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Difference between revisions of "Colon"
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==Grossing== | ==Grossing== | ||
*Lymph nodes - should get at least 12 - if it is cancer.<ref name=pmid18780863>{{cite journal |author=Bilimoria KY, Bentrem DJ, Stewart AK, ''et al.'' |title=Lymph node evaluation as a colon cancer quality measure: a national hospital report card |journal=J. Natl. Cancer Inst. |volume=100 |issue=18 |pages=1310–7 |year=2008 |month=September |pmid=18780863 |doi=10.1093/jnci/djn293 |url=http://www.medscape.com/viewarticle/581463}}</ref> | *[[Lymph nodes]] - should get at least 12 - if it is cancer.<ref name=pmid18780863>{{cite journal |author=Bilimoria KY, Bentrem DJ, Stewart AK, ''et al.'' |title=Lymph node evaluation as a colon cancer quality measure: a national hospital report card |journal=J. Natl. Cancer Inst. |volume=100 |issue=18 |pages=1310–7 |year=2008 |month=September |pmid=18780863 |doi=10.1093/jnci/djn293 |url=http://www.medscape.com/viewarticle/581463}}</ref> | ||
===Quirke method==== | |||
*Bowel is not opened. | *Bowel is not opened. | ||
**References: <ref name=pmid18667357>{{cite journal |author=West NP, Morris EJ, Rotimi O, Cairns A, Finan PJ, Quirke P |title=Pathology grading of colon cancer surgical resection and its association with survival: a retrospective observational study |journal=Lancet Oncol. |volume=9 |issue=9 |pages=857–65 |year=2008 |month=September |pmid=18667357 |doi=10.1016/S1470-2045(08)70181-5 |url=}}</ref>, <ref name=pmid18541901>{{cite journal |author=West NP, Finan PJ, Anderin C, Lindholm J, Holm T, Quirke P |title=Evidence of the oncologic superiority of cylindrical abdominoperineal excision for low rectal cancer |journal=J. Clin. Oncol. |volume=26 |issue=21 |pages=3517–22 |year=2008 |month=July |pmid=18541901 |doi=10.1200/JCO.2007.14.5961 |url=}}</ref>. | **References: <ref name=pmid18667357>{{cite journal |author=West NP, Morris EJ, Rotimi O, Cairns A, Finan PJ, Quirke P |title=Pathology grading of colon cancer surgical resection and its association with survival: a retrospective observational study |journal=Lancet Oncol. |volume=9 |issue=9 |pages=857–65 |year=2008 |month=September |pmid=18667357 |doi=10.1016/S1470-2045(08)70181-5 |url=}}</ref>, <ref name=pmid18541901>{{cite journal |author=West NP, Finan PJ, Anderin C, Lindholm J, Holm T, Quirke P |title=Evidence of the oncologic superiority of cylindrical abdominoperineal excision for low rectal cancer |journal=J. Clin. Oncol. |volume=26 |issue=21 |pages=3517–22 |year=2008 |month=July |pmid=18541901 |doi=10.1200/JCO.2007.14.5961 |url=}}</ref>. | ||
===Standard method=== | |||
*Bowel is prep'ed by opening it along the antimesenteric side. | *Bowel is prep'ed by opening it along the antimesenteric side. | ||
*Dimensions - length, circumference at both margins. | *Dimensions - length, circumference at both margins. | ||
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==Common clinical problems== | ==Common clinical problems== | ||
===Obstruction=== | ===Obstruction=== | ||
Top three (in adults):<ref>[http://www.emedicine.com/EMERG/topic65.htm http://www.emedicine.com/EMERG/topic65.htm]</ref> | Top three (in adults):<ref>URL: [http://www.emedicine.com/EMERG/topic65.htm http://www.emedicine.com/EMERG/topic65.htm]. Accessed on: 28 June 2011.</ref> | ||
*Neoplasia | *Neoplasia. | ||
*Volvulus (cecal, sigmoid) | *Volvulus (cecal, sigmoid). | ||
*Diverticular disease + stricture formation. | *Diverticular disease + stricture formation. | ||
===Bleeding=== | ===Bleeding=== | ||
Mnemonic ''CHAND'':<ref>TN 2007 G29.</ref> | Mnemonic ''CHAND'':<ref>TN 2007 G29.</ref> | ||
*Colitis (radiation, infectious, ischemic, IBD (UC >CD), iatrogenic (anticoagulants)) | *Colitis (radiation, infectious, ischemic, IBD (UC >CD), iatrogenic (anticoagulants)). | ||
*Hemorrhoids | *Hemorrhoids. | ||
*Angiodysplasia | *Angiodysplasia. | ||
*Neoplastic | *Neoplastic. | ||
*Diverticular disease. | *Diverticular disease. | ||
Infectious colitis with bleeding - causes: | Infectious colitis with bleeding - causes: | ||
*Enterohemorrhagic Escherichia coli (EHEC) -- commonly 0157:H7 | *Enterohemorrhagic Escherichia coli (EHEC) -- commonly 0157:H7. | ||
*Campylobacter jejuni | *Campylobacter jejuni. | ||
*Clostridium difficile | *Clostridium difficile. | ||
*Shigella. | *Shigella. | ||
Infectious colitis in the immunosuppressed: | Infectious colitis in the immunosuppressed: | ||
*Cytomegalovirus (CMV).<ref name=pmid7934809>{{cite journal |author=Golden MP, Hammer SM, Wanke CA, Albrecht MA |title=Cytomegalovirus vasculitis. Case reports and review of the literature |journal=Medicine (Baltimore) |volume=73 |issue=5 |pages=246–55 |year=1994 |month=September |pmid=7934809 |doi= |url=}}</ref> | *[[Cytomegalovirus]] (CMV).<ref name=pmid7934809>{{cite journal |author=Golden MP, Hammer SM, Wanke CA, Albrecht MA |title=Cytomegalovirus vasculitis. Case reports and review of the literature |journal=Medicine (Baltimore) |volume=73 |issue=5 |pages=246–55 |year=1994 |month=September |pmid=7934809 |doi= |url=}}</ref> | ||
**May afflict patients with IBD and lead to colectomy... as IBD patients are put on immunosuppression.<ref name=pmid17026558>{{cite journal |author=Kandiel A, Lashner B |title=Cytomegalovirus colitis complicating inflammatory bowel disease |journal=Am. J. Gastroenterol. |volume=101 |issue=12 |pages=2857–65 |year=2006 |month=December |pmid=17026558 |doi=10.1111/j.1572-0241.2006.00869.x |url=}}</ref> | **May afflict patients with IBD and lead to colectomy... as IBD patients are put on immunosuppression.<ref name=pmid17026558>{{cite journal |author=Kandiel A, Lashner B |title=Cytomegalovirus colitis complicating inflammatory bowel disease |journal=Am. J. Gastroenterol. |volume=101 |issue=12 |pages=2857–65 |year=2006 |month=December |pmid=17026558 |doi=10.1111/j.1572-0241.2006.00869.x |url=}}</ref> | ||
**Organ transplant recipients. | **Organ transplant recipients. | ||
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{{main|Inflammatory bowel disease}} | {{main|Inflammatory bowel disease}} | ||
The bread 'n butter of gastroenterology. A detailed discussion of '''IBD''' is in the ''[[inflammatory bowel disease]]'' article. | The bread 'n butter of gastroenterology. A detailed discussion of '''IBD''' is in the ''[[inflammatory bowel disease]]'' article. It comes in two main flavours (Crohn's disease, ulcerative colitis). | ||
===Microscopic=== | ===Microscopic=== | ||
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Histology of pseudomembranes:<ref name=Ref_PBoD837-8>{{Ref PBoD|837-8}}</ref> | Histology of pseudomembranes:<ref name=Ref_PBoD837-8>{{Ref PBoD|837-8}}</ref> | ||
*Loss of surf. epithelium. | *Loss of surf. epithelium. | ||
* | *[[PMN]]s in lamina propria. | ||
*+/- capillary fibrin thrombi. | *+/- capillary fibrin thrombi. | ||
NB: Pseudomembranes arise from the crypts. | NB: Pseudomembranes arise from the crypts. | ||
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*May be associated with aortic stenosis; known as ''Heyde syndrome''.<ref name=pmid19652242>{{cite journal |author=Hui YT, Lam WM, Fong NM, Yuen PK, Lam JT |title=Heyde's syndrome: diagnosis and management by the novel single-balloon enteroscopy |journal=Hong Kong Med J |volume=15 |issue=4 |pages=301–3 |year=2009 |month=August |pmid=19652242 |doi= |url=http://www.hkmj.org/abstracts/v15n4/301.htm}}</ref> | *May be associated with aortic stenosis; known as ''Heyde syndrome''.<ref name=pmid19652242>{{cite journal |author=Hui YT, Lam WM, Fong NM, Yuen PK, Lam JT |title=Heyde's syndrome: diagnosis and management by the novel single-balloon enteroscopy |journal=Hong Kong Med J |volume=15 |issue=4 |pages=301–3 |year=2009 |month=August |pmid=19652242 |doi= |url=http://www.hkmj.org/abstracts/v15n4/301.htm}}</ref> | ||
Location: | |||
*Cecum. | *Cecum. | ||
Epidemiology: | |||
*Older people. | *Older people. | ||
Etiology: | |||
*Thought to be caused by the higher wall tension of cecum (due to larger diameter) and result from (intermittent) venous occulsion/focal dilation of vessels.<ref name=Ref_PBoD854>{{Ref PBoD|854}}</ref> | *Thought to be caused by the higher wall tension of cecum (due to larger diameter) and result from (intermittent) venous occulsion/focal dilation of vessels.<ref name=Ref_PBoD854>{{Ref PBoD|854}}</ref> | ||
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==Polyps== | ==Polyps== | ||
{{main|Intestinal polyps}} | {{main|Intestinal polyps}} | ||
Polyps are the bread & butter of GI pathology. They are very common. | Polyps are the bread & butter of [[GI pathology]]. They are very common. | ||
Main types: | Main types: | ||
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*Mucosal ulceration. | *Mucosal ulceration. | ||
*"Three-lies disease":<ref name=pmid18271667>{{cite journal |author=Crespo Pérez L, Moreira Vicente V, Redondo Verge C, López San Román A, Milicua Salamero JM |title=["The three-lies disease": solitary rectal ulcer syndrome] |language=Spanish; Castilian |journal=Rev Esp Enferm Dig |volume=99 |issue=11 |pages=663–6 |year=2007 |month=November |pmid=18271667 |doi= |url=http://www.grupoaran.com/mrmUpdate/lecturaPDFfromXML.asp?IdArt=459864&TO=RVN&Eng=1}}</ref> | *"Three-lies disease":<ref name=pmid18271667>{{cite journal |author=Crespo Pérez L, Moreira Vicente V, Redondo Verge C, López San Román A, Milicua Salamero JM |title=["The three-lies disease": solitary rectal ulcer syndrome] |language=Spanish; Castilian |journal=Rev Esp Enferm Dig |volume=99 |issue=11 |pages=663–6 |year=2007 |month=November |pmid=18271667 |doi= |url=http://www.grupoaran.com/mrmUpdate/lecturaPDFfromXML.asp?IdArt=459864&TO=RVN&Eng=1}}</ref> | ||
# May not be solitary | # May not be solitary. | ||
# May not be rectal -- can be in left colon | # May not be rectal -- can be in left colon. | ||
# May not be ulcerating -- non-ulcerated lesions: polypoid and/or erythematous. | # May not be ulcerating -- non-ulcerated lesions: polypoid and/or erythematous. | ||