Hirschsprung's Disease: Diagnosis and Treatment

Hirschsprung's Disease

• The aganglionic segment is contracted, not dilated
• Descending colon is not the most common site of aganglionosis
• Barium enema can be diagnostic
• Seen only in infants and children
• Barium enema does not show calcification
• Duhamel's operation is completed for Hirschsprung's disease
• Best diagnosed by rectal biopsy
• Not autosomal dominant
• Absent ganglionic cells are found in both myenteric and submucous plexus
• Rectal biopsy is diagnostic
• The aganglionic segment is distal to the dilated segment
• Involves the rectosigmoid part of the intestine
• Extended myectomy is appropriate for short segment Hirschsprung's disease with minimal symptoms
• Rectal biopsy is the investigation of choice
• Congenital megacolon includes dilatation and hypertrophy of the pelvic colon, and loud borborygmi; symptoms appear soon after birth, but not large stool
• Aganglionic segment is normal or contracted
• Chronic constipation is the predominant cause of fecal soiling in children
• Absence of ganglion in myenteric plexus is seen in Hirschsprung's disease
• Rectal biopsy findings likely to show lack of ganglion cells in a newborn with a bloated abdomen and scant meconium passage.
• All of the procedures except Bayar's are done for correction
• Normal saline is used for rectal washouts
• Large bulky stools aren't features of congenital megacolon
• Excision of aganglionic segment treats Hirschsprung's
• Most probable diagnosis for a child with constipation, abdominal distension, and a transition zone at the recto-sigmoid junction through barium enema study is Hirschsprung's
• Abdominal distention is the most common presentation

Colonic Diverticula

• Sigmoid colon is the most common site for acquired diverticula
• Commonly presents with pneumaturia
• Diverticular disease of the colon can cause abdominal pain, constipation, and mucus in stools
• Barium enema best diagnoses colonic diverticulosis
• Barium enema in colonic diverticula appears distinct
• Superior Mesenteric Artery is frequently implicated in massive bleeds
• Mucosa is inflamed in acute diverticulitis of the colon
• Diverticular disease is rarely observed in the jejunum
• Fistulization is an emergency relating to acute diverticulitis
• Ascending colon is where it most commonly bleeds
• The term "Left sided appendicitis" indicates diverticulitis
• A obese patient with diverticular perforation is best treated by Hartman's procedure
• Barium enema is the best investigation for colonic diverticulitis
• Hinchey classification identifies complicated diverticulitis

Colorectal Polyps

• Polyp invading neck in between head and stalk is level 2 based on Hagitt's classification
• Cowden's syndrome is not a predisposing factor for colorectal carcinoma
• Adenomatous polyps have the potential to grow into cancer
• Potentially malignant intestinal polyps except Crohn's disease
• Peutz-Jegher's syndrome is not associated with GI malignancy
• Pedunculated polyps aren't risk factors for malignancy
• Hamartomatous polyps are likely diagnosis for a child post operation after intussusception
• Carcinoma of the colon occurs in all patients with familial adenomatous polyposis.
• Double-contrast barium enema is the best radiological method for diagnosing colonic polyps
• Sessile polyps are high malignant potential
• Villous adenoma is maximum in malignancy
• Polyps of familial polyposis coli exhibit malignant change

Familial Adenomatous Polyposis

• Juvenile polyposis syndrome isn't neoplastic
• Pigmented macules, anemia, and abdominal pain signify Peutz-Jegher's
• Familial polyposis coli is strongly correlated with colorectal cancer
• Prophylactic polypectomy is done is familial polyposis
• Multiple flat polyps indicate potential malignancy
• Peutz-Jegher's syndrome is the most probable diagnosis given presentation
• AR inheritance isn't true of Familial Adenomatous Polyposis
• Juvenile polyp is MC type of polyp is children
• The Metabolic abnormality seen in large colorectal villous adenoma is Hypokalemic metabolic alkalosis

• 100 polyps isn't required for diagnosis

• CA pancreas is most common associated cancer in FAP
• Duodenal adenoma is true about FAP
• Desmoid tumor isn't all the given syndromes
• Hamartomatous polyp isn't all associated with FAP syndrome
• Colon polyps, osteomas, and giant gastric folds don't fit familial polyposis
• Duodenal polyps don't fit the syndromes
• Flexible sigmoidoscopy is the next screening test

Hereditary Non-Polyposis Colon Cancer

• HNPCC known as Lynch syndrome
• cutaneous sebaceous adenomas are seen in Muir-Torre syndrome.
• Amsterdam criteria exclude FAP: At least three relatives should be affected. Two successive generations need to be affected. And all the three should be first degree relative
• CA stomach is the most common extra-intestinal malignancy in HNPCC: Bony exostosis, multiple epidermal cyst all fit hereditary polyposis colon
• MSH-2 and hMLH-1are The most common mismatch repair gene mutation in HNPCC are Ulcerative colitis Familial polyposis isn't premalignant

Carcinoma Colon

• APC isn't involved The Right sided colon carcinoma and hepatic cancer isn't due to Cholecystectomy commonly undergoes malignancy commonly undergoes malignant transformation
• Sigmoid is the most common site
• Left isn't Constricting type of colonic
• colic Right is a frequent symptom
• Right colon is of the Fungating type
• Left side of the colon presents anemia
• Liver Solitary presentation isn't surgery
• Sigmoid is involved On barium enema
• CEA metastasize is frequent
• 1% isn't true about colon
• Acceptable Colonoscopy recurrence
• Nodal is most of colon
• Metastases tumour tendency
• tumor side associate individuals
• Sigmoid side of tenesmus colon
• is by Colonoscopy for polyps

Carcinoma Colon Treatment

• The perforations of colon is Caecum
• Right mass symptoms are ascend type
• Three nodes represent
• IIIC M1MO Stage is the right classification
• Hartman’s procedure is used for older Obstruct
• Hartman, Right, , is not an option for colon options
• The bowel Mechanical spectrum colon
• Resection metastasize
• Washing in and isn't true

Colonic Ischemia

• Thumb Diverticulitis for printing
• Inhibit large most in needed for colon
• Colitis not often involved
• Is most accurate, is not for . most
• Accordion, Metrois not for colon is .