altered bowel habits

Question 1

alternating diarrhea with constipation may be a sign of ?

Answer 1

carcinoma of the left side
annular carcinomas at the recto sigmoid junction

Question 2

constipation from birth , gross abdominal distention , what is the most likely diagnosis ?

Answer 2

hirschsprung

Question 3

what is normal transit constipation ?

Answer 3

colonic transit and anorectal functions are normal

Question 4

what are the alarming symptoms associated with constipation ?

Answer 4

weight loss of more than 4.5
new onset of symptoms in elderly patients
family history of colon cancer
anemia
blood and mucus in stool
lack of response to treatment

Question 5

what are the three main types of stools associated with diarrhea ?

Answer 5

watery
inflammatory
fatty

Question 6

what are the types of watery diarrhea ?

Answer 6

secretory - electrolyte rich, diarrhea persists with fasting
osmotic - diarrhea decreases with fasting

Question 7

what are the neoplastic causes of each secretory and osmotic diarrhea ?

Answer 7

secretory diarrhea - neuroendocrine tumors, GIT secreting excessive mucus

inflammatory diarrhea : colonic carcinoma, lymphoma

Question 8

what is the patients description of mucus discharge ?

Answer 8

passing slime

Question 9

what is mucus discharge usually associated with ?

Answer 9

villous adenoma

Question 10

which inflammatory disease is highly associated with tenesmus ?

Answer 10

Ulcerative colitis

Question 11

at what stages of cancer is usually tenesmus indicated ?

Answer 11

stage II
stage III

Question 12

what is the rule regarding distance and obstruction ?

Answer 12

the more the distal the lesion the more the obstructive symptoms

Question 13

what is the presentation of right sided malignancies ?

Answer 13

1- present late as they do not cause obstructive symptoms
2- presentation is usually due to blood loss, anemia orr altered bowel habits

Question 14

what is the nature of malignancies present in the transverse and the descending colon ?

Answer 14

ulcerative or infiltrative

Question 15

what is the presentation of rectal cancers ?

Answer 15

dark red blood streaked on the stool

Question 16

what are the signs that there is local invasion in rectal neoplasms ?

Answer 16

1- faecal incontinence
2- fistula in ano
3- back pain
4- bladder symptoms
5- rectovaginal fistula
6- renal impairment
7- unilateral or bilateral leg oedema

Question 17

bowel distention in the absence of an anatomic lesion ?

Answer 17

intestinal pseudo-obstruction

Question 18

what are the bowel habits associated with thyroid disease ?

Answer 18

diarrhea in hyperthyroidism
constipation in hypothyroidism

Question 19

what are the differentials of steatorrhea ?

Answer 19

pancreatitis
malabsorption
celiac disease
cystic fibrosis
exocrine pancreatic insufficiency

Question 20

severe constipation in young women dating from adolescence or following pelvic surgery ?

Answer 20

slow transit constipation

Question 21

” passing water through the back passage “

Answer 21

usually a rectal cancer or villous adenoma

Question 22

combination of muscle weakness (hypokalemia) and dehydration along with “ passing slime” ?

Answer 22

villous adenoma

Question 23

What are other surgical causes of watery diarrhea with hypokalemia?

Answer 23

1- Vipoma secreting tumors can cause pancreatic cholera
2- diarrhea persists even during fasting

(secretory diarrhea )

Question 24

what is tenesmus pathognomonic for ?

Answer 24

rectal mucosal involvement

Question 25

what may cause local anorectal pain in rectal carcinoma ?

Answer 25

spread to local structures
tumor invades thee anal canal

Question 26

what can be used for the assessment of rectal tumors ?

Answer 26

DRE
rigid sigmoidoscopy
full length colonoscopy