"Apple core" sign seen in
i.e. (Carcinoma descending colon): (1181-Love & Bailly 25th)* Barium enema showing a carcinoma of the sigmoid colon. It may have a 'apple core' appearance i.e. a short irregular stenosis with sharp shoulders at each end.* Carcinoma of the left colon appears as a fixed filling defect with an annular "apple core" configuration lesion of the right colon may appears as - constriction or an intraluminal mass (663 - CSDT13th)CEA levels are high in 70% of patients with cancer of large intestine but less than half of patients with localize disease are CEA positive. CEA does not therefore serve as a useful screening procedure, nor is it an accurate diagnostic test for colorectal cancer in a curable stage. CEA is helpfid in detecting recurrence after curative surgical resection; if high CEA levels return to normal after operation and then rise progressively during the follow up period, recurrence of cancer is likely (663-CSDT 13th)* Apple jelly nodules are seen in Lupus vulgaris*** Claw appearance on barium enema - Intussusception* Napkin - Ring sign - carcinoma colonRisk Factors for the Development of Colorectal cancer* Diet: Animal fat, High caloric diet, High saturated fat consumption* Hereditary syndromes (Autosomal dominant inheritance* Polyposis coli* Nonpolyposis syndrome (Lynch syndrome)* Inflammatory bowel syndrome (UC & CD)* Streptococcus bovis bacteremia* Uretero sigmoidostomy* DM and obesity* Tobacco use* Sedentary life style* High red meat consumption* High content of refined carbohydrate* There is narrowing of terminal ileum due to irritability This along with shortened rigid caecum is called as "Sterilin sign" seen in Crohn's disease and Ileocaecal TuberculosisCROHN'S DISEASE or REGIONAL ENTERITISULCERATIVE COLITIS* Terminal ileum is the Most common site*** Granularity & asymmetrical involvement with skip lesion* Ulcer - Apthous ulcer and fissure ulcer* Cobblestone pattern** (Serpiginous transverse ulcer seperated by areas of edema)* Rigidity of mesenteric border and pseudosacculation of anti mesenteric border (Omega sign)* Wide gapping of bowel loops due to thickening of bowel wall* Stricture : long segment (String sign of cantor)*** Collar button ulcer* Double Tracking (longitudinal submucosal ulceration over several centimeter)* Symmetrical involvement of colon* Rectum involvement in 95% of cases*** Thumbprinting** due to mucosal oedema* Blunting of haustral fold (Pipestem appearance)*** Inflammatory polyp*** Back wash ileitis. In UG when whole colon involved, the inflammation extends 1-2 cm into terminal ileum in 10-20% cases called Backwash ilitis* Gaseless abdomen in X-ray***
Carcinoma descending colon
Ulcerative colitis
Tuberculosis
Diverticulitis
Small & Large Intestine