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Why do Hemorroids develope?
Who are at high risk?
what is the MCC?
They develope because of persistant elevation of venous pressure in the hemorrhoidal plexus
- Pregnant females
- 30years old
- Straining at stool
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
What is this?
This is Diverticulitus.
Recall that a true diverticulum has to have all three layer?
What do you see? What is it?
See Multiple Air/fluid filled levels (Stair step pattern)
If it cannot be reduced it is called? If this is prolonged it could lead to?
- -Right sided
- -Can lead to Ischemia and an obstruction
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
What does Sessile mean?
What does Pedunculated mean?
Name the Pedunculated polyps? Which are neoplastic and non-neoplastic?
- Hamaromatous (Non-neoplastic)
Name the Sessile polyps and which are neoplastic and which are not.
- NeoplasticVillous Adenoma
What is this?
90% Colon polyps>50% over 50
Patient comes in with Hyperpigmentation around the lips. What do they have?
- Hamartomatous polyps
- - Peutz-Jeghers Type
What its it? What age?
- This is a Peutz Jeghers polyp.
- See Splying so Smooth muscle
Seen in the Children in their Teens
What is this? What age? malignant?
This is a Juvenile "retention" polyp
Seen in Children
Inflammatory (Pseud) Polyp
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
What is Serrated Adenoma
- Considered a varient of Hyperplastic polyp.
- has some premalignent potential
- This is a Villous Adenoma
- Broad Bassed Sessile
What gene is associated 100% with colon cancer?
APC gene------Famillial Adenomatous Polyposis
Hereditary Non-Polyposis colorectal carcinomas.
What is it called?
What is its inheritance?
What is its mutation?
Lynch or Warthin-Lynch syndrome
What is the genetic Sequence of mutation of adenoma-carcinoma?
APC--> K Ras--> p53
Malignant Risk increase with?
- polyp size
- Severity of the epithelial dysplasia
- Hystologic architecture
What is it?
- 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
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,
- Survival: All Patients
- –1 year: 80-90% (stage 1 &2)
- –5 year: 60%
#2 cancer killer in U.S.
Colorectal cancer Staging
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
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
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
Multiple Carcinoid Tumors
If the Carcinoid tumor is in the
- Single and Benign
- Multiple and malignant
What are the Clinical Symptoms of Carcinmoid Syndrome?
- Severe episodic skin flushing
- Diarrhea, Abdominal cramping
- Asthma, Bronchoconstriction
- Carcinoid heart disease (tricuspid valve insufficiency).
no known specific function
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
Mucocele, secondary to a mucinous Cystadenoma