Colorectal disorders

Question 1

Ulcerative collitis- Sx

Answer 1

• Rectal bleeding, bloody diarrhea
• Bright red blood
• Tenesmus
• Abd cramping
• Fever & sweats
• Friability, erosion, pseudopolyps

Question 2

Ulcerative collitis- Eti

Answer 2

• Inflammation of colon only
• Idiopathic
• Periods of symptomatic flare ups
• Nonsmokers
• Appendectomy before 20 increased risk

Question 3

Chrons disease- Eti

Answer 3

• Any portion of GI tract- mouth to anus
• Anus may be spared
• Smokers
• 40% ilium + colon
• Terminal ilium most commonly involved

Question 4

Chrons disease- Sx

Answer 4

• Diarrhea
• ABd pain & RLQ tenderness or mass
• Wt. loss
• Fever & night sweats
• Iron deficiency anemia
• Obstructive symptoms- N/V postprandial pain
• Fistulations
• Arthralgials, pyoderma, erythema nodosum, gallstones

Question 5

Chrons disease- Dx

Answer 5

• Biopsy/ pathology report
• CT scan- evaluation of small bowel
• Stool studies
  Endoscopy: Normal mucosa next to abnormal:
• Stellate ulcer
• Skip lesion
• Cobblestoning
• Deep linear ulcers

Question 6

Irritable Bowel Syndrome- Eti

Answer 6

• Late teens- 20s
• W>M
• Common functional bowel disorder
• Idiopatic

Question 7

Irritable Bowel Syndrome- Sx

Answer 7

• Sx > 3 months
• Subjective distension
• Abd pain, intermittent, crampy, relieved by deification
• Alternating constipation & diarrhea
• Normal phys exam

Question 8

Irritable Bowel Syndrome- Dx

Answer 8

• Dx of exclusion- rule out cancer, celiac, parasite, etc

Question 9

Irritable Bowel Syndrome- Tx

Answer 9

• Antispasmodics or antidiarrheals
• Fiber
• Antidepressants

Question 10

Ulcerative colitis- Dx

Answer 10

• Sigmoidoscopy

- Abd radiograph for toxic megacolon

Question 11

Ulcerative colitis- Tx

Answer 11

• Biologics
• Corticosteroids
• Antibiotics

Question 12

Toxic megacolon- Eti

Answer 12

Complication of UC in <2% of patients

Question 13

Toxic megacolon- Sx

Answer 13

Colonic dilations > 6cm with signs of toxicity

Question 14

Toxic megacolon- Dx

Answer 14

Abd radiograph

Question 15

Toxic megacolon- Tx

Answer 15

Broad spectrum abx

Question 16

Diverticulosis- Eti

Answer 16

• Increased in western societies & age

- Diet, marfan, scleroderma

Question 17

Diverticulosis- Sx

Answer 17

• Normal physical exam

- Nonspecific complaints- constipation, abd pain, fluctuating bowel habits

Question 18

Diverticulosis- Dx

Answer 18

• Barium enema & CT imaging

Question 19

Diverticulosis- Tx

Answer 19

High fiber diet & fiber supplements

Question 20

Diverticulitis- Eti

Answer 20

• 25% pts > 40
• Increases with age
• 10-20% patient with diverticulosis

Question 21

Diverticulitis- Sx

Answer 21

• LLQ aching abd pain
• Constipation or diarrhea
• low grade fever
• LLQ mass
• N/V

Question 22

Diverticulitis- Dx

Answer 22

• CT abd scan

- Colonoscopy contraindicated

Question 23

Diverticulitis- Tx

Answer 23

• Clear liquid diet

- Broad spectrum abx

Question 24

Colorectal cancer- Eti

Answer 24

• 2nd leading cause of death due to malignancy
• 6% americans- 40% die
• Personal/ fam hx
• Most adenocarcinoma
• Increased risk with age, blacks, red meat, IBD

Question 25

Colorectal cancer- Sx

Answer 25

- Iron deficiency anemia - fatigue - abd pain - obstructive symptoms - Alternating constipation & diarrhea

Question 26

Colorectal cancer- Dx

Answer 26

- Colonoscopy | - Staging- TNM

Question 27

Colorectal cancer- Tx

Answer 27

- Stage II-III: Chemo | - Stage IV: Chemo, biologics, surgical excision

Question 28

Polyps- Eti

Answer 28

- Cause of 95% of adenocarcinoma | - Present in 30% adults > 50

Question 29

Polyps- Sx

Answer 29

- Occult blood loss & anemia - Ulceration -> hematochezia - Asymptomatic

Question 30

Polyps- Dx

Answer 30

- Colonoscopy & biopsy | - FIT test

Question 31

Polyps- Tx

Answer 31

- Polypectomy

Question 32

Polyposis- Eti

Answer 32

- Inherited condition - 1:10,000 - Develop at 15, CA by 40 - Colorectal CA inevitable by 50

Question 33

Polyposis- Sx

Answer 33

- Fam hx | - + genetic testing

Question 34

Polyposis- Dx

Answer 34

- Genetic counseling/ testing | - endoscopy every 1-3 years

Question 35

Polyposis- Tx

Answer 35

- Cox 2 inhibitors reduce number/ some - Surgery - Frequent sigmoidoscopy