Colon polyps
Introduction
Introduction to colon polyps It is a kind of bulging lesion that protrudes from the mucosal surface into the intestinal lumen of the colon. It is called colon polyps before the pathological properties are determined. According to the pathology, adenomatous polyps (including papillary adenomas) are most common. Inflammatory polyps, the result of long-term inflammation-stimulated hyperplasia of the intestinal mucosa, hamartoma-type polyps, other, such as mucosal hypertrophy, hyperplastic polyps, lymphoid hyperplasia, carcinoid and other diseases. basic knowledge The proportion of illness: 0.09% Susceptible people: no specific population Mode of infection: non-infectious Complications: colitis
Cause
Colon polyp cause
So far, the cause of colon polyps is unclear. Some may be associated with long-term inflammatory stimuli or heredity.
The occurrence of colon polyps is related to many factors:
1, long-term diarrhea, many patients with intestinal mucosa easily allergic, such as drinking alcohol, eating chili or greasy food or seafood after diarrhea, some patients will have diarrhea for no reason, so that intestinal mucosa will appear chronic inflammation, easy to lead to the intestine Polyps grow.
2, long-term constipation, constipation patients often have a bowel movement once a day, feces long-term storage in the intestine will produce a variety of toxins, resulting in chronic inflammation of the intestinal mucosa, easy to grow polyps.
3. Genetics, such as familial polyposis, is a genetic disease.
4, inflammatory diseases, such as ulcerative colitis, clones and other diseases are prone to polyps.
The occurrence of colon polyps may be related to the following factors, as follows:
Living habits (20%):
The incidence of fibrous polyps in food is less, and vice versa. Smoking is also closely related to adenomatous polyps. A small adenoma occurs in the smoking history within 20 years, and more than 20 years in smoking history. A large adenoma.
Genetics (20%):
The occurrence of certain multiple polyps is genetically related. The patient inherits the defective APC allele from the parental germ cells, and another APC allele in the colon epithelium is normal at birth. When the allele is mutated, an adenoma occurs at the site of the mutation. This mutation is called a somatic mutation.
Infection (10%):
It has been reported that the occurrence of adenomatous polyps is associated with viral infection.
Age (10%):
The incidence of colon polyps increases with age.
Embryo abnormality (5%):
Juvenile polyposis is mostly hamartoma, which may be related to abnormal embryonic development.
Prevention
Colon polyp prevention
1. Aspirin prevents female colon polyps: Some women have a common genetic variation that can slow down the breakdown of aspirin. These women can reduce the risk of colon polyps if they insist on taking aspirin. In contrast, in women who do not have this genetic variant, aspirin does not reduce the risk of colon polyps.
2, calcium supplementation helps prevent colon polyps: Calcium can help humans fight colon polyps and colon cancer, even if patients have had these diseases before. Studies have shown that those who take calcium tablets every day have a 19-34% reduction in the risk of recurrence of colon polyps. Calcium-rich foods include milk and other dairy products, as well as broccoli. In addition, vitamin D (which helps the body's absorption of calcium) also shows a reduction in the risk of colorectal cancer. You can get enough vitamin D by properly ingesting some animal liver, egg yolk, fish and dairy products with vitamin D. Sunlight also converts a chemical component of the skin into available vitamin D. If you don't drink milk or sun, you may want to consider taking a "vitamin D + calcium" compound supplement.
3. Fruits, vegetables and whole grains help prevent colon polyps: These foods are rich in fiber and can reduce the risk of colon polyps. In addition, fruits and vegetables are also rich in antioxidants that can prevent colon cancer.
4, no smoking, drinking can prevent colon polyps: smoking, excessive drinking will increase the risk of colon polyps and colon cancer. Women should not drink more than 150 ml of wine per day, or 360 ml of beer, or 40 ml of white wine, while men should not be more than twice as many as women. If you have a family history of colon cancer, you should especially reduce smoking and drinking to reduce the risk.
5, adhere to physical exercise, maintain a healthy weight: weight control can independently reduce the risk of colon disease. It is recommended to exercise at least 30 minutes each time, five times a week. If you have 45 minutes of moderate-intensity exercise every day, it will work better in reducing the risk of bowel cancer.
6, have a good attitude to deal with stress, work and rest, do not fatigue. Visible pressure is an important cause of cancer. Chinese medicine believes that stress leads to excessive physical weakness, which leads to decreased immune function, endocrine disorders, metabolic disorders in the body, leading to the deposition of acidic substances in the body. Stress can also lead to mental stress causing qi stagnation and blood stasis. Invagination and so on.
7, do not eat contaminated food, such as contaminated water, crops, poultry, eggs, moldy food, etc., to eat some green organic food, to prevent disease from mouth.
Complication
Colon polyp complications Complications colitis
After the operation, the main complications include burns, hemorrhage, intestinal perforation, etc., and reports of death caused by flammable gas in the colon during electrocautery. The prevention is mainly based on skillful operation techniques, strict compliance with operational specifications, and intestinal preparation. Try not to use mannitol.
Symptom
Colon polyp symptoms Common symptoms Abdominal pain, abdominal distension, urgency, heavy mucus, dysfunction, constipation, stop, excretion, bloody stool, abnormal frequency
1, intermittent blood in the stool or stool surface with blood, mostly bright red, is not uncommon for large bleeding; secondary inflammation can be associated with a lot of mucus or mucus blood, can be urgency, constipation or increased stool, long pedicle or position near the anus Those who have polyps can come out of the anus, and those who cause intussusception can be seen.
2, a small number of patients may have abdominal distension, discomfort, pain or abdominal pain.
Examine
Colon polyp examination
1, rectal examination can touch low polyps.
2, anoscope, straight B-ray or fiber colonoscopy can be seen directly to see polyps.
3, barium enema can show filling defects.
Diagnosis
Diagnosis and identification of colon polyps
diagnosis
1, history of blood in the stool or mucus pus and blood.
2, polyps or colonoscopy found polyps.
3. How many filling defects are seen in the barium enema.
Differential diagnosis
1, family colon adenomatous polyps: also known as familial colon polyposis or familial adenoma.
The disease is often stained with dominant herdity, with a penetrance rate of 50%. It is estimated that 1 out of every 7,000-10,000 newborns have been reported. There are reports of multiple families in China, and 20% have no family history. It may be a gene. In the new case of mutation, the age of onset is around 20 years old. There are only a few polyps at the beginning. Later, the progressive increase and the size are different. The adenoma is sessile or hemitose-like, and the distribution is often dense. String, the total number is more than 100, can be found in the whole colon or rectum, common symptoms are blood in the stool, pus and bloody stools or diarrhea, and some may have abdominal pain or abdominal discomfort. If the lesion is not removed, it will eventually develop into colon cancer, barium enema and colonoscopy. The examination is helpful for diagnosing the disease. It should also pay attention to the detection of family members, mobilize their children, siblings, and parents to the hospital for systemic examination to detect asymptomatic patients early.
Once the disease is diagnosed, early surgery is appropriate. For patients under 20 years old, if the symptoms are not obvious, the operation may not be performed temporarily; if the polyp volume increases, or the polyp diameter is > 2 cm, or the polyps have become cancerous; abdominal pain, diarrhea, blood in the stool If the symptoms are aggravated, surgical treatment should be performed in time. The whole method of rectal resection or exfoliation of the rectal mucosa to the tooth line is performed. The ileum is anastomosed with the anal canal through the rectum. If necessary, the terminal ileum is used as a storage bag. If the rectal polyps have become cancerous, Radical resection should be performed.
2, Gardner syndrome: this disease is a common stained dominant genetic disease, is a kind of intestinal polyposis with bone and soft tissue tumors, the clinical manifestations and familial colon adenomatous polyposis have the same characteristics, the number of polyps generally <100 Large, large, but also highly malignant tendency, but the age of cancer is a little later, osteoma is seen in the skull, lower jaw sphenoid bone, long bones of the extremities, soft tissue tumors have epidermoid cysts, sebaceous cysts, fibroids, hard fibroids, etc. At the same time, there are thyroid or adrenal tumors, 90% of patients with fundus pigmentation, the treatment principle of this disease is the same as familial polyposis.
3, Turcot syndrome: this disease is an autosomal recessive genetic disease, less common, clinical manifestations in addition to familial colon adenoma, with other organs of the tumor, usually with a central nervous system tumor, Such as glioma or medulloblastoma of the brain or spinal cord, therefore also known as glioma polyposis syndrome, colon cancer adenoma has a high cancer rate, often cancerous in the teens and lead to death.
4, Peutz-Jeghers syndrome: also known as melanin-one gastrointestinal multiple polyposis syndrome, the disease is an autosomal dominant genetic disease, 40% of patients have a family history, mostly between the parents and their children have a simultaneous onset, Mostly seen in children or young people, the main clinical manifestations are mucocutaneous melanin deposition and multiple polyposis of the gastrointestinal tract. The pigmentation is mainly distributed in the lips, cheek mucosa and fingers, and the palm of the toes is brown, dark brown, due to the disease. Polyps are extensive, and the rate of malignant transformation is relatively low. Therefore, symptomatic treatment is generally given. If polyps are large or have complications or intestinal obstruction, surgical treatment can be performed. Colon polyps can be removed by endoscopic electrocautery. Large polyps can be operated and cut separately. The intestine wall is removed from the polyps to avoid intussusception in the future. For patients with this disease, long-term follow-up is still needed after surgery, because polyps can recur.
5, Cronkhite-Canada syndrome: also known as polyposis - pigmentation - alopecia - nail atrophy syndrome, the disease is acquired, non-familial disease, the main features are four:
(1) polyps throughout the gastrointestinal tract;
(2) changes in ectoderm, such as hair loss, nail dystrophy and pigmentation;
(3) Family history of polyposis-free disease;
(4) adult onset, symptoms are most common with diarrhea, see more than 80% of cases have diarrhea, large amount of defecation, and contain fat or gross blood, most have weight loss, followed by abdominal pain, anorexia, fatigue, libido and taste loss.
