MC affected site of Hirschsprung’s Disease?
Rectosigmoid (75%)Q >splenic flexure or transverse colon (17%)
Increased Risk for Hirschsprung disease?
- Positive family historyQ
- Down syndromeQ
Pathogenesis of Hirshprung disease?
- Absent ganglion cells in the Auerbach’s and Meissner’s plexus with hypertrophy of nerve trunksQ in the plexus
- Associated with muscular spasm of the distal colon and internal anal sphincter resulting in a functional obstructionQ
- Abnormal bowel is the contracted distal segment, whereas the normal bowel is the proximal, dilated portionQ.
Gold standard for the diagnosis of Hirschsprung’s disease?
Rectal biopsy - Confirms the diagnosis on demonstration of: - AganglionosisQ - Hypertrophic nerve fibres in the nerve plexusQ
Treatment of Hirschsprung’s disease?
- Short segment disease - Extended myectomyQ removing a strip of rectal wall upto the area where normal ganglion cells start may be sufficient
- Long segment disease - Temporary colostomyQ for a few months to allow proximal intestine to return to its normal caliber followed by definitive procedures: - SwensonQ - DuhamelQ – Soave
MC siteQ of colonic diverticula?
Diagnosis of diverticulosis?
- Barium enema is investigation of choice for colonic diverticulosisQ.
- Thickening of the circular muscle fibres develops a concertina or saw-tooth appearance on barium enemaQ.
What is Diverticulitis?
It is the result of inflammation (perforation) of colonic diverticulumQ
HincheyQ Classification of Sigmoid Diverticulitis?
- Stage I Pericolic or mesenteric abscess
- Stage II Walled-off pelvic abscess
- Stage III Generalized purulent peritonitis
- Stage IV Generalized fecal peritonitis
Investigation of choice for colonic diverticulosis?
Investigation of choice for diverticulitisQ?
Treatment of diverticulitis?
- Sigmoid colectomy with a primary anastomosisQ
- For diverticular perforation - resect the diseased sigmoid colon, construct a colostomy using noninflamed descending colon, and suture the divided end of the rectum closed. This procedure is called Hartmann’s operationQ. Anastomosis between the descending colon and rectum to restore intestinal continuity is done after a period of at least 10 weeksQ
Indications of Surgery in Diverticulitis?
- • Who do not improve on medical therapyQ
- • Patients who have atleast two documented attacksQ of diverticulitis
- • In all patients with complicated diverticulitisQ
- • For recurrent or persistent hemorrhageQ
MC cause of significant lower GI bleeding?
- DiverticulaQ - more than 75% stop spontaneouslyQ
- Although diverticular disease is much more common on the left side, right-sided disease is responsible for more than half episodes of bleedingQ
Haggit classification of polyp?
- 0 Does not invade the muscularis mucosa (carcinoma-in-situ or Intramucosal carcinoma)Q
- 1 Invades through the muscularis mucosa into the submucosa but is limited to the head of the polyp.
- 2 Invades the level of the neck of the polyp (junction between the head and the stalk)Q
- 3 Invades any part of the stalkQ
- 4 Invades into the submucosa of the bowel wall below the stalk of the polyp but above the muscularis propriaQ.
- By definition, all sessile polyps with invasive carcinoma are level 4 by Haggitt criteria.
Classification of colorectal polyp?
- Neoplasic polyp - Adenomatous polyps or Adenomas (Tubular (MC), Tubulovillous, Villous (highest risk of malignancy))
- Non neoplastic polyp -
- 1. Hyperplastic polyps
- 2. Hamartomatous polyps:
- - Juvenile polyps (MC) - PJS
- 3. Inflammatory polyps – UC, CD
Hyperplastic Polyps – histological appearance of these polyps is serrated (saw-toothed appearance)
Histological characteristics of PJS?
Arborization and PseuoinvasionQ
What is Cowden disease?
- Multiple hamartomatous tumors arising from all three embryonal cell layers (ectoderm, mesoderm and endoderm), mucocutaneous lesions, developmental anomaliesQ and a predilection to develop breast and thyroid neoplasia.
- Polyps arise more commonly from ectodermalQ rather than endodermal elements
MC feature in Cowden disease?
- Multiple trichilemmomasQ (type of benign hair shaft tumor)
- 2nd MC system involved: CNS
Best investigation for diagnosis of colorectal polyps?
Colonoscopy >Double-contrast barium enemaQ
Screening for Colorectal Cancer?
- American Cancer Society suggests fecal Hemoccult screening annually and flexible sigmoidoscopy every 5 years beginning at age 50 for asymptomatic individualsQ having no colorectal cancer risk factors.
- Double-contrast barium enema is done when colonoscopy is contraindicatedQ
Why is colorectal cancer is an ideal candidate for screening?
- • It is a common and serious problemQ
- • Precursor lesions existQ
- • It is slow growingQ
- • Testing is availableQ