Carcinoma of Colon:

1
Carcinoma of Colon

• The second commonest cause of death from
  malignant disease in the UK, after lung cancer in
  males and breast cancer in females.
• Sigmoid is the commonest site in the colon,
  followed by rectal tumours.
• Classification is either Benign or Malignant
• Benign Adenomatous Polyps
• Papilloma
• Lipoma
• Neurofibroma
• Malignant Primary or Secondary
• Primary Carcinoma, Lymphoma or Carcinoid
  Syndrome
• Secondary Invasion from surrounding tumours.

2
Carcinoma of Colon

• Predisposing factors

3
Carcinoma of Colon

• Pathology
• Dukes Staging Criteria
• Type A
• Type B
• Type C
• Type D
• TNM classification system also used.
• Local spread
• Lymphatic spread
• Blood

4
Carcinoma of Colon

• Clinical Features
• Local effects
• Right sided lesions
• Left sided lesions -
• General effects -
• Effects of Secondaries

5
Carcinoma of Colon

• Investigations
• Treatment
• Preoperative
• Operative
• Postoperative

6
Carcinoma of Colon

• Colonic resections are based on the blood supply
  to the colon.
• Superior Mesenteric Artery
• Inferior Mesenteric Artery
• Tumours of Right Colon
• Tumours of the Transverse Colon
• Tumours of Left Colon
• Rectal Tumours
• Distal rectal tumours that are difficult to
  excise without damaging the anal sphincters, then
  abdominoperineal resection performed.

7
Carcinoma of Colon

• Non-Obstructive cases, bowel preparation used and
  primary resection with continuity anastomosis
  performed.
• Obstructive cases, bowel preparation
  contraindicated, primary goal is to relieve the
  obstruction, so usually primary resection
  performed with defunctioning colostomy or
  ileostomy.
• Colostomies

8
Large Bowel Obstruction
Reminder of the Features of Obstruction (bowel
occluded without damage to the blood
supply) Features suggesting strangulation
(occlusion of the blood supply to bowel)
9
Large Bowel Obstruction

• Commonest Causes
• 20 of people have a competent ileocaecal valve,
  thus decompression of the large bowel back into
  the small bowel is not possible, leading to rapid
  build up in the pressure within the colon. This
  may lead to perforation, which usually occurs at
  the caecum because this is the thinnest walled
  and most distensible part of the colon.
• Volvulus

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Large Bowel Obstruction

• Sigmoid Vovulus
• Caecal Volvulus

11
Diverticula of the Colon

• Definitions
• Pathology
• Aetiology
• Clinical Features

12
Diverticula of the Colon

• Acute Diverticulitis
• Complications

13
Diverticula of the Colon

• Chronic Diverticular Disease
• Change of bowel habit diarrhoea constipation
• Gripey abdominal pain, pellety stools.
• Large bowel obstruction is not uncommon.
• Blood mucus per rectum (painless)
• Sudden severe rectal haemorrhage profuse bright
  red blood, usually in elderly often
  hypertensive patients.
• Colovesical fistula

14
Diverticula of the Colon

• Investigations

15
Diverticula of the Colon

• Treatment
• Acute diverticulitis
• Pericolic abscess
• General peritonitis
• Chronic diverticular disease
• Colovesical fistula

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Lower Gastrointestinal Haemorrhage

• Differential Diagnosis
• Age is an important determinant, with
  haemorrhoids, carcinoma and angiodysplasia being
  more common in elderly patients, whilst infective
  colitis ulcerative colitis are more common in
  younger patients.
• History required
• Resuscitation (ABC etc)

17
Lower Gastrointestinal Haemorrhage

• Angiodysplasia
• Clinical feature
• Investigations
• Treatment

18
Haemorrhoids

• Anatomy
• Classification
• First Degree
• Second Degree
• Third Degree

19
Haemorrhoids

• Definition
• Aetiology
• Causes
• Clinical Features

20
Haemorrhoids

• Investigations
• Management

21
Fissure in Ano

• Definition
• Clinical Features

22
Fissure in Ano

• Examination
• Treatment