| |
CROHN's |
UC |
ANAL FISSURE |
COLORECTAL CANCER |
| INCIDENCE |
5-10/100,000/year |
10/100,000/year |
1 in 350 in European Union |
3rd most common cancer. Lifetime risk 1 in 22 |
| AGE |
Bimodal distribution. First peak at 15-30, second peak at 60-80. Majority of cases before 30 years old |
Bimodal distribution. Incidence peaks 15-25, then second smaller peak at 55-65 |
Primarily young adults |
Risk rises after 40 years old. |
| SEX |
M:F 1.1-1.8:1 |
F>M |
F=M |
F=M |
| GEOGRAPHY |
More common in Caucasians |
Common in the Ashkenazi Jewish population |
No increased prevalence geographically |
Higher incidence in Western nations |
| PREDISPOSING FACTORS |
FHx
Smoking |
FHx
Smoking protective |
Localised ischaemia. No known causative factor |
FHX, Age, Smoking, diet, IBD, Ureterosigmoidostomy |
| MACROSCOPIC APPEARANCE |
Affects anywhere from mouth to anus
"skip" lesions,
Cobblestoning,
Fissures,
Fistulas |
Continuous uninterrupted inflammation from rectum proximally |
90% found in the posterior midline. |
Polypoidal, circumferential, ulcerating, exophytic appearances |
| MICROSCOPIC APPEARANCE |
Trasmural inflammation with granuloma formation. Few crypt abscesses. |
Inflammation confined to mucosa. Granulomas rarely seen. Crypt abscesses multiple. |
Thought to be an ischaemic ulcer due to reduced blood supply in posterior midline |
95% adenocarcinoma
55% found in the recto-sigmoid region
Dukes A - confined to mucosa
Dukes B - breached muscularis propria
Dukes C - lymphatic spread
Dukes C2 - apical node involved
Dukes D - distant met
|
| SYMPTOMS |
Wide range of gastrointestinal symptoms ranging from insidious onset to acute onset |
Bloody diarrhoea, abdominal cramps, extra-intestinal manifestations |
Pain on defaecation predominant symptom, PR Bleeding, pruritis |
COBH, PR bleeding, Iron deficiency anaemia, tenesmus, abdominal mass |
| TREATMENT |
Primarily medical with nutrition, steroids +/- immunosuppressants, if surgery then bowel conservation surgery performed |
Primarily medical with nutrition, steroids +/- immunosuppressants. Surgery when indicated. |
Initially medical with diltiazem or GTN ointment, then surgery when medical management fails |
Primarily surgical |
| PROGNOSIS |
Chronic disease process with recurrent relapses
GI tract cancer leading cause of disease related death |
Majority controlled with medical therapy. If not, then surgery is curative by colectomy. |
Majority of uncomplicated fissures heal with conservative management |
5 year survival
Dukes A - 90%
Dukes B - 70%
Dukes C1 - 60%
Dukes C2 - 35%
Dukes D - 5% |
| |
| |
SIGMOID VOLVULUS |
PILONIDAL SINUS |
HAEMORRHOIDS |
DIVERTICULAR DISEASE |
| INCIDENCE |
Accounts for 5% of causes of large bowel obstruction |
Approximately 0.7% |
Approximately 4% |
Incidence increases with age - 5% by 5th decade, 90% by 9th decade |
| AGE |
Most common >50 |
Most common age group 10-30 |
Most common age group 45-65 |
Incidence increases with age |
| SEX |
M>F |
M>F |
M=F |
M=F |
| GEOGRAPHY |
Increased incidence in South America, Africa and parts of Asia |
Increased incidence in Caucasians compared to Africans and Asians |
Low incidence in the developing world |
Common in developed countries - uncommon in Africa and Asia |
| PREDISPOSING FACTORS |
Anatomic defect, age, chronic constipation, nursing home or mental health patients |
Age, Hirsute, occupations involving sitting |
Age, Obesity, Constipation, increased straining, pregnancy |
Age, Low fibre diet, Obesity, Constipation |
| MACROSCOPIC APPEARANCE |
Narrow band attached to long sigmoid mesentery + redundant loops of colon predisposes to volvulus |
Sinus tracts form in the natal cleft |
Grade 1 - symptomatic
Grade 2 - prolapse with defaecation but reduce spontaneously
Grade 3 - Prolapse and require manual reduction
Grade 4 - Irreducible |
Abnormal mucosal and submucosal outpouchings through the muscle wall of the colon. Left sided disease more common in Western world. Right sided in developing world |
| MICROSCOPIC APPEARANCE |
N/A |
Due to folliculitis leading to follicular rupture and abscess formation |
Cushions of submucosal vascular tissue located in the anal canal |
N/A |
| SYMPTOMS |
Same as those of large bowel obstruction - absolute constipation + distension |
Varied - from asymptomatic to abscess formation to chronic disease |
Varied - from asymptomatic to PR bleeding to acute thrombosis and stangulation |
Majority remain asymptomatic (80-85%}. Other symptoms include those of PR Bleeding, diverticulitis, diverticular abscess, perforation, fistula and stricture |
| TREATMENT |
Primarily conservative with flatus tube or colonoscopic decompression |
Varies according to presentation. Majority managed surgically |
According to degree. 1st and 2nd degree non-surgical management. 3rd and 4th degree - surgical usually |
Primarily conservative. Surgical management applied according to clinical presentation |
| PROGNOSIS |
Unrecognised volvulus leads to reported mortality of 20-25% |
Over 40% develop recurrence |
Excellent |
Depends on severity but worse if diagnosed at a younger age |
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