Clinical Approach - Colorectal Dz Flashcards
How can you tell when a pt w rectal bleeding has pathology located more proximal to the anus?
problem in anus = bright red blood coating stool, on toilet paper, or dripping into toilet
dark blood/mixed blood with stool = pathology in rectum or more proximal
How should a digital rectal exam be performed?
feel coccyx, then levator ani muscle, feel sacral hollow, prostate in male or tip of cervix in female
always palpate sphincteric mechanism
What is anoscopy?
short scope looks at distal rectum and anal canal
essential for defining hemorrhoids
What is proctoscopy?
inspects rectum up to recto-sigmoid junction
can visualize and biopsy
economical
What is fiber-optic endoscopy?
asses distal colon, or entire colon
= flexoid sigmoidoscopy
What is a barium enema?
gives good outline of bowel
might miss polyps, biopsy and intervention not possible
What is virtual colonoscopy?
reconstruction of colon structure using CT and computer 3D modeling
similar accuracy to colonoscopy but not invasive
but cannot biopsy or intervene
What are the possible complications of diverticulosis?
diverticulitis - neck becomes obstructed and perfs
abscess - drain
peritonitis from perf - surgery!
fistula - most often to bladder - surgery!
What is the clinical presentation of diverticulitis?
LLQ pain, fever, constipation or diarrhea
What separates internal and external hemorrhoids?
the dentate line
