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P. POLYPES AND Tumors of the Large Intestine
1. Benign polyps, polyposis and tumors.
The etiology and pathogenesis, as well as tumors, in general, have not yet been sufficiently studied. Benign tumors (according to WHO, Geneva, 1981) are divided into three groups:
3). non-epithelial tumors.
Among the epithelial tumors of the colon, which make up the vast majority of all its tumors, distinguish between adenoma and adenomatosis.
Adenoma (tubular, villous, tuberous villous adenoma) is a benign tumor of the glandular epithelium on the leg or wide base, having the form of a polyp. There is a clear relationship between different types of adenomas: most often, adenoma per
initially has a tubular structure and small size. As growth and size increase, villi increases and the malignancy index sharply increases - from 2% in tubular adenoma to 40% in villous.
If multiple adenomas are found in the colon, but not less than 100, then, according to the WHO international histological classification, this process should be classified as adenomatosis. With a smaller number, we can talk about multiple adenomas. With adenomatosis, usually all adenomas have a predominantly tubular structure. The degree of dysplasia can be different.
A carcinoid is second in frequency among colon tumors; morphologically, it is no different from carcinoid of the small intestine, but is less common in the colon.
Non-epithelial benign tumors of the colon can have the structure of leiomyomas, leiomyoblastomas, neurilemomas, lipomas, hem and lymphangiomas, fibromas, etc.
All of them are extremely rare, localized in any layers of the wall, but more often in the mucous membrane of the submucosal layer and during endoscopic examination they look like polyps.
However, a polyp is a collective term used to refer to pathological formations of various origins that rise above the surface of the mucous membrane. In addition to tumors, these formations can be tumor-like processes that are different in etiology and origin. These include gamar toms, in particular the Peitz-Jägers-Touraine polyp and the juvenile polyp, similar in structure to similar formations in the colon.
Especially often in the colon there is a hyperplastic (metalloplastic) polyp, which has recently been attributed to pre-tumor formations, since it is most often found next to a malignant tumor of the rectum and colon, as well as in connection with the possibility of its transformation into cancer.
An inflammatory polyp is a nodular polypoid formation with inflammatory stromal infiltration, covered with normal or regenerating epithelium, often ulcerated.
In addition to dividing all of the above polyps by etiology and histological structure, the size of the polyps, the presence and nature of the legs of the polyp, and finally the number of polyps are important for the clinic.
CLINIC. For a long time, benign tumors and colon polyps can be asymptomatic. Only when the tumor reaches a sufficiently large size do symptoms of colon obstruction arise, and when a part of the tumor or polyp breaks up, intestinal bleeding occurs. Colon polyps in more than half the cases cause colon cancer. Most often, malignancy of the so-called villous polyp appears.
The diagnosis is made using colonoscopy or irrigoscopy. The treatment of benign tumors or polyps of the colon is most often surgical. However, small tumors and polyps can be removed with modern endoscopic techniques (electrocoagulation, laser coagulation, removal with a special “loop” and DR -) -
Hereditary familial polyposis of the gastrointestinal tract.
a) Diffuse (familial) polyposis is a hereditary disease manifested by a clinical triad:
the presence of many polyps (of the order of several hundred) from the epithelium of the mucous membrane;
the family nature of the lesion;
localization of the lesion throughout the gastrointestinal tract.
The disease ends with the obligatory development of cancer as a result of malignancy of polyps.
b) Gardner's syndrome (illness) is a disease characterized by multiple skin and subcutaneous lesions that occur simultaneously with tumor lesions of the bones and tumors of soft tissues in combination with polyposis of the gastrointestinal tract. This is a pleiotropic dominant-hereditary disease, with a varying degree of penetrance, based on mesenchymal dysplasia. The first manifestations of the disease are usually detected in people over 10 years old, often after 20 years. This is a multiple polyposis of the colon (sometimes also the 12 ™ duodenum and stomach) with a tendency to cancerous degeneration, multiple osteomas and osteofibromas of the bones of the skull and other parts of the skeleton, multiple atheromas, dermoid cysts, subcutaneous fibromas, leiomyomas, premature tooth loss.
The main diagnostic method is irrigoscopy; to detect bone lesions - radiography or scintigraphy of the bone skeleton. Of the bones, the upper and lower jaw are most often affected. Surgical treatment: total colectomy with pleostomy.
c) Kronkhait-Canada syndrome - which is a complex of congenital anomalies; generalized polyposis of the gastrointestinal tract (including the stomach and duodenum), nail atrophy, alopecia, skin hyperpigmentation, sometimes in combination with exudative enteropathy, malabsorption syndrome, hypocalcemia, potassium and magnesium.
d) Generalized gastrointestinal juvenile polyposis. It is characterized by the early - in adolescence - the development of multiple polyps throughout the digestive tract, starting from the stomach and ending with the rectum. With this form of polyposis, no extraintestinal manifestations are observed, as well as malignancy of polyps.
e) Tarkot syndrome. In 1959, Y. Tarcot and MPDespire described in the brother and sister cancer of the central nervous system associated with familial colon polyposis. f) Peitz-Jägers-Touraine syndrome, which is characterized by a triad:
hereditary nature of the disease;
age spots on the skin and mucous membranes. Women get sick more often, inherited in an autosomal dominant manner.
g) Familial (juvenile) colon polyposis is a hereditary disease with an autosomal dominant transmission path.
Polyps are found in adolescence, but they are found in early childhood, and even in old age. It is believed that this type of familial polyposis is extremely conducive to the development of a cancerous tumor: the transformation of a colon polyp into a cancerous tumor is possible in 95% of cases. Cancer usually develops early, up to 40 years. Describes the combination of polyposis of the colon with cancer of the stomach, small intestine.
The knowledge of hereditary polyps of the digestive tract is not only of purely scientific importance, but also allows doctors in each case to accurately determine the prognosis of the disease and, at high risk of malignancy of polyps with certain, most life-threatening forms of multiple hereditary polyposis, recommend the only possible remedy to patients , although morally difficult and technically quite complex, total colectomy, if possible, with the application of an ileorectal anastomosis.
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P. POLYPES AND Tumors of the Large Intestine
- Tumors of the small and large intestine
Epithelial tumors make up the majority of intestinal neoplasms. Moreover, the colon, including the rectum, is one of the most common organ localizations of primary tumors. As an oncological cause of death for both sexes, colorectal cancer takes second place after bronchogenic carcinoma. The vast majority of cases of colon cancer are
- FORMATION OF A J-SHAPED TANK FROM A HIGH GUT FOR REPLACEMENT OF A DIRECT GUT
In the surgical treatment of cancer of the female genitalia, the rectosigmoid colon is often removed. Then, reconstructive operations are performed, such as the removal of the final section of the sigmoid colon or very low colorectostomy. After these operations, patients may experience undesirable frequent bowel movements, up to 6-8 times a day. Assigning opiates to solve this problem may
- Colon cancer
The main principles of carcinogenesis of solid tumors were established by the example of colon tumors and form the basis for the study of tumors of other localizations. But even in the development of these quite well-studied tumors, various options are possible. In the case of hereditary adenomatous polyposis, the patient has a mutation of the APC gene in stem cells, the formation of a clone of mutated
- Colon cancer
The end of the twentieth century. was marked by a significant change in the structure of cancer incidence. In Russia, colon cancer (colorectal cancer) came in third place. The incidence of malignant neoplasms of the cecum and colon among men is 11.6, among women - 9.2 per 100 thousand adults, and rectal cancer - 11.0 and 7.1, respectively. Colorectal cancer is
- Colon Cancer Screening Tests
Screening tests are used to detect the asymptomatic course of the disease in apparently healthy people. To some extent, these tests are designed to increase a person’s life expectancy and improve its quality. An effective test should have sensitivity (optimal detection of patients), specificity (give a minimum of false positive results) and be accessible to a wide range of patients.
- FRONT BODY RESECTION WITH GAMBEE LOW ANASTOMOSIS
The purpose of this operation is to resect the rectosigmoid colon and to reanastomose the colon and rectum with a single-row suture according to Gambi. The physiological consequences. After removal of the rectosigmoid colon, the physiological consequences are minimal. If the patient received a course of radiation therapy in the pelvic area, then before performing a low anastomosis, it should be applied for 8-10 weeks
- FRONT BODY RESECTION WITH A LOW ANASTOMOSIS BY STRASBOURG-BAKER
The Strasbourg-Baker method involves applying a side-to-end anastomosis between the sigmoid colon and the rectal stump without shutting down the inferior mesenteric artery from the blood supply. It is also commonly used to preserve the anterior hemorrhoidal artery. An anastomosis according to Strasbourg-Baker can be formed with a manual seam or using a modern stapler (ACC). If
- Colon Syndromes
Violation of the stool (frequent urge to defecate with small portions of feces containing mucus, sometimes blood, diarrhea can be replaced by constipation). • Pain (aching pain in the lower abdomen, less often colicky pain, decreasing after defecation, gas discharge, worse after eating coarse, greasy, fried foods). • Dyspeptic (bad taste in the mouth, belching with air, bloating).
- Organic Colonic Disorders
Chronic colitis. Classification of chronic colitis. 1. According to the localization of the process: 1) right-sided; 2) left-sided; 3) transverse; 4) total. 2. The phase of the process: 1) exacerbation; 2) remission. 3. Type of intestinal dyskinesia: 1) hypomotor; 2) hypermotor; 3) mixed. Diagnosis of chronic colitis. 1. Sigmoidoscopy (catarrhal or catarrh-follicular proctosigmoiditis). 2.
- The structure and functions of the small and large intestine. Congenital malformations of the intestine
In an adult, the length of the small intestine reaches about 6 m, and the large - 1.5 m. In addition to the width and structure of the outer shells, the small intestine differs from the thick structure of the mucous membrane, in which circular folds, intestinal villi and crypts (intestinal glands). The villi protrude into the lumen in the form of finger-shaped outgrowths covered with a cylindrical epithelium. Similar to
- LECTURE No. 10. Chronic diseases of the colon in children. Clinic, diagnosis, treatment
Chronic non-specific diseases of the colon. 1. Functional disorders: 1) chronic constipation; 2) irritable bowel syndrome; 3) diverticular disease. 2. Organic disorders: 1) chronic colitis; 2) ulcerative colitis; 3) Crohn's disease; 4) intestinal amyloidosis. Classification of functional bowel disorders. 1. Intestinal upset: 1) irritable syndrome
- I. Tumors
1. Benign tumors of the small intestine. The international classification of intestinal tumors (WHO, Geneva, 1981) distinguishes the following benign tumors of the small intestine: 1) Epithelial tumors are represented by an adenoma. It has the form of a polyp on the leg or on a wide base and can be tubular, villous and tubulovirus. 2) Carcinoids occur in the crypt region of the mucosa
- TUMOR GROWTH. TUMOR PROGRESSION. TUMOR MORPHOGENESIS. INVASION AND METASTASIS OF MALIGNANT TUMORS. BIOMOLECULAR TUMORS MARKERS. ANTITUMOR IMMUNITY. PARANEOPLASTIC SYNDROMES. BASIC PRINCIPLES OF CLASSIFICATION OF TUMORS. MORPHOLOGICAL FEATURES OF TUMORS FROM EPITELIUM AND TUMORS FROM TISSUES - DERIVATED MESENCHIMES
TUMOR GROWTH. TUMOR PROGRESSION. TUMOR MORPHOGENESIS. INVASION AND METASTASIS OF MALIGNANT TUMORS. BIOMOLECULAR TUMORS MARKERS. ANTITUMOR IMMUNITY. PARANEOPLASTIC SYNDROMES. BASIC PRINCIPLES OF CLASSIFICATION OF TUMORS. MORPHOLOGICAL FEATURES OF TUMORS FROM EPITELIUM AND TUMORS FROM TISSUES - DERIVATIVES
- Bowel disease. Infectious enterocolitis (dysentery, typhoid fever, cholera). Nonspecific ulcerative colitis. Crohn's disease. Coronary bowel disease. Appendicitis. Colon cancer
1. Macroscopic characteristics of the small intestine with cholera enteritis 1. a gray-yellow film tightly adhered to the wall 2. ulceration of the mucous membrane 3. multiple hemorrhages 4. wall sclerosis 2. Elements of the pathogenesis of typhoid fever 1. bacteremia 2. bacteriocholia 3. cerebral swelling 4. exudative inflammation 5. hypersensitivity reaction in the lymphoid apparatus 3. Modern
- The role of the large intestine in the life of vegetarians and meat-eaters (Mechnikov, Shatalova and large intestine)
"For a long time, scientists could not understand what role the large intestine plays in our body. I. Mechnikov even thought that we simply did not need such an organ." “There is nothing surprising in the fact that Ilya Ilyich Mechnikov underestimated the role of the colon. Indeed, if the body receives essential amino acids with animal proteins, and nobody has the functions of the large intestine
- benign leg epithelial tumors growing from the mucous membrane. Classification of colon polyposis (according to V L. Rivkin, 1969) Group I. Polyps: a) single; b) group 1. Glandular and glandular-villous (adenomas and adenopapillomas); 2. Hyperplate (miliary). 3. Cystogranulating. 4. Rare non-epithelial polypoid formations. II group.
- Non-tumor polyps
The vast majority of such formations that occur, in particular, in the colon, are sporadic, and the frequency of their development increases as a person ages. Non-tumor polyps (mostly hyperplastic) make up about 90% of all colon epithelial polyps and are found in more than 50% of people 60 years of age or older. Inflammatory (pseudo-) polyps,
- MESENCHYMAL TUMORS. TUMORS OF MELANINE-FORMING I FABRIC. TUMORS OF THE CENTRAL NERVOUS SYSTEM, BRAIN CELLS AND PERIPHERAL NERVES
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- Fibroepithelial polyps.
Fibroepithelial polyps are rare ureteral mucosal formations that can lead to obstruction. Similar changes can be detected at any level of the urinary tract, but in terms of the frequency of occurrence of fibroepithelial polyps, the ureters are in the first place, followed by the urethra, pelvis, bladder. In men, the predominant localization is
Polyps of the cervix uteri are growths on the cervix (often in the walls of the cervical canal) in the form of a leg with a connective tissue skeleton (rod) covered with a multilayer flat or cylindrical epithelium with glandular structures in the thickness. There are simple (formed glandular or glandular-fibrous formations without proliferative changes) and adenomatous (formations with