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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 www.smso.net
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
II. Diverticular DiseaseIII. Angiodysplasias www.smso.net
IV. Mechanical Problems • Volvulous • Megacolon www.smso.net
V. Neoplastic Disease • Colo-rectal tumours www.smso.net
Blood supply Of the Midgut
Coronal Section Of the Rectum & Anal Canal
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
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
Ulcerative Colitis
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
Macroscopic • Annular Left Colon • Tubular • Ulcerative Right Colon • Fungative www.smso.net
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
Spread • Local infiltration • Lymphatic – E P I C • Blood stream • Trans coelomic www.smso.net
Duke’s Classification • Limited to Rectal Wall • To Extra-Rectal tissue • Regional lymphnodes involved • Blood spread www.smso.net
Staging of colorectal carcinoma • Duke’s staging:
Investigations • Specific: - sigmoidoscopy (+ biopsy if the carcinoma is rectal)
- barium enema (“apple core appearance”) + contrast enema for tumour involving only mucosa
A computed tomographic scan of a patient with Perforating tumour of sigmoid colon
