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Why do Hemorroids develope?
Who are at high risk?
Age?
what is the MCC?
They develope because of persistant elevation of venous pressure in the hemorrhoidal plexus
- Pregnant females
- 30years old
- Straining at stool
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What is Diverticular disease?
What side? what location in bowel?
What is the pathogenesis?
- -It is an Aquired Diverticulum
- -left side of colon and particularly in the sigmoid colon
- 1-Weekness in the Colonic wall
- 2-Increase in the intraluminal pressure
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This is Diverticulitus.
Recall that a true diverticulum has to have all three layer?
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What do you see? What is it?
See Multiple Air/fluid filled levels (Stair step pattern)
Intestinal Obstruction
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- Herniation
- Adhesion
- Intussusception
- Volvulus
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Hernia, Inguinal
What side?
Sex?
If it cannot be reduced it is called? If this is prolonged it could lead to?
- -Right sided
- -Boys
- -Incarceration
- -Can lead to Ischemia and an obstruction
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Name the rare malignant tumors of the small bowel and their locations.
- Adenocarinomas --- in the duodenum
- note?: Adenoma is also here (benign)
- Carcinoids-- in the ileum
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What does Sessile mean?
What does Pedunculated mean?
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Name the Pedunculated polyps? Which are neoplastic and non-neoplastic?
- Hamaromatous (Non-neoplastic)
- -Juvenile
- -Peutz-Jeghers
Tubular Adenoma (Neoplastic)
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Name the Sessile polyps and which are neoplastic and which are not.
- Non-Neoplastic
- Hyperplastic
- Inflammatory
- Lymphoid
- NeoplasticVillous Adenoma
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Hyperplastic polyp
90% Colon polyps>50% over 50
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Patient comes in with Hyperpigmentation around the lips. What do they have?
- Hamartomatous polyps
- - Peutz-Jeghers Type
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- This is a Peutz Jeghers polyp.
- See Splying so Smooth muscle
Seen in the Children in their Teens
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What is this? What age? malignant?
This is a Juvenile "retention" polyp
Seen in Children
no malignancy
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Inflammatory (Pseud) Polyp
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What are the Three Types of adenomatous polyps?
Which is most common?
- 1.Tubular adenoma
- Most common Small and Pedunculated
- 2.Tubulovillous adenoma
- 3.Villous Adenomalarge and Sessile
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What is Serrated Adenoma
- Considered a varient of Hyperplastic polyp.
- has some premalignent potential
-
- This is a Villous Adenoma
- Broad Bassed Sessile
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What gene is associated 100% with colon cancer?
APC gene------Famillial Adenomatous Polyposis
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Hereditary Non-Polyposis colorectal carcinomas.
What is it called?
What is its inheritance?
What is its mutation?
Lynch or Warthin-Lynch syndrome
AD
DNA mismatch
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What is the genetic Sequence of mutation of adenoma-carcinoma?
APC--> K Ras--> p53
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Adenomatous Polyp
Malignant Risk increase with?
- polyp size
- Severity of the epithelial dysplasia
- Hystologic architecture
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Colorectal Carcinoma
What is it?
Sex?
Side?
Risk factors?
- A common Malignant tumor
- Seen slightly more in men
- 70% on the Left side
- Risk Factors:
- Advancing age (50)
- History of CIBD
- Obesity, Smoking, Alcohol use, diet
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Colorectal Carcinoma
How do they grow?
Right sided, Grows into the tintestinal lumen as a polypoid Bulky mass
When Left sided, Grows as an infiltrative-ulcerative type. This leads to Obstruction,
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Colorectal Carcinoma
mortality?
Ranked?
- Survival: All Patients
- –1 year: 80-90% (stage 1 &2)
- –5 year: 60%
#2 cancer killer in U.S.
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Colorectal cancer Staging
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Tumor Node Metastasis
- •Stage I T1 or T2 N0 M0
- •Stage II T3 or T4 N0 M0
- •Stage III Any T N1 or N2 M0
- •Stage IV Any T Any N M1
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Screening starting at 50
- -A fecal occult blood test (FOBT) every year
- -A flexible sigmoidoscopy (FSIG) every five years
- -Annual fecal occult blood test and flexible sigmoidoscopy every five years*
- -A double-contrast barium enema every five years
- -A colonoscopy every ten years
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Cacinoid tumor
Locations?
What do they look like?
At what size is it considered malignant?
- Apendix 90%
- Distal Ileum next MC
- They are small and rarely metastasis
- Greater than 2 cm
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Multiple Carcinoid Tumors
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If the Carcinoid tumor is in the
Appendix
Ileum
- Single and Benign
- Multiple and malignant
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What are the Clinical Symptoms of Carcinmoid Syndrome?
- Severe episodic skin flushing
- Diarrhea, Abdominal cramping
- Asthma, Bronchoconstriction
- Carcinoid heart disease (tricuspid valve insufficiency).
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Vermiform Appendix
location
arises from
rich in?
-
no known specific function
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Acute Appendicitis
Sex?
Clinical Findings
Seen in Males more
- –Initial peri-umbilical pain, localizing to RLQ
- –Nausea and/or vomiting
- –Abdominal tenderness, particularly in bernies point
- –Mild fever
- –Leukocytosis; 15,000 – 20,000
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Mucocele, secondary to a mucinous Cystadenoma
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