CBL 1 Y2B2

By PBL 12
 1. IDENTIFY DIFFICULT TERMS.
SITI IZZATUL HILWANI BINTI MOHD SUFIAN MAHYU
2111176
 Hematemesis - Vomiting out
Melanic stool - Black stool
blood

Hemoptysis - Coughing out

Dyspnea - Shorness of breath
blood

Mammogram - An x-ray picture Lympadenopathy - Swelling of

of the breast the lymph nodes

Ascites - The build-up of fluid in the

space between the lining of the
abdomen and abdominal organs
 2. IDENTIFY THE CHIEF COMPLAINT.
SITI IZZATUL HILWANI BINTI MOHD SUFIAN MAHYU
2111176
CONSTIPATION FOR
ABOUT ONE-MONTH
DURATION
3. CAUSES OF CONSTIPATION
MUHAMMAD SYAHMI BIN HUZIR 2110475
 IMPAIRED MOTILITY
Inadequate dietary fiber Inactivity Hypothyroidism Amyloidosis

Fiber helps absorb water in Good muscle tone is Low thyroid hormone Amyloid deposits in the GI
the GI tract so that stools important for regular levels will slow all body's tract can interfere with
can pass through smoothly bowel movements function including bowel the function and motility
movements of the gut

Irritable bowel syndrome Pregnancy

Hypokalemia

Group of symptoms that affect Increase in progesterone

Electrolyte imbalance can lead
digestive tract including repeated hormones that relax the
to muscle weakness thus
pain in abdomen and changes in intestinal muscle causing food
affect the peristaltic action of
bowel movements, which may be and waste to move slower
colon
diarrhea, constipation, or both. through digestive system
 OBSTRUCTION
Tumor Stricture Volvulus
Intussusception
Serious condition in which Loop of intestine twists
Colorectal cancer Stricture colon in part of the intestine slides around itself and the
Crohn's disease into an adjacent part of the mesentery that supplies
intestine it, causing a bowel
obstruction
 NEUROLOGICAL MEDICATION
DISORDERS
Antacids that contain aluminum and calcium
Multiple sclerosis
(Aluminium hydroxide, calcium carbonate)
Anticholinergics
The disease can interrupt the
Anticonvulsants -used to prevent seizures
messages nerves send to and
Calcium channel blockers (verapamil)
from the brain that signal for
a bowel movement
Diuretics
Iron supplement
Anti Parkinson’s drugs
Parkinson's disease
Stroke Antidepressants
Constipation may occur
Loss of normal due to the improper
bowel function due functioning of the
to a nerve problem autonomic nervous system
4. NORMAL DEFECATION REFLEX
ZAHRA KHADIJAH BINTI SANUSI
2117536
Defecation is the process by
which the body gets rid of
waste products. WHAT IS
The process of eliminating
DEFECATION
stool from the body requires REFLEX?
the work of the defecation
reflex.
 TWO MAJOR REFLEXES

MYENTERIC DEFECATION PARASYMAPTHETIC WHAT IS DEFECAT

REFLEX DEFECATION REFLEX REFLEX?

INCREASING PERISTALSIS MOTION OF MOVING

AND PROPEL STOOL STOOL SIMILAR
TOWARDS THE RECTUM VOLUNTARY ACTION
 HOW DOES THE DEFECATION
REFLEX WORK?

The rectum (a reservoir) and mass peristalsis (mass movement) causes the faeces

to enter the rectum.

Distension of the rectum initiates reflex contractions of its musculature and the

desire to defecate.

The urge to defecate first occurs (about18mmHg).

 CONSCIOUS AND
PARASYMPATHETIC
PATHWAYS OF THE
DEFECATION REFLEX
 HOW DOES THE DEFECATION
REFLEX WORK?

The defecation reflex occurs when the internal anal sphincter relaxes and the

external anal sphincter contracts, causing the faeces to be expelled.

Voluntary defecation initiated by voluntarily relaxing the external sphincter and

contracting the abdominal muscles.

Gastrocolic reflex (action of gastrin on the colon) increase colon motility+urge to

defecate.
 5. DISEASES/MEDICAL
CONDITIONS THAT CAN LEAD TO
PASSING BLOOD IN THE STOOL
Ahmad Malek Hazim Bin Ahmad Latifi 2113137
RECTAL/OCCULT BLEEDING

Colorectal
Hemorrhoids
Cancer

Anal Anal
Fissure Abscess/Fistula
 RECTAL/OCCULT BLEEDING

Diverticulitis Ulcers

Inflammatory Bowel Large

Disease (IBD) Polyps
 Hemorrhoids

The most common cause of rectal bleeding.

Swollen veins in the rectum (internal hemorrhoid)
Swollen veins in the anus (external hemorrhoid)
Caused by chronic constipation, straining during
bowel movement, pregnancy, lifting heavy objects,
anal intercouse and obesity.
As the swelling increases, pressure from surrounding
tissues or stool can cause hemorrhoid to rupture
and bleed.
 Diverticulitis

When small pouches called diverticuli developed in

the weakened section of the intestine.
Diverticulitis occurs when hard piece of stool or
digested food gets trapped in one of the
diverticulitis and bacteria will start proliferation,
which causes infection later on.
Occurs when a small artery located within the
diverticulum is eroded and bleeds into the colon.
 Colorectal Cancer

Colon cancer may develop from polyps (growth) in

the colon’s lining.
May metastasize to other body parts via lymphatic
system/blood vessels.
Causes bleeding as there is angiogenesis and the
tumour’s blood vessels are fragile and easily rupture
by each bowel movements.
The cancerous tumour may also grow to adjacent
blood vessels which will cause compression, rupture
and bleeding.
 6. CLINICAL PRESENTATIONS
OF THE PATIENT
SYAZWAN FARIZ BIN SHAMSUL AZMAR
(2012003)

Anemia of chronic disease: Symptoms, treatment & causes (no date) Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/diseases/14477-anemia-
of-chronic-disease (Accessed: January 9, 2023).
MD Anderson Cancer Center and Nathan-Garner, L. (2012) How does menopause affect cancer risk?, MD Anderson Cancer Center. MD Anderson Cancer Center.
Availableat:https://www.mdanderson.org/publications/focused-on-health/FOH-menopause-
cancer.h201589835.html#:~:text=How%20does%20menopause%20affect%20a,cancer%20because%20they're%20older. (Accessed: January 9, 2023).
Weight loss (2020) Cancer.Net. Available at: https://www.cancer.net/coping-with-cancer/physical-emotional-and-social-effects-cancer/managing-physical-side-
 CLINICAL PRESENTATION
01 Cancer fatigue affects 02 Common among people
Experienced 80%-100% of cancer She had a with cancer.
increasing patients. weight loss of 40% of people say they
weakness Some cancers release about 5 had unexplained weight
proteins called loss when they were first
and fatigue kilograms over
cytokines diagnosed with cancer.
for the last 3- the past six
4 months. months.

03 Men are at higher risk of Women going through

developing prostate cancer, 04
She has menopause have a greater
while women are at higher She had chance of developing
hypertension risk of developing attained
and is on cancer.
endometrial & breast menopause
treatment. cancers.
Angiotensin II, can stimulate
the production of VEGF,
which in turn augments
cancerrelated angiogenesis.
 CLINICAL PRESENTATION
05 Increase chance to
Her late mother was develop cancer
diagnosed with gastric
carcinoma at the age of
55. Her father died at the
age of 60 due to an acute
myocardial infarction.

06 Anaemia of chronic
Pale disease

Most common differential

07
diagnosis for a left iliac fossa
There was an ill-
mass:
defined mass in the diverticulitis, colon
left iliac fossa cancer, ovarian mass.
 7. INVESTIGATION FINDINGS
SYAZWAN FARIZ BIN SHAMSUL AZMAR
(2012003)

Fecal occult blood test (2022) Mayo Clinic. Mayo Foundation for Medical Education and Research. Available at: https://www.mayoclinic.org/tests-
procedures/fecal-occult-blood-test/about/pac-20394112 (Accessed: January 9, 2023).
Cancer grade vs. cancer stage (no date) MD Anderson Cancer Center. Available at: https://www.mdanderson.org/patients-family/diagnosis-treatment/a-new-
diagnosis/cancer-grade-vs--cancer-stage.html (Accessed: January 9, 2023).
Niknejad, M. (2022) Apple Core Sign (colon): Radiology reference article, Radiopaedia Blog RSS. Radiopaedia.org. Available at:
https://radiopaedia.org/articles/apple-core-sign-colon-1 (Accessed: January 9, 2023).
 Investigation findings
1. Full blood count :
Hb 7.5 g/L (12-17);
Hypochromic microcytic anaemia
MCV 69.0 fl (80-98);
MCH 25.0 pg (27-32);
MCHC 29.0 g/dl (31-35);

2. Liver function test :

ALP is an enzyme that is elevated by various
ALP: 170 IU /L (20-120) hepatobiliary diseases.
Its elevation is thought to indicate bile stasis.
3. Fecal occult blood test:
Positive May indicate colon cancer or polyps in
the colon or rectum
 Investigation findings
4. Colonoscopy:
A circumferential growth approximately 6 cm in length was found
located about 45 cm from the anal verge, biopsies were taken.
5. CT scan
There was an apple core lesion in the left lower abdomen in the sigmoid
colon. Multiple small lesions were seen in the liver.
The napkin ring sign, is most frequently associated with constriction of the
lumen of the colon by a stenosing annular colorectal carcinoma.
6. CEA level:
44.7 ng/mL (<3)
7. Histopathological findings:
Poorly differentiated adenocarcinoma of the colon
Grade 3: Cancer cells and tissue look very abnormal.
8. MANAGEMENT OF COLON CANCER
MUHAMMAD HAIKAL HAFIZ BIN ROSLAN
2116365
Reference :
1. https://www.cancer.org/cancer/colon-rectal-
cancer/treating/colon-surgery.html
2. https://teachmesurgery.com/general/large-
bowel/colorectal-cancer/
3. https://www.mayoclinic.org/diseases-conditions/colon-
cancer/diagnosis-treatment/drc-
20353674#:~:text=Treatment%20for%20colon%20cancer%
20usually,chemotherapy%2C%20might%20also%20be%20
recommended.
1. SURGICAL
Removal of tumor, surrounding health tissue
and nearby lymph nodes
Colectomy : Surgery to remove colon
Hemicolectomy : partial colectomy on cancer
segment and normal segment on the both sides
Total colectomy : not often needed
Remaining section reattached
2. CHEMOTHERAPY
Drugs to destroy cancer cells
Usually given after surgery
If the cancer is large / has spread to lymph nodes
Given before surgery to shrink large cancer
Can relieve symptoms of colon cancer
Example : FOLFOX (Folinic Acid, Fluorouracil & Oxaliplatin)
3. RADIOTHERAPY
Powerful energy sources, such as X-
rays and protons, to kill cancer cells
Used to shrink a large cancer before
an operation
Sometimes radiation is combined with
chemotherapy.
4. PALLIATIVE CARE
Focuses on providing relief from pain
and other symptoms of a serious illness
Not curative, for reducing cancer
growth & symptoms control
Stage IV colon cancer has a
relative 5-year survival rate
of about 14%.
9. GROSS ANATOMY OF THE COLON
NUR FAQIHAH BINTI ISWADY (2119804)
 PARTS OF
COLON

3 5

1
2 Appendix
7 6
1

2
3

5
6

7
10. HISTOLOGY OF THE COLON
WAN NUR BATREISYA BINTI WAN SAIFUL AZMI
2115430
 MUCOSA SUBMUCOSA
Simple columnar epithelium with numerous goblet
Comprises blood vessels, lymph nodes
cells (absorptive cells & mucus-secreting goblet
and particularly fat tissue.
cells)
No Brunners’s glands and Peyer’s patches
Lamina propria​fills space between crypts
(contains numerous blood and lymphatic vessels,
collagens, lymphocytes and plasma cells)
form defense mechanisms against invading
pathogens together with intraepithelial
lymphocytes & lymphoid aggregates
MUSCULARIS
EXTERNA SEROSA
covers the connective tissue and
Smooth muscle layer: ​Inner circular​ adipose cells in the transverse and
& ​Outer longitudinal sigmoid colon.
OL form 3 thick bundles as ​taenia The ascending and descending colon
coli are retroperitoneal, and their posterior
surface is lined with adventitia
11. FACTORS/MEDICAL CONDITIONS
THAT CAN INCREASE RISK
OF COLON CANCER
Najwa Nabilah Binti Mohd Rizuhan | 2113856

References :
https://www.cancer.net/cancer-
types/colorectal-cancer/risk-factors-
and-prevention
 Old age
-common in age >50 yrs old
Family history of Colon Cancer
-first degree relative has colon cancer before age 60 yrs old
History of IBD
-pro-neoplastic effects of chronic intestinal inflammation
-Ulcerative Colitis >Crohn’s Disease
Dietary habits
-high intake of fat, red meat and processed meat
-high intake of dietary fiber partially counteracts the unfavorable effects
Smoking
Alcohol consumption
Physical inactivity and obesity
 Genetic condition
1.Lynch Syndrome / hereditary non-polyposis colorectal cancer (HNPCC)
-inherited changes (mutations) in genes that affect a process that fixes mistakes
made when DNA is copied (DNA mismatch repair)
-more likely to be diagnosed at a young age before 50
2.Familial adenomatous polyposis(FAP)
-inherited mutation of APC gene
-increase growth of polyps presence in colon and rectum
-occur in midteen and cause complication in 40s if left untreated
3.Attenuated FAP
-develop polyps later in life
4.Gardner Syndrome
- develop other tumors outside the gastrointestinal organs
5.Turcot syndromes
-variant of either FAP or Lynch syndrome
6.Peutz-Jeghers Syndrome
-developing hamartomatous polyps(common polyps in children) in the digestive
tract
-autosomal dominant inheritence of mutated gene STK11
-can also develop cancers of the breast, colon and rectum, pancreas, stomach,
testicles, ovaries, lung, cervix, and other
12. IMPORTANCE OF TUMOR MARKERS
IN COLORECTAL CANCER
Ahmad Malek Hazim Bin Ahmad Latifi 2113137
Tumour markers are used to
detect the presence of
cancerous cells as well as
the type.
It can be used for diagnostic CARCINOEMBRYONIC
purposes but should‘nt be
the confirming test.
ANTIGEN
It can also be used to
monitor patients who
already diagnosed with
colorectal cancer. (With
other tests as well)
13. EPIDEMIOLOGY OF COLON CANCER
IN MALAYSIA
SITI IZZATUL HILWANI BINTI MOHD SUFIAN MAHYU
2111176
BASED ON The most common cancer among men
STUDY IN
2020 The second most common cancer
among women

Cases are usually detected at late stage

(3 or 4), leading too an increased risk of
death

1. Malay (69.1%)
2. Chinese (23%)
3. Indian (6.9%)
14. PATHOGENESIS OF COLON CANCER
SORFINA HANIS SAZA SAIFUL EFFENDI
 Epigenetic
Genetic abnormalities
abnormalities

3. Cp Islands Methylation
• CpG islands - region of
1. APC / Beta-catenin
2. MSI Pathway genome that contain
pathway
large no of CoG
dinucleotide repeats
• located within close to
tumour suppressor gene
• normal -unmethylated

Enhance progression along either

APC/B-Catenin Pathway
MSI Pathway
 1. APC/B-Catenin Pathway
APC = Adenomatous Polyposis Coli gene
tumour suppressor gene =
seen in
Classic adenoma-carcinoma sequence
80% of sporadic colon cancer

Germ loss of function mutation of APC (at

5q21)
often associated with familial adenomatous polyposis
autosomal dominant disorder
100- 1k adenomatous polyps along colon
lead to malignant cancer
 Homozygous loss of
Germ-line (inherited) /
-Methylation abnormalities additional cancer
somatic. (Acquired) Proto-oncogene -Additional mutations
-Inactivation of normal -suppresor genes
mutations of cancer mutations -Gross chromosomal alterations
alleles (2nd hit) -Overexpression of
suppresor genes ( 1st hit )
COX-2

APC at 5q21 APC Beta-Catenin KRAS at 12p12 Telomerase, many genes

p53 at 17p13
LOH at 18q21
(SMAD2 and SMAD)
 2. MSI Pathway
Microsatellite Instability Pathway
Loss of DNA repair gene
defects in DNA mismatch repair
Gene involved: MLHI, MSH2, MSH6, PMSI, PMS2
Result in repetitive DNA sequence become unstable during replication cycle
Accumulation of numerous gene
Mutation involves gene that regulate cell survival & proliferation -> cancer
COMPLICATION OF
COLON CANCER
NURUL LIYANA BINTI ABD HALIM HAPIZ
2119756
 COMPLICATION OF
COLON CANCER
1) Bowel obstruction 2) Metastasize
More common in the It is hard to cure when the
advanced stage of cancer. cancer cells already
Bowel becomes blocked metastasize
and the waste of digested Depending on location:
food cannot pass through. 1) Liver - Jaundice
Cancer in the abdominal 2) Lung - Shortness of
area can damage the breath
nerve. Muscle cannot 3) Bone - Bone pain
contract properly. 4) Brain - Dizziness, seizure
5) Lymph node
 COMPLICATION OF
COLON CANCER
3) Anemia 4) Perforation
Tumours that grow
Due to haemorrhage through the wall of the
Tumour cells release intestine
chemicals that leads to During chemotheraphy,
angiogenesis tumours shrink and leave a
When the tumour grows, hole
the vessels can burst, Rupture of thin wall allows
leads to loss of red blood spillage of fecal materials
cells. leads to peritonitis

https://www.mountsinai.org/health-library/diseases-conditions/colon-
cancer#:~:text=Possible%20Complications&text=Blockage%20of%20the%20colon%2C%20causing,a%20second%2
0primary%20colorectal%20cancer
THANK YOU
I hope you can get helpful
knowledge from this presentation.
Good luck!