiology • Histology and grading • Forms and sites • Dissemination and staging (Duke’s classification) • Clinical presentations and complications • Diagnosis • Management www.smso.net

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  17. The sites in which the carcinoma develop are:

  18. Ulcerative Colitis

  19. Familial Adenomatous Polyposis

  20. What is the Differential diagnosis of bleeding per rectum?

  21. Neoplasms of Colon & Rectum Pre-malignant disease of colon & rectum • Adenoma • Familial Adenomatous Polyposis Syndrome • Inflammatory Bowel Disease • Schistomosomiasis • Irradiation Proctocalitis • Hereditary Colon Cancer www.smso.net

  22. Macroscopic • Annular Left Colon • Tubular • Ulcerative Right Colon • Fungative www.smso.net

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  25. Microscopic • Adenocarcinoma – commonest • Squamous Carcinoma – Anus & Lower Rectum • Colloid Carcinoma – Rectum • Carcinoid – Appendix • Melanoma • Lymphomas, sarcoma, etc. A well differentiated B moderate C anaplastic www.smso.net

  26. Spread • Local infiltration • Lymphatic – E P I C • Blood stream • Trans coelomic www.smso.net

  27. Duke’s Classification • Limited to Rectal Wall • To Extra-Rectal tissue • Regional lymphnodes involved • Blood spread www.smso.net

  28. Staging of colorectal carcinoma • Duke’s staging:

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  32. Investigations • Specific: - sigmoidoscopy (+ biopsy if the carcinoma is rectal)

  33. - colonoscopy

  34. Colonoscopy showing a colonic cancer

  35. - barium enema (“apple core appearance”) + contrast enema for tumour involving only mucosa

  36. A computed tomographic scan of a patient with Perforating tumour of sigmoid colon

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