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Colon Diseases

Colon Diseases. Dr. Rezvan Mirzaei. Clinical Evaluation. Symptoms Abdominal Pain Rectal Bleeding, Anemia Bowel Habit Change Weight Loss Mucus Discharge Constipation & Diarrhea Incontinence. History. Medical Surgical Obstetric Family: Polyp, Colorectal Ca, Other Cancers. P/E.

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Colon Diseases

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  1. Colon Diseases Dr. RezvanMirzaei

  2. Clinical Evaluation • Symptoms • Abdominal Pain • Rectal Bleeding, Anemia • Bowel Habit Change • Weight Loss • Mucus Discharge • Constipation & Diarrhea • Incontinence

  3. History • Medical • Surgical • Obstetric • Family: Polyp, Colorectal Ca, Other Cancers

  4. P/E • Abdominal • Perineal • DRE

  5. Endoscopy • Anoscopy: 8 cm • Rigid Proctoscopy: 25 cm, Partial Bowel Prep • Colonoscopy: 160 cm, complete oral bowel prep

  6. Laboratory studies • Fecal Occult Blood • Stool Studies • Tumor Markers • Genetic Testing

  7. Imaging • Plain X-Ray • Contrast Study • CT • Virtual Colonoscopy • MRI • Positron Emission Tomography (PET) • Endorectal & Endoanal Ultrasound • Colon Transit Time (CTT)

  8. Plain X-ray, Hirschprung

  9. CTT

  10. IntrarectalSono-Ca

  11. Diverticular Disease • False Diverticula • Mucosa & Muscularis Mucosa herniation through the colonic wall • Between the taeniae coli where the main blood vessels penetrate the colonic wall • PulsionDiverticula: resulting from high intraluminal pressure

  12. Diverticular Disease • Diverticular Disease = Symptomatic Diverticula • Diverticulosis = Diverticula without inflammation • Diverticulitis = Diverticula with inflammation & infection

  13. Barium Enema - Diverticulosis

  14. Diverticular Disease • Most common site: Sigmoid • Acquired • Low Fiber Diet => Smaller stool volume =>High intraluminal pressure & high colonic wall tension for propulsion

  15. Diverticular Disease • Complications • Bleeding • Inflammation

  16. Adeno carcinoma • Most common malignancy of GI - Risk factors - Age > 50 - Family hx of colorectal CA (20%) - Diet (High animal Fat-Low fiber) - Alcohol, Smoking - Obesity

  17. Risk Factors • IBD: Chronic inflammation predisposes the mucosa to malignant changes(duration & extent of colitis, Primary sclerosingcholangitis) • Ulcerative & Crohn’sPancolitis • 2% after 10 years • 8% after 20 years • 18 % after 30 years • Irradiation • Ureterosigmoidostomy • Acromegaly

  18. Symptoms - Change in bowel habit • Rectal bleeding • Unexplained anemia • Weight loss

  19. Polyps • Any projection from the surface of the intestinal mucosa • Neoplastic (Tubular, Villous, Tubulovillous, Serrated Polyps) • Hamartomatous (Juvenile, Peutz-jeghers) • Inflmmatory (Pseudopolyp, Benign lymphoid) • Hyper plastic • Pedunculated, Sessile

  20. Adenoma-Carcinoma sequence • Risk of malignant degeneration is related to size & type of polyp - Tubular adenoma 5% - Villous adenoma 40% - Tubulovillous 22% • Size: - rare <1 cm - 35-50% >2 cm

  21. Polyp • Treatment - Colonoscopic removal + Follow up - Colectomy * Impossible colonoscopic removal * Focus of invasive cancer in specimen

  22. Familial AdenamotousPolyposis (FAP) • Hundreds to thousands of adenamatous polyps shortly after puberty • Lifetime risk of CA approaches 100% by age of 50

  23. Familial AdenamotousPolyposis (FAP) • Screening relatives by APC gene testing • Of patients with FAP => 75% APC mutation testing is positive - Positive APC testing => sigmoidoscopy beginning 10-15 years - Negative => Screening starting at the age of 50 • 25% without other affected family members

  24. Barium Enema-Polyposis

  25. FAP treatment • Surgery - Total proctocolectomy + end Ileostomy - Restorative proctocolectomy + ileal pouch-anal Anastomosis

  26. Total Proctocolectomy

  27. Total Proctocolectomy

  28. End Ileostomy

  29. Total Proctocolectomy + Ileoanal J Pouch + Diverting Ileostomy

  30. Attenuated FAP • 10 to 100 polyps dominantly located in the right colon • CA develops in >50% • Also at risk for duodenal polyposis • Treatment: - Total Abdominal colectomy + ileorectalanastomosis + colonoscopicpolypectomy (rectum)

  31. Total abdominal-Subtotal colectomy

  32. Inflammatory Polyps (Pseudopolyps) • IBD • Amebic colitis • Ischemic Colitis • Not premalignant

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