CM- Colorectal Disease Flashcards
What are the 4 chief complaints/symptoms patients present with regarding colorectal area?
- Pain
- Bleeding
- Constipation
- diarrhea
What is the prognostic difference between pain with stool and a bowel movement vs. pain not associated with stool or a bowel movement?
Pain with a bowel movement - a problem that can easily be found on exam
Pain w/o = a more complicated pattern of occurrences that might not be visible on inspection.
How can you tell when bleeding occurs at the anus vs. more proximally?
The closer to the anus, the brighter red the blood will be.
Outlet anal pathology = bright red coating stool, on toilet paper or dripping into the toilet
Rectum or colon = dark blood and/or blood mixed in stool
What 3 things describe constipation?
- infrequent bowel movement
- hard stool
- excessive straining
What is tenesmus?
the feeling of rectal fullness and an impending urge to defecate.
common feeling in persons that have had diarrhea
What is the very first step of the rectal examination?
- inspect the abdomen for presence/absence of distension
What position should the patient be in for the rectal exam?
Left lateral with knees brought up to chest as much as possible.
Describe the steps of the rectal examination.
- Inspection- look for abdominal distension AND part the butt cheeks to inspect:
- gluteal folds
- anus/perinanal skin
- perineum - Make note of external draining sites and spread them to reveal anal fissure
- Palpate perinanal skin including superficial sphincter at the verge which can disclose tunnel of induration leading to external draining site
Describe the steps of the DRE.
- Lubricate your finger
- Pressure on the posterior anus allows the finger to go into the canal
- Once the finger is above levator ani, start posteriorly and feel the coccyx
- Feel the sacral hollow and the soft mucosa over the sacrum
- Turn finger anteriorly and feel for prostate or cervical tip
- Palpate sphincteric mechanism in anal canal between finger and thumb for lumps, indurations, defects
- Use stool on exam finger for guaiac test for the presence of blood in stool
Where are the pain fibers located in the rectum?
Distal to the dentate line so the DRE should be relatively gentle
What is anoscopy? What are the pros and cons?
The use of a short scope to look at the very distal rectum and anal canal.
Pro: essential for defining hemorrhoids
Con: none of the colon is visualized
What is proctoscopy?
What parts of the GI tract are visualized?
What are the pros and cons?
It is a 25cm tube with a light and eye piece to see the rectum up to the rectosigmoid junction.
Pro: excellent visualization, can biopsy, economic in terms of time/equipment
Con: usually only goes up to peritoneal reflection
What parts of the GI tract are visualized by fiberoptic sigmoidoscopy and colonoscopy?
What are pros and cons to each approach?
Flexible fiberoptic sigmoidoscopy - assesses descending colon down to the rectum
Pro: economic and cost saving with barium enema
Con: if a polyp is found, you have to do a colonoscopy anyway
Colonoscopy- assesses the entire colon
Pro: preferred method bc it views the whole colon
Con: expensive, risks of complications, needs extensive patient prep
What are the pros and cons of the barium enema?
Pros: cost effective, fine outline of bowel and mucosa
Con: miss 8-12% of polyps, can’t biopsy or do therapeutic intervention
What is virtual colonoscopy?
What are pros/cons?
reconstruction of details of the colon by using CT images.
Pros: non-invasive
Cons: can’t biopsy or do therapeutic intervention
