colon

Colon cancer genetics

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 False in Colo Rectal Cancer  pathogenesis

a) APC mutation FOR Aberrant crytpt foci formation

b) KRAS for ACF to Early Adenom

c) DCC for Intermediate to Late Adenoma

d) P53 for Large Adenoma to CRC

Answer for premium 

 

Acute diverticulitis

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Q) False regarding the management of Acute Diverticulitis, Sigmoid colon inflammation and Fat stranding in CT ?

a) Outpatient treatment in most cases

b) Do a colonoscopy after the resolution of acute symptoms

c) Elective Colectomy to be done

d) IV antibiotics to be started`

The pathogenesis of acute diverticulitis is often attributed to the obstruction of diverticula by fecaliths, leading to increased intraluminal pressure, bacterial overgrowth, and subsequent inflammation or perforation

Answer Free  c

Sigmoid diverticulitis can be complicated and uncomplicated

Complicated means diverticulum associated with abscess, perforation, obstruction, fistula 

This question is about an uncomplicated acute diverticulitis 

It can be managed in outpatient setting

It requires IV antibiotics and diet modification

After resolution of symptoms, colonoscopy is to be done after 6 weeks to rule out the presence of other diverticula and neoplasm

Colectomy is not required in all cases. Current recommendations suggest that the decision for surgery should be individualized, taking into consideration the frequency and severity of recurrences. The patient’s overall medical condition and comorbidities should also be included in the analysis

Questions on colon

Acute diverticulitis

Hyperbaric oxygen therapy for Radiation Proctitis

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Q)  A 60 year old male is contemplating hyperbaric oxygen therapy for  radiation proctitis. Which of the following is not true regarding this?

A. Indicated in acute radiation proctitis but not in subacute or chronic radiation proctitis
B. Oxygen increases the growth of residual tumor and hence tumor should be completely
resected
C. Complications include Parkinsonism, barotrauma
D. Usually 30-40 sessions are required for treatment

Ans  a

This statement is not true because hyperbaric oxygen therapy (HBOT) is not only indicated in acute radiation proctitis but can also be beneficial in subacute and chronic radiation proctitis. Studies have shown that HBOT can promote healing in chronic radiation injuries as well.

Hyperbaric oxygen overcomes chronic tissue hypoxia in radiation damaged tissues and with repeated sessions induces growth of regenerative tissue, capillaries, and epithelium. Successful therapy may take multiple sessions. 18 to 60 treatments

HBO treatments for hypoxic wounds are usually delivered at 1.9 to 2.5 atm for sessions of 90 to 120 minutes each. Treatments are given once daily, five to six times per week and should be given as an adjunct to surgical or medical therapies. Clinical evidence of wound improvement should be noted after 15 to 20 treatments.

Complications of HBO therapy are caused by changes in atmospheric pressure and elevated PO2. Middle ear barotrauma, ranging from tympanic membrane hyperemia to eardrum perforation, is the most common complication.

Pneumothorax  brain oxygen toxicity, manifested by convulsions
resembling grand mal seizures; oxygen lung toxicity, resulting from damage from oxygen free radicals to lung parenchyma and airways and ranging from tracheobronchitis to full-blown respiratory distress syndrome; and transient myopia.

Absolute contraindications to HBO therapy are

(1) uncontrolled pneumothorax

(2) current or recent treatment with bleomycin or doxorubicin (potential aggravation of cardiac and pulmonary
toxicity), and

(3) treatment with disulfiram (increases risk of developing oxygen toxicity).

More questions on rectum

 

Familial Adenomatous polyposis

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Q. All are true about adenomatous polyposis syndrome except? ( Repeated in NOV INI SS) 
A. 25% do not have family history
B. Attenuated FAP has less than 100 polyps and delayed onset (50-55 yrs)
C. More than 20 rectal polyps have to be operated as there is high risk of Carcinoma
D. Attenuated FAP don’t have extracolonic manifestations and carry APC mutation

Ans d

Attenuated FAP is a phenotypically distinct variant of FAP in which

(1) affected individuals have fewer than 100 adenomas

(2) the polyps are more proximally distributed in the colon, and

(3) the onset of colorectal cancer is about 15 years later than in patients with FAP.

Germline mutations in the APC gene are found in 80% to 90% of patients with classic FAP and in 10% to 30% of patients with AFAP.

About 25% of patients with FAP have a de novo mutation and thus have no family history.

Attenuated FAP is a milder form of classic familial adenomatous polyposis (FAP) and is characterized by fewer colon polyps (an average of 30) and a delay in the development of colon cancer (average age 50 to 55 years) (True)

 AFAP is caused by mutations in the APC gene and is inherited in an autosomal dominant manner. 

Mutations responsible for this variant occur in the extreme upstream or downstream
portions of the APC gene.

Sabiston 21 page 1368

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Malignancy in UC

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Q. All are true regarding malignancy in UC except
A. Increased risk with pancolitis and increased duration
B. Screening for malignancy should start 8-10 yrs after onset of symptoms
C. Poorly differentiated
D. Surveillance should start as soon as remission occurs,  to pick up missed colon cancer

 

CEA

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Q True regarding CEA is  (AIIMS 2017 , JIPMER 2016) 

a) Low specificity

b) Falls after 1 week of surgery to baseline

c) Preoperative high value is good prognostic marker

d) Follow up, first test of CEA in 8-10 days followed by weekly tests thereafter

Another question on CEA can be seen here

Answer 

FAP

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Q) Which of the following is a type of Familial Adenomatous Polyposis 
A. Garderner syndrome
B. PJS
C. Juvenille polyps
D. Hamartomatous polyp

Answer (Q 75)