altered bowel habits Flashcards
alternating diarrhea with constipation may be a sign of ?
carcinoma of the left side
annular carcinomas at the recto sigmoid junction
constipation from birth , gross abdominal distention , what is the most likely diagnosis ?
hirschsprung
what is normal transit constipation ?
colonic transit and anorectal functions are normal
what are the alarming symptoms associated with constipation ?
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
what are the three main types of stools associated with diarrhea ?
watery
inflammatory
fatty
what are the types of watery diarrhea ?
secretory - electrolyte rich, diarrhea persists with fasting
osmotic - diarrhea decreases with fasting
what are the neoplastic causes of each secretory and osmotic diarrhea ?
secretory diarrhea - neuroendocrine tumors, GIT secreting excessive mucus
inflammatory diarrhea : colonic carcinoma, lymphoma
what is the patients description of mucus discharge ?
passing slime
what is mucus discharge usually associated with ?
villous adenoma
which inflammatory disease is highly associated with tenesmus ?
Ulcerative colitis
at what stages of cancer is usually tenesmus indicated ?
stage II
stage III
what is the rule regarding distance and obstruction ?
the more the distal the lesion the more the obstructive symptoms
what is the presentation of right sided malignancies ?
1- present late as they do not cause obstructive symptoms
2- presentation is usually due to blood loss, anemia orr altered bowel habits
what is the nature of malignancies present in the transverse and the descending colon ?
ulcerative or infiltrative
what is the presentation of rectal cancers ?
dark red blood streaked on the stool
what are the signs that there is local invasion in rectal neoplasms ?
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
bowel distention in the absence of an anatomic lesion ?
intestinal pseudo-obstruction
what are the bowel habits associated with thyroid disease ?
diarrhea in hyperthyroidism
constipation in hypothyroidism
what are the differentials of steatorrhea ?
pancreatitis
malabsorption
celiac disease
cystic fibrosis
exocrine pancreatic insufficiency
severe constipation in young women dating from adolescence or following pelvic surgery ?
slow transit constipation
” passing water through the back passage “
usually a rectal cancer or villous adenoma
combination of muscle weakness (hypokalemia) and dehydration along with “ passing slime” ?
villous adenoma
What are other surgical causes of watery diarrhea with hypokalemia?
1- Vipoma secreting tumors can cause pancreatic cholera
2- diarrhea persists even during fasting
(secretory diarrhea )
what is tenesmus pathognomonic for ?
rectal mucosal involvement
what may cause local anorectal pain in rectal carcinoma ?
spread to local structures
tumor invades thee anal canal
what can be used for the assessment of rectal tumors ?
DRE
rigid sigmoidoscopy
full length colonoscopy
