Diseases of the colon

Epidemiology Colon cancer is one of the first places in the structure of cancer. Among the malignant tumors of the digestive cancer of the colon in the CIS in third place. Usually affects people between the ages of 50 to 70 years, with the same frequency for both men and women. Neoplasm of the colon and rectum are most common in economically developed countries, which is associated with dietary patterns, diet deficient in fiber and slag. Also in the occurrence of cancer of the colon plays a major part precancerous lesions, which include polyps and polyposis of the colon, villous adenoma, ulcerative colitis, Crohn's disease.

Anatomical sections of the colon

1 - hepatic flexure, 2 - ascending colon, 3 - cecum, 4 - transverse colon, 5 - splenic flexure, 6 - descending colon, 7 - the sigmoid colon, 8 - rectum.

1 - average intestinal colic artery; 2 - right colonic intestinal artery;

3 - iliac artery intestinal colic; 4 - inferior mesenteric artery, 5 -

marginal branch; 6 - superior mesenteric artery artery, 7 - left colonic intestinal

artery; 8 - sigmoid intestinal branches.

Blood supply to the colon

The functions of the colon

• Motor,

• Absorptive,

• Excretory.

• In the colon is absorption of water (up to 95%), electrolytes, some gaseous substances. Thanks to the activity of intestinal microflors in the colon it is involved into the metabolism of B vitamins and vitamin K

Histological structure of the colon

The wall of the colon consists of mucosa, submucosa, muscular and serous membranes. In the mucosal epithelium differentiate, lamina propria and muscle plate. The mucosa of the colon lacks villi, but it has a large number of crypts. In his own plate mucosal concentrations of K are associated lymphoid tissue in the form of single and group of lymph (Peyer's patches) of the follicles. Muscle membrane is represented by longitudinal and circular smooth muscle fibers.

Colonoscopy

Normal terminal ileum

Colonoscopy

Ileocecal valve (Baugins flap).

Colonoscopy

The hepatic flexure of the colon.

Colonoscopy

Transverse colon

Colonoscopy

Rectum

Anomalies and malformations

•Dystopy

•Dolichosigmoid

•Dolichocolon

•Stenosis

•Atresia

Hirschsprung's disease

Hirschsprung disease (megacolon) - a hereditary disease colon associated with the violation of its evacuation activities, and accompanied by constipation and abdominal distention.

Can occur in one in every 5,000 newborns. As a rule, occurs in children and adolescents in adults is extremely rare

The etiology of Hirschsprung’s disease

The hypoplasia (gipoganglioz) or no

(aganglioz) intramuscular ganglion cells

and submucosal nerve plexus.

Diagnosis of Hirschsprung's disease

•Complaints

•Anamnesis of disease

•Rectal exam

•Sigmoidoscopy

•Colonoscopy

The clinical picture•Constipation

• bloating

•abdominal pain.

•Assimetric abdomen

•General signs: weakness,

nausea, vomiting, appetite

deteriorates.

Diagnostics

Rectal examination

Irrigography

Treatment: Surgery is the removal of without ganglionar zone and decompensated advanced parts of a colon followed by reduction of intestinal

permeability.

Ulcerative colitis

Ulcerative colitis - a chronic inflammatory disease of the colon, affecting, as a rule, direct mucous membrane and other parts of the colon, which has a continuous or relapsing chronic course.

PathogenesisSensitization

The development of autoimmunity

Subsidence in the intestinal mucosa antigen-antibody reaction

The development of colitis, ulcers

Joining a secondary infection

Violation of the innervation of gut

Nutritional deficiency

Etiology

• Infectious theory• Allergic theory

Diagnosis

• Patient complaints • Anamnesis• Sigmoidoscopy • Irrigografy • Colonoscopy

Endoscopic picture at NUC

Clinical picture:

•diarrhea (up to 40 times a day) with the release of blood and mucus,

sometimes - pus,

•severe abdomen pain,

•tenesmus,

•vomiting,

•high body temperature.

•leukocytosis with a shift of leukocyte to the left, decrease in

hemoglobin, hematocrit

Differential diagnosis

•Dysentery

• Proctitis

• Crohn's Disease

Treatment Conservative treatment: • A diet rich in protein, carbohydrate restriction, and dairy

products • Desensitization and antihistamines (diphenhydramine, pipolfen,

suprastin, tavegil) • Vitamins (A, E, C, K, B) • Bacteriostatic drugs (etazol, ftalazol, sulgin, enteroseptol) • Salazopiridazin • Steroids (prednisone, dexamethasone) Surgical Treatment - • Applied to the development of complications: • Profuse bleeding • Perforated ulcer • Toxic dilatation

Diverticulosis of COLONDiverticulum - a blind ending saccate protrusion

limited area of a hollow organ, particularly the colon. Diverticulosis means having diverticuls multiple.

Сomplications:

Diverticulitis

Stricture

Bleeding

Perforation

Clinical manifestations of diverticular disease are absent. Diverticulitis: Pain in the abdomenUnstable stool Сonstipation DiarrheaDecreased appetite, nausea, vomiting occasionally The clinical picture very similar to that in acute appendicitis, but the symptoms are detected on the left. Against the background of diverticulitis diverticulum perforation may occur in the free abdominal cavity (from 2 - 27%) with peritonitis.

Clinical picture:

DiagnosisDiagnosis of diverticular disease is based on data from medical history, results of radiologic and colonoscopic studies. When diverticulitis performance X-ray and endoscopic studies is dangerous because of the possibility of perforation diverticulum.

Diagnosis of diverticular sigmoid gut filled with intestinal content

Diverticuls and inflamed stenosis

(Narrowing).

Bleeding diverticulum

Colonoscopy

Endoscopic picture of the diverticulosis of the colon

TreatmentConservative •diet •antispasmodics •antibiotics •sulfa drugs •warm enema with an antiseptic solution

surgery •perforation of a diverticulum, •development of intestinal obstruction •internal fistulas, •massive bleeding, •expressed diverticulitis with frequent exacerbations, with failure of medical treatment.

•When diverticulitis of the colon is removed lesion ulcer (hemicolectomy, resection of the sigmoid colon), it is appropriate combination of these operations with myotomy of the colon, which leads to a decrease in intraluminal pressure.

Polyps and polyposis of the colon and rectum

75% cases polyps are common originated from the epithelium of sigmoid colon and rectum

There are distinguished:

juvenile,

hyperplastic,

glandular (adenomatous),

glandular-villous polyps,

villous adenoma,

diffuse polyposis of the colon

(the true and secondary).

Diagnosis: along with the clinical symptoms and anemnesis data are important and recto-colonoscopy, irrigography

Sigmoid colon polyp on a stalk

Large colon polyp (6x6 cm) base diameter of 3 cm polyp considerably narrows the lumen of the intestine, causing partial obstruction

Colon polyp on a broad basis

Colon polyps on the stem

Minor bleeding from the removed polyp

TreatmentChoice of treatment of polyps and diffuse polyposis colon cancer should be individualized. Solitary polyps removed by electrocautery or a recto-colonoscopy.

Polipectomy

Annealing polyp with loop The remaining stump of the polyp with large central vessel

Overlay clips on the vessel In order to avoid bleeding 

Conservative treatment of colon polyps is futile. Any polyp found during colonoscopy, should be removed through the endoscope or transanal and examined under a microscope

Example of endoscopic resection of villous adenomas, tubular

Tubular-villous adenoma of the colon

The plot of the colon after endoscopic resection of adenomas

The vast majority of researchers rightly says that cancer

(adenocarcinoma), colon (colorectal) cancer in most cases

increases from benign polyps (adenomas)

Colon cancer - a malignant epithelial tumor that affects the most distal colon. For a long time may be asymptomatic, and only at a relatively late stage there are signs of gastrointestinal bleeding, constipation and abdominal pain of varying intensity.

Colon cancer

•Stage I - limited small tumor, localized in the thickness of mucosal or submucosal layer. Metastases in the lymph nodes there. •Stage II: a) large tumor, but it takes no more than a semicircle intestine, does not go beyond it, without metastases in regional lymph nodes, and b) a tumor of the same size or smaller with a single metastasis to the nearest lymph nodes. •Stage III: a) the tumor is more than a semicircle gut, grows all of its adjacent wall or peritoneum, with no metastases in regional lymph nodes, and b) a tumor of any size in the presence of multiple metastases to regional lymph nodes. •Stage IV: extensive swelling, germinating in the adjacent organs, with multiple metastases to regional lymph nodes or any swelling in the presence of distant metastases.

There are four stages of colon cancer

ClinicClinical picture: depends on the location of

the tumor, the type of growth, size, presence of complications

It involves pain, intestinal discomfort, intestinal disorders, abnormal discharge, breach of the general condition of patients and sometimes the presence of palpable tumors.

Intestinal discomfort

Manifested loss of appetite, belching, nausea, feeling of heaviness in the epigastric region. Intestinal disorder caused by inflammatory changes in the intestinal wall, disorders of motility and narrowing of the lumen. They appear constipation, diarrhea, constipation, alternating diarrhea and, rumbling in the abdomen, abdominal distention. With a sharp narrowing of the lumen of the intestine develops obstructive ileus - a partial or complete.

Pathological dischargePathological discharge: an admixture of blood, pus, mucus in the stool is seen in 40-50% of patients. Blood in the stool is a result of the collapse of the tumor, and mucus and pus due to inflammation in the area of decay and associated colitis.

In some patients the only clinical expression of disease is the presence of palpable tumors (most often in tumors of the right half of the

colon)

Clinical forms of cancer

Toxico-anemic

Manifested loss of appetite, nausea, retching, vomiting, feeling of heaviness, general fatiqug

Enterocolitic form

Bloating, heavyness in abdomen, constipation. Stool with blood and pus

Clinical forms of cancerDyspeptic form

Manifested loss of appetite, nausea, retching, vomiting, feeling of heaviness and swelling in the epigastric area, pain in the upper abdomen.

Obstructive forms

The leading symptom of obstructive cancer ileus. This gives rise to attacks of abdominal pain, rumbling in the abdomen, swelling, bloating, no discharge of feces and gas. Initially, these symptoms are independently, occasionally repeating, which is typical for a partial bowel obstruction.

Clinical forms of cancerPseudo-inflammatory form

It is characterized by abdominal pain and increasing the temperature temperature of the body. Intestinal disorders are expressed weak. In a blood test reveal leukocytosis, increased sedimentation rate.

cancer forms

When the cancer forms a tumor in the abdomen or the patient discovers, or a physician in the study of the patient. At the same time other manifestations of tumors of the colon in a patient or not they are expressed very poorly.

Complications

• Ileus obstruction

• Inflammation of the tissues surrounding the tumor

• Perforation of the tumor,

• Intestinal bleeding,

• Fistula between the colon and neighboring organs.

Diagnostics

•Complaints

•History of disease

•MSCT

•Colonoscopy

(Various options for colorectal cancer)

Diagnostics

Diagnostics

Treatment•Treatment: Surgical methodTreatment: Surgical method

•X-ray and chemotherapy for cancer X-ray and chemotherapy for cancer

of the colon are ineffectiveof the colon are ineffective

Case fatality: at radical operations performed for cancer Colon is 6-8%. Five-year survival depends the stage of disease and degree of differentiation of tumor cells and among radically operated an average of 50%

The tactics of general physician:

1. Collecting the patient^s complains and

history

2. To refer for the MSCT

3. Referring and preparing for colonoscopy

and irrigography

4.To refer in time for proctologyst’s

examination