Ulcerative colitis exam Questions

Q56). Ulcerative Colitis with malignancy

a) has a better prognosis than Ca Colon

b) Is related to disease activity

c) is related to duration of ulcerative colitis

d) Malignancy is more in ano rectal ulcerative colitis

Q57) In ulcerative coilitis with toxic megacolon

lowest recurrence is seen in

a) complete proctocolectomy and brook's ileostomy

b) Ileo rectal anastomosis

c) koch's pouch

d) Ileo anal pull through procedure

Q58) All are premalignant except

a) Turcot syndrome

b) cowden syndrome

c) Juvenile polyposis coli

d) none

Q59) Colonic polyps are seen to regress with

a) Azathioprine

b) streptozocin

c) Sulindac

Q60) All are precancerous for carcinoma colon except

a. crohn's disease

b. Bile acids

c. Fats

d. carotene

Answers

57) a

Total proctocolectomy with brooke's ileostomy removes almost all of the diseased segment.

IRA and IPAA leave behind rectal mucosa which may or may not be diseased

58) d

Turcot syndrome Turcot et al first described an association between colonic polyps and tumors. The colonic/rectal polyps are adenomatous, usually multiple, and 1-30 mm in diameter. Most central nervous tumors are supratentorial glioblastoma with occasional medulloblastoma. Other reported abnormalities include sebaceous cysts, papillary carcinoma of the thyroid, leukemia, and spinal cord tumors. They are definately premalignant PN

Cowden syndrome is a rare disorder that is inherited in autosomal dominant manner with intra-familial and inter-familial differences in the expressivity of symptoms Ii is mostly not malignant and no endoscopic screening is reuired but risk of malignancy at extra gi sites is morer.

JPCis premalignant Patients with polyps should undergo endoscopic surveillance every 1-3 year. Colectomy is recommended for patients who have numerous polyps in the colon; however, surveillance of the ileal pouch should be continued because of the risk of malignant change.

59)c

60) d

Carotene, Vit C and Calcium reduce the risk of colonic malignancy.

Answers

56) c

Carcinoma of the colon afflicts patients with ulcerative colitis 7 to 30 times more frequently than it does the general population.

The risk of colon cancer in ulcerative colitis is related to two factors: (1) duration of the colitis, and (2) extent of colonic involvement. The risk of colon cancer for patients who have had the disease less than 10 years is low, but this risk steadily increases. The cancer risk for patients who have had disease activity for 10 to 20 years is 23 times that of the general population, while a disease duration of more than 20 years is associated with a cancer risk 32 times greater than that of the general population. The extent of colonic involvement in colitis also influences the risk of cancer. The incidence of cancer when ulcerative colitis is limited to the rectum or to the left side of the colon is much lower than when ulcerative colitis involves the entire colon.

The colonic malignancy associated with ulcerative colitis is generally an adenocarcinoma evenly scattered throughout the colon. The adenocarcinoma is often flatter than cancers in the general population and has fewer overhanging margins. It is generally considered extremely aggressive.