Colorectal disorders Flashcards
Ulcerative collitis- Sx
- Rectal bleeding, bloody diarrhea
- Bright red blood
- Tenesmus
- Abd cramping
- Fever & sweats
- Friability, erosion, pseudopolyps
Ulcerative collitis- Eti
- Inflammation of colon only
- Idiopathic
- Periods of symptomatic flare ups
- Nonsmokers
- Appendectomy before 20 increased risk
Chrons disease- Eti
- Any portion of GI tract- mouth to anus
- Anus may be spared
- Smokers
- 40% ilium + colon
- Terminal ilium most commonly involved
Chrons disease- Sx
- 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
Chrons disease- Dx
- 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
Irritable Bowel Syndrome- Eti
- Late teens- 20s
- W>M
- Common functional bowel disorder
- Idiopatic
Irritable Bowel Syndrome- Sx
- Sx > 3 months
- Subjective distension
- Abd pain, intermittent, crampy, relieved by deification
- Alternating constipation & diarrhea
- Normal phys exam
Irritable Bowel Syndrome- Dx
- Dx of exclusion- rule out cancer, celiac, parasite, etc
Irritable Bowel Syndrome- Tx
- Antispasmodics or antidiarrheals
- Fiber
- Antidepressants
Ulcerative colitis- Dx
- Sigmoidoscopy
- Abd radiograph for toxic megacolon
Ulcerative colitis- Tx
- Biologics
- Corticosteroids
- Antibiotics
Toxic megacolon- Eti
Complication of UC in <2% of patients
Toxic megacolon- Sx
Colonic dilations > 6cm with signs of toxicity
Toxic megacolon- Dx
Abd radiograph
Toxic megacolon- Tx
Broad spectrum abx
Diverticulosis- Eti
- Increased in western societies & age
- Diet, marfan, scleroderma
Diverticulosis- Sx
- Normal physical exam
- Nonspecific complaints- constipation, abd pain, fluctuating bowel habits
Diverticulosis- Dx
- Barium enema & CT imaging
Diverticulosis- Tx
High fiber diet & fiber supplements
Diverticulitis- Eti
- 25% pts > 40
- Increases with age
- 10-20% patient with diverticulosis
Diverticulitis- Sx
- LLQ aching abd pain
- Constipation or diarrhea
- low grade fever
- LLQ mass
- N/V
Diverticulitis- Dx
- CT abd scan
- Colonoscopy contraindicated
Diverticulitis- Tx
- Clear liquid diet
- Broad spectrum abx
Colorectal cancer- Eti
- 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
Colorectal cancer- Sx
- Iron deficiency anemia
- fatigue
- abd pain
- obstructive symptoms
- Alternating constipation & diarrhea
Colorectal cancer- Dx
- Colonoscopy
- Staging- TNM
Colorectal cancer- Tx
- Stage II-III: Chemo
- Stage IV: Chemo, biologics, surgical excision
Polyps- Eti
- Cause of 95% of adenocarcinoma
- Present in 30% adults > 50
Polyps- Sx
- Occult blood loss & anemia
- Ulceration -> hematochezia
- Asymptomatic
Polyps- Dx
- Colonoscopy & biopsy
- FIT test
Polyps- Tx
- Polypectomy
Polyposis- Eti
- Inherited condition
- 1:10,000
- Develop at 15, CA by 40
- Colorectal CA inevitable by 50
Polyposis- Sx
- Fam hx
- + genetic testing
Polyposis- Dx
- Genetic counseling/ testing
- endoscopy every 1-3 years
Polyposis- Tx
- Cox 2 inhibitors reduce number/ some
- Surgery
- Frequent sigmoidoscopy
