Teaching Plan Name:BaoJian Wang Academic Year:2012-2013 Term:2 Date.April 23 Period:3-4 Sonand 2010 MBBS autumn Textbook Diagnostic Imaging mtemationals$tudents Content Gastrointestinal Imaging 4 Teaching hours 2 Objectives Key points Diagnosis of colo carcinoma Poo Howto distinguish small and large Content for self study Congenital anorectal anomalies Teaching equipment multimedia Related knowedge Physics of X-ray Teaching methods Heuristic method /discuss Outlines requirements and time allocation Colon Carcinoma(colorectal cancer) -is a cancer from uncontrolled cell growth in thecolon or rectum(parts of the large intestine).or in the appendix.Genetic analysis shows that colon and rectal tumours are essentially genetically the same cancer. Risk factors include the following: ·Age50 orolder. A family history of carcinoma of the colon or rectum. A personal history of carcinoma of the colon,rectum,ovary,endometrium, or breast A history of polyps in the colon. Signs and symptoms 10 The symptoms and signs of colorectal cancer depend on the location of tumor in the bowel,and whether it has warning signs incl ude:worsening constip d in the sto old. weight ranemia are hig
1 Teaching Plan Name：BaoJian Wang Academic Year：2012-2013 Term :2 Date.April 23 Period：3-4 Textbook Diagnostic Imaging Specialty and Stratification 2010 MBBS autumn (international students) Content Gastrointestinal Imaging 4 Teaching hours 2 Objectives To grasp the imaging of colon Carcinoma and bowel obstruction Key points Diagnosis of colon carcinoma Points difficult to understand How to distinguish small intestine obstruction and large intestine obstruction Content for self study Congenital anorectal anomalies Teaching equipment multimedia Related knowledge Physics of X-ray Teaching methods Heuristic method /discuss Outlines, requirements and time allocation Colon Carcinoma( colorectal cancer) ~ is a cancer from uncontrolled cell growth in thecolon or rectum (parts of the large intestine), or in the appendix. Genetic analysis shows that colon and rectal tumours are essentially genetically the same cancer. Risk factors include the following: • Age 50 or older. • A family history of carcinoma of the colon or rectum. • A personal history of carcinoma of the colon, rectum, ovary, endometrium, or breast. • A history of polyps in the colon. Signs and symptoms The symptoms and signs of colorectal cancer depend on the location of tumor in the bowel, and whether it has spread elsewhere in the body (metastasis). The classic warning signs include: worsening constipation, blood in the stool, weight loss, fever, loss of appetite, and nausea or vomiting in someone over 50 years old. While rectal bleeding or anemia are high-risk features in those over the age of 50, other commonly described symptoms including weight loss and change in bowel habit are typically only concerning if associated with bleeding. 5’ 5’ 10’
Outlinesrequrements and time Location .Rectum(15%).sigmoid (20%),descending colon(10%).transverse toehm cocanon seems h advancing years Mn left coo with chronic r colitis X-Ray Manifestations 15 ityhich givsr cnespeciayn ca-rare :SMHeeigadewtoutaniegaieobsnmetiom Crohn's disease Crohn's disease is a type of inflammatory bowel disease (IBD),resulting in swelling and dysfunction of the intestinal tract.It can occurs in all age groups Causes 5 The cause of Crohn's disease is unknown.No infectious agent(virus,bacteria, or fungi)has been identified as the cause of Crohn's disease.Evidences show it's a disorder of the immune system X rays Diagnosis ures gipn” netimes a loop of bowel is so narrow either from spasm in an extensively ulcerated and fibrosis in the bowel wall,that its ● When there is obvious disease in the terminal ileum,the cecum may be contracted. ne eon comin m dema ●
2 Outlines, requirements and time allocation Location • Rectum (15%), sigmoid (20%), descending colon (10%), transverse colon (12%), ascending colon (8%), cecum (8%) • Location seems to be changing and moving back to cecum • More common in right colon with advancing years • More common in left colon with chronic ulcerative colitis X-Ray Manifestations • 90-95% rate of detection by BE • Polypoid filling defect • Annular constricting=apple-core lesion • Scirrhous ca-rare infiltrating type which gives lead-pipe appearance seen especially in ulcerative colitis • Calcifications-rare • May have retrograde without antegrade obstruction Crohn's disease Crohn's disease is a type of inflammatory bowel disease (IBD), resulting in swelling and dysfunction of the intestinal tract. It can occurs in all age groups Causes The cause of Crohn's disease is unknown. No infectious agent (virus, bacteria, or fungi) has been identified as the cause of Crohn's disease. Evidences show it’s a disorder of the immune system X rays Diagnosis Strictures ⚫ extremely variable in length. ⚫ “the string sign”-Sometimes a loop of bowel is so narrow, either from spasm in an extensively ulcerated loop of bowel or edema and fibrosis in the bowel wall, that its appearance has been called “the string sign”. ⚫ The bowel proximal to a stricture is often dilated. ⚫ When there is obvious disease in the terminal ileum, the cecum may be contracted. Ulcers ⚫ Ulcers are seen sometimes quite deep. ⚫ Cobblestone appearance-fine ulceration combined with mucosal edema. Mucosal abnormalities ⚫ the mucosal folds may become thickened ,distorted ,or even disappear owing to thickening of the bowel wall 5’ 15’ 5’ 15’
Outlines,requirements and time allocation Ulcerative colitis Ulcerative colitis is a inflammatory bowel disease of unknown origin belonging to the same group of chronic inflammatory bowel disease (IBD)as Crohn's disease(CD). ● The prevalence of the disease is estimated at about 6-8 cases per 100,000 population with an equal distribution between men and women. 10 X rays Diagnosis ● Widespread ulceration-The cardinal (main)sign;The ulcers are usually shallow but in severe cases may be quite deep. ● Loss of the haustra in the affected portions of the colon-In all but the milder cases ● Rigid tube-owing to narrowing and shortening of the colon ● Pseudopolyps-small filling defects projecting into the lumen of the bowel formed by swollen mucosa 10 UC VS CD ● Ulcerative colitis differs from Crohn's disease,which is a form of IBD that affects both the small and large intestines. ● The inflammation of ulcerative colitis occurs only in the lining of the intestine(unlike Crohn's disease which affects all of the layers of the intestinal wall). ● Like Crohn's disease,ulcerative colitis occurs in all age groups,with the most common age of diagnosis being 15-35 years of age. Bowel obstruction 153 ● Bowel obstruction is a failure of onward passage of intestinal content due to mechanical obstruction. ● In children,the site of the obstruction is almost always in the small bowel. The symptoms are those of bile stained vomiting,abdominal distension,the extent of which depends on the level of the obstruction,and absence of bowel gas distal to the level of the obstruction.The child frequently also presents with failure of opening of the bowels. 3
3 Outlines, requirements and time allocation Ulcerative colitis ⚫ Ulcerative colitis is a inflammatory bowel disease of unknown origin belonging to the same group of chronic inflammatory bowel disease (IBD) as Crohn’s disease (CD). ⚫ The prevalence of the disease is estimated at about 6-8 cases per 100,000 population with an equal distribution between men and women. X rays Diagnosis ⚫ Widespread ulceration — The cardinal (main) sign; The ulcers are usually shallow but in severe cases may be quite deep. ⚫ Loss of the haustra in the affected portions of the colon — In all but the milder cases ⚫ Rigid tube —owing to narrowing and shortening of the colon ⚫ Pseudopolyps—small filling defects projecting into the lumen of the bowel formed by swollen mucosa UC VS CD ⚫ Ulcerative colitis differs from Crohn's disease, which is a form of IBD that affects both the small and large intestines. ⚫ The inflammation of ulcerative colitis occurs only in the lining of the intestine (unlike Crohn's disease which affects all of the layers of the intestinal wall). ⚫ Like Crohn's disease, ulcerative colitis occurs in all age groups, with the most common age of diagnosis being 15-35 years of age. Bowel obstruction ⚫ Bowel obstruction is a failure of onward passage of intestinal content due to mechanical obstruction. ⚫ In children, the site of the obstruction is almost always in the small bowel. ⚫ The symptoms are those of bile stained vomiting, abdominal distension, the extent of which depends on the level of the obstruction, and absence of bowel gas distal to the level of the obstruction. The child frequently also presents with failure of opening of the bowels. 5’ 10’ 10’ 15’