Gastroenterology Quiz on Diverticulosis and Colitis
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Questions and Answers

What percentage of lower gastrointestinal (GIT) bleeding cases due to diverticulosis stop spontaneously?

  • 50%
  • 95%
  • 20%
  • 80% (correct)

    • In uncomplicated colonic diverticulosis, laboratory values are typically abnormal.

    False (B)

    What is the likely cause of urinary symptoms such as dysuria and frequency in complicated colonic diverticulitis?

    proximity of the bladder to the inflamed sigmoid colon

    Rupture of the ______ at the dome or neck of diverticula can cause lower gastrointestinal bleeding.

    <p>vasa recta</p> Signup and view all the answers

    What are common symptoms of uncomplicated colonic diverticulosis?

    <p>Colicky abdominal pain, bloating, and altered bowel habits (C)</p> Signup and view all the answers

    High fever is a common symptom of uncomplicated diverticulitis.

    <p>False (B)</p> Signup and view all the answers

    Match the following complications of diverticulitis with their corresponding signs or symptoms:

    <p>Pericolic abscess = Localized tender abdominal mass. Generalized peritonitis = Generalized tenderness, rigidity, guarding, absent intestinal sound and free gas in plain erect on abdomen. Colovesical fistula = Frequency, pneumaturia and fecaluria. Colovaginal fistula = Passage of feces through the vagina.</p> Signup and view all the answers

    Dietary folic acid supplementation decreases the risk of developing cancer in long-standing ulcerative colitis cases.

    <p>True (A)</p> Signup and view all the answers

    Which of the listed conditions represents an emergent indication for surgical treatment of ulcerative colitis?

    <p>Toxic megacolon not responding to treatment within 72 hours (B)</p> Signup and view all the answers

    Name one antibiotic that was first known to be associated with C. difficile colitis.

    <p>Clindamycin</p> Signup and view all the answers

    Pseudomembranous colitis is caused by the overgrowth of C. difficile, a gram-______ anaerobic bacillus.

    <p>positive</p> Signup and view all the answers

    Which of the following is NOT a risk factor for developing C. difficile infection?

    <p>Consumption of probiotics (D)</p> Signup and view all the answers

    A stool culture is not useful in the diagnosis of pseudomembranous colitis.

    <p>False (B)</p> Signup and view all the answers

    Which of the following is a treatment option for mild cases of pseudomembranous colitis?

    <p>Oral metronidazole (D)</p> Signup and view all the answers

    What is the definition of rectal prolapse as described in the text?

    <p>An abnormal descent of part or all of the upper rectum through the lower rectum and/ or the anal canal to protrude outside the anus.</p> Signup and view all the answers

    Match the following surgical procedures with their descriptions:

    <p>Total colectomy with ileostomy and rectal preservation = Removal of the entire colon, creating an opening in the abdomen (ileostomy) for waste elimination, while preserving the rectum. Total colectomy with ileorectal anastomosis = Removal of the entire colon, connecting the ileum (small intestine) to the rectum. Total proctocolectomy with ileostomy = Removal of the entire colon and rectum, with an ileostomy for waste elimination. Total proctocolectomy with ileoanal pouch (restorative proctocolectomy) = Removal of the entire colon and rectum, creating a pouch from the ileum that is connected to the anus, allowing for more normal waste elimination.</p> Signup and view all the answers

    Which of the following dietary factors is associated with an increased risk of colorectal cancer?

    <p>Low intake of fruits and vegetables (C)</p> Signup and view all the answers

    Which imaging technique is considered the most accurate for staging rectal cancer?

    <p>Endorectal Ultrasonography (ERUS) (D)</p> Signup and view all the answers

    Colorectal cancer is more common in males than in females in the cecum.

    <p>False (B)</p> Signup and view all the answers

    What is the most common microscopic type of colorectal cancer?

    <p>Adenocarcinoma</p> Signup and view all the answers

    Carcinoembryonic antigen (CEA) is a specific diagnostic marker for colorectal cancer.

    <p>False (B)</p> Signup and view all the answers

    The surgical procedures for colorectal cancer are similar to those for ______.

    <p>Ulcerative Colitis</p> Signup and view all the answers

    In the Modified Dukes staging system, what does stage A indicate?

    <p>tumor is limited to submucosa</p> Signup and view all the answers

    Which of the following is a hereditary CRC syndrome?

    <p>Familial adenomatous polyposis (FAP) (A)</p> Signup and view all the answers

    A right hemicolectomy is indicated for cancer of the caecum and ______ colon.

    <p>ascending</p> Signup and view all the answers

    Match the following surgical procedures with their indicated locations of colon cancer:

    <p>Right hemicolectomy = Cancer of the caecum and ascending colon Transverse colectomy = Tumor of the middle transverse colon Left hemicolectomy = Cancer of the descending colon Extended Right hemicolectomy = Cancer of the hepatic flexure</p> Signup and view all the answers

    The transverse colon is the most common site affected by colorectal cancer.

    <p>False (B)</p> Signup and view all the answers

    Name one lifestyle choice associated with an increased risk for colorectal cancer.

    <p>Alcohol and tobacco consumption, obesity, sedentary habits</p> Signup and view all the answers

    Of the gross types of colorectal cancer, the ______ type is the most common on the left side.

    <p>ulcerative</p> Signup and view all the answers

    Match the following risk factors with their respective categories:

    <p>Ulcerative Colitis = Predisposing factor Red meat and animal fat = Environmental factor Ashkenazi Jews = Ethnic background HNPCC = Hereditary CRC Syndrome</p> Signup and view all the answers

    In which population is the median age of colorectal cancer diagnosis less than 50 years?

    <p>Egypt (B)</p> Signup and view all the answers

    Which of the following is the most common presenting symptom associated with colon cancer?

    <p>Abdominal pain (C)</p> Signup and view all the answers

    Obstruction is a common first presentation of right colon cancer.

    <p>False (B)</p> Signup and view all the answers

    What type of anemia is commonly associated with right colon cancer?

    <p>Iron deficiency anemia</p> Signup and view all the answers

    __________ is a sense of incomplete evacuation, frequently seen in rectal cancer.

    <p>Tenesmus</p> Signup and view all the answers

    Match the type of colon cancer with its characteristic symptom:

    <p>Right Colon Cancer = Iron Deficiency Anemia Left Colon Cancer = Colicky Pain Rectal Cancer = Tenesmus</p> Signup and view all the answers

    Which of the following symptoms is more commonly associated with left colon cancer compared to right colon cancer?

    <p>Increasing constipation (D)</p> Signup and view all the answers

    Fresh blood in the rectum is more commonly associated with right-sided colon cancer than rectal cancer.

    <p>False (B)</p> Signup and view all the answers

    What specific location of right colon cancer might present like appendicitis, especially in older adults?

    <p>Cecum</p> Signup and view all the answers

    __________ diarrhea is a specific type of bowel habit change associated with rectal cancer.

    <p>Spurious morning</p> Signup and view all the answers

    In which type of colorectal cancer is a hard mass in the right iliac fossa most likely to be palpated in non-obstructed conditions?

    <p>Cecum and right colon cancer (A)</p> Signup and view all the answers

    Flashcards

    Lower GIT bleeding

    Massive bleeding occurs in 5% of cases, often stops spontaneously in 80%.

    Colonic diverticulosis symptoms

    Majority are asymptomatic; may have colicky pain, bloating, and altered bowel habits.

    Diverticulitis symptoms

    Lower abdominal pain, altered bowel habits, nausea, vomiting, and urinary symptoms.

    Signs of complicated diverticulitis

    Rigidity and tenderness in the left iliac fossa, possibly indicative of appendicitis.

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    Pericolic abscess

    Localized tender abdominal mass indicating infection near the colon.

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    Colovesical fistula symptoms

    Frequency, pneumaturia, fecaluria; diagnosed via barium enema or cystoscopy.

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    Generalized peritonitis signs

    Generalized tenderness, rigidity, guarding, absent intestinal sound, and free gas presence.

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    Folic Acid Supplementation

    Dietary folic acid reduces cancer risk in chronic cases.

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    Surgical Indications

    Situations requiring surgery: emergent or elective due to disease complications.

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    Toxic Megacolon

    Severe colonic dilation not improving within 72 hours; an emergent complication.

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    Total Colectomy

    Surgical removal of the entire colon; can include ileostomy or anastomosis.

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    Pseudomembranous Colitis

    Diarrhea due to C. difficile overgrowth after antibiotic use.

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    C. difficile

    Gram-positive, anaerobic bacillus causing colitis and diarrhea after antibiotics.

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    Colostomy

    Surgical procedure creating an opening from the colon to the abdominal surface.

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    Stool Transplantation

    Reintroducing normal gut bacteria to treat refractory intestinal disease.

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    Rectal Prolapse

    Abnormal descent of the rectum through the anus, causing protrusion.

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    Colorectal Cancer Epidemiology

    Most common in individuals over 50 years, but can occur in younger ages. More common in females.

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    Predisposing Factors

    Factors increasing risk include low fiber, high fat diet, smoking, alcohol, and long-term Ulcerative Colitis.

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    Familial Adenomatous Polyposis (FAP)

    Hereditary syndrome increasing colorectal cancer risk; characterized by multiple polyps.

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    Hereditary Nonpolyposis CRC (HNPCC)

    Also known as Lynch syndrome; hereditary condition that increases the risk of colorectal and other cancers without polyps.

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    Environmental Factors for CRC

    High red meat & animal fat diet, low fiber intake, and sedentary lifestyle increase colorectal cancer risk.

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    Site of Colorectal Tumors

    2/3 of colorectal tumors are in the rectum and sigmoid colon; transverse colon is the least common site.

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    Annular Infiltration

    A gross type of colorectal cancer causing obstruction; often presents as a 'ring'.

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    Microscopic Types of Colorectal Cancer

    Includes adenocarcinoma, colloid carcinoma, anaplastic carcinoma, malignant melanoma, carcinoid, lymphoma, and GIST.

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    Low-Risk Factors for CRC

    Higher folate and calcium intake, along with estrogen replacement therapy, can lower colorectal cancer risk.

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    Age as a Risk Factor

    Colorectal cancer risk increases with age, particularly noted over 50 in the West and less than 50 in Egypt.

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    Endosonography (ERUS)

    Most accurate method for rectal cancer staging, examining five layers.

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    Carcinoembryonic antigen (CEA)

    A glycoprotein elevated in CRC, used as a prognostic marker.

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    TNM Staging

    A system used to stage colorectal cancer based on tumor size, node involvement, and metastasis.

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    Modified Dukes Staging

    A system categorizing CRC based on tumor invasion and spread to lymph nodes.

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    Surgical options for colon cancer

    Various surgeries like hemicolectomy, depending on tumor location.

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    Common Symptoms of Colon Cancer

    Abdominal pain, change in bowel habits, rectal bleeding, and occult blood.

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    Right Colon Cancer Symptoms

    Change in bowel habits, diarrhea, vague pain, and iron deficiency anemia.

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    Left Colon Cancer Symptoms

    Increase in constipation, colicky pain, weight loss, and rectal bleeding.

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    Symptoms of Rectal Cancer

    Bleeding, mucus discharge, tenesmus, and pain.

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    Tenesmus

    A sensation of incomplete evacuation during defecation.

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    Iron Deficiency Anemia in Colon Cancer

    Common in right colon cancer, presenting with weakness and pallor.

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    Mass Presentation in Colon Cancer

    Palpable mass in right colon, more common in left colon and rectum.

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    Change in Bowel Habits

    Includes both diarrhea and constipation depending on where cancer is.

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    Colicky Pain

    Pain related to bowel obstruction, common in left colon cancer.

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    Weight Loss as a Symptom

    Sign of cancer; common in right colon (more advanced cases).

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    Study Notes

    Colorectal Surgery

    • Diverticulum: a sac-like protrusion in the colonic wall, resulting from mucosal and submucosal herniation through weak spots in the muscular wall.
    • Diverticulosis: the presence of multiple diverticula without symptoms.
    • Prevalence: most common in industrialized western countries, increasing with age (5-10% before 50, 30% after 50, 50% after 70, 66% over 85). Less common in Egypt, often linked to chronic constipation due to low fiber diets.

    Etiology and Pathogenesis

    • Low-fiber diet: contributes to muscle incoordination and spasmodic contractions, leading to increased intraluminal pressure and herniation through weak points.
    • Colonic muscle wall weakness and loss of compliance: associated with age.

    Pathology

    • Common site: sigmoid colon (90%).
    • Less common: right colon and rectum (greater compliance).
    • Rectum is not affected.

    Complications

    • Diverticulitis: due to content stagnation and infection.
    • Perforation: localized or generalized peritonitis.
    • Fistula: external (colocutaneous), internal (colovesical, colovaginal, coloenteric).
    • Intestinal obstruction: from inflammation-induced fibrosis and stenosis.
    • Lower gastrointestinal bleeding: from rupture of vasa recta.

    Clinical Picture

    • Uncomplicated diverticulosis: often asymptomatic.
    • Complicated diverticulitis: lower abdominal pain (usually left side for sigmoid, right for right colon), gastrointestinal disturbances, urinary symptoms (frequency, urgency, dysuria), fever.

    Investigations

    • Barium enema: avoid in acute inflammation (risk of perforation).
    • Colonoscopy: delayed until inflammation subsides to avoid perforation risk, useful in cases with bleeding to pinpoint the site and rule out other causes.
    • Ultrasound/CT: helpful in acute stages (abscess, stricture, fistula), especially useful in ruling out other pathologies in acute cases.
    • Scintigraphy/mesenteric angiography: used in cases of bleeding to identify the site.
    • Plain abdominal X-ray: detects free air (perforation), fluid levels (obstruction).

    Treatment

    • Uncomplicated diverticulosis: high-fiber diet, antispasmodics.
    • Complicated diverticulitis (acute): conservative treatment (NPO, bed rest, antibiotics, IV fluids), CT-guided drainage if abscess is present, surgery (proximal colostomy in abscesses not treatable via CT) for persistent issues or peritonitis.
    • Complicated diverticulitis (chronic): surgical treatment (elective colectomy in recurrent cases).
    • Bleeding per rectum: resuscitation, angiography, localization (resection or total colectomy)

    Inflammatory Bowel Disease (IBD)

    • Unknown etiology (genetic, immunological, infectious theories)
    • Characterized by varieties (proctitis, proctosigmoiditis, left-sided colitis, subtotal colitis, pancolitis, black wash ileitis).

    Rectal Prolapse

    • Definition: abnormal descent of part or all of the upper rectum outside the anus.
    • Types: partial or complete.
    • Causes: weight loss, chronic diarrhea, advanced hemorrhoids, sphincter atony, history of previous surgeries.
    • Complications: ulceration, infection, bleeding, irreducibility, strangulation, fecal incontinence, anal discharge

    Benign Intestinal Polyps

    • Types: neoplastic adenomas (tubular, tubulovillous, villous), hamartomatous (juvenile polyps, Peutz-Jeghers polyps).
    • Classification of benign intestinal polyps.

    Colorectal Cancer

    • Epidemiology: usually above age 50, cancer cecum more common in females.
    • Predisposing factors: low fiber diet, smoking, alcohol, ulcerative colitis (> 10 years), villous adenoma (> 2 cm), FAP, Gardner syndrome, and HNPCC.
    • Risk factors: hereditary syndromes, nonpolyposis syndrome, hamartomatous polyp syndromes, inflammatory bowel disease, personal/family history of CRC, ethnic background, and age.
    • Environmental factors: increased risk with a diet high in red meat, animal fat, and low fiber. Lifestyle choices include alcohol and tobacco consumption, and obesity.

    Clinical Picture of Primary Colorectal Cancer

    • Presenting symptoms: abdominal pain, change in bowel habits, rectal bleeding, and occult blood in the stool.
    • Common presenting features according to location (right vs. left vs. rectum).

    Spread of Colorectal Cancer

    -Direct: intramural, circumferential, transmural

    • Lymphatic: spread to regional lymph nodes.
    • Venous: spread to the liver and lungs
    • Transperitoneal: spread to other organs or masses.

    Complications of Colorectal Cancer

    • Intestinal obstruction.
    • Perforation.
    • Bleeding (anemia). Intussusception.
    • Grading of CRC: Grade I (best), II, III (worst).

    Investigation

    • Endoscopy: gold standard, visualization, biopsy, exclude synchronous tumors (7%) and polyp follow up high-risk patients.
    • Barium enema: accurate for tumors limited to mucosa, visualization
    • Endosonography: for evaluating the degree of local invasion, lymph node spread.
    • CT/MRI: detects local spread, lymph node invasion, liver metastasis, valuable in the detection of local spread and regional lymph node metastasis with accuracy (70%).

    Treatment of Cancer

    • Operable (surgical): Right/Left hemicolectomy, transverse colectomy (localized), subtotal colectomy, total colectomy (extent-dependent), laparoscopic colectomy.
    • Inoperable (palliative): diverting colostomy, palliative bypasses, chemotherapy, radiotherapy.

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    Test your knowledge on diverticulosis and colitis with this comprehensive quiz. You'll explore causes, symptoms, and treatment indications associated with various gastrointestinal conditions. Perfect for students in medical or healthcare-related fields.

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