» LARGE INTESTINES ˃APPENDIX ˃ASCENDING COLON ˃TRANSVERSE COLON ˃DESCENDING COLON ˃SIGMOID.

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Presentation transcript:

» LARGE INTESTINES ˃APPENDIX ˃ASCENDING COLON ˃TRANSVERSE COLON ˃DESCENDING COLON ˃SIGMOID

» Peritoneum- ˃Upper third covered anteriorly and laterally ˃Middle covered only anteriorly ˃Lower none ˃Forms rectovesical and rectouterine space as reflects anteriorly

» Superior Rectal » Middle Rectal » Inferior Rectal » Anastomosis

» Parallels arteries » Dual Drainage » Superior rectal drains into portal » Middle/Inf. –drain into systemic

» Starts at anorectal junction and end at anal verge » Anal columns consist of longitudinal folds » Superior border is anorectal line which divides the rectum and anus » Inferior border is the dentate line » Dentate line divides columnar above and squamous below » Sup. Rectal supplies the anus above the dentate

» Innervation above dentate is same as the rectum –only sensitive to stretch » Below the dentate the inferior rectal of the pudendal supplies the anus- pain touch temperature

» Abnormal growth of mucosa » Pedunculated-stalk » Sessile-flat » Nonneoplastic polyps: Hyperplastic Inflamatory-regenerating epithelium Juvenile<10 years –hamartomas-distal colon

» Series of molecular changes » Mutation in k-ras on chromosome 12 p is found in 65% of sporadic colon ca » Deletions in APC gene (5q –tumor supressor gene)

COLORECTAL POLYPS Table CLASSIFICATION OF COLORECTAL POLYPS MUCOSAL POLYPS NeoplasticBENIGN Adenomatous polyps (dysplastic mucosa) TubularTubulovillousVillous MALIGNANT Carcinoma in situ Invasive carcinoma Polypoid carcinoma Nonneoplastic Hyperplastic polyps Juvenile polyps Peutz-Jeghers polyps Inflammatory polyps Normal epithelium SUBMUCOSAL POLYPS LipomasLeiomyomas Colitis cystica profunda Pneumatosis cystoides intestinalis Lymphoid aggregates Lymphoma (primary or secondary) Carcinoids Metastatic neoplasms

» FAP- thousand of polyps deletion APC gene (5q) IAA » Colon ca at mean age of 35 » Gardener’s –variant of FAP –osteomas, lipomas and sarcomas » Turcot’s –brain tumors » Variable manifestations of mutation in same gene

» Lynch syndrome » Autosomal dominant » Mutation on chromosome 2 » Other cancers endometrial stomach and urinary tract

» Peutz-Jeghers –hamartomas polyps associated with cutaneous pigmented lesions » Low risk of malignancy » Cowden’s DZ hamartomas with facial epithelial lesions-increased risk for breast cancer » Cronkhite Canada –hamartomas, alopecia diarrheas and hyerpigmentation

» Radiation for rectal cancer » Generally recommended for pts with stage II dz » Colon ca-chemo for stage II/III » 5-FU/LV

» Squamous cell cancer » Bowen dz carcinoma in situ » Chemo /RT » Nigro Protocol » Excellent sphincter preservation