The Colon - Week 10 Flashcards
What are common non-GI diseases that include constipation as a symptom?
- Neurogenic
> Not going when need to
> Stress
> Emotions (grief, terror)
> Spinal cord lesions (MS, meningitis, tabes dorsalis)
> Peripheral nerve lesions (diabetic neuropathy, Hirschsprung’s)
> Acquired megacolon (Chagas’ disease)
> Drugs (opiates, atropine)
> Low back pain (often made worse by straining) - Muscular
> Atony secondary to laxative abuse
> Hypothyroidism
> Pregnancy
> Emphysema
> Electrolyte imbalances - Mechanical
> Mass (neoplasm, inflammatory lesions [diverticular abscess], hemorrhoids, fissures
> Acute obstruction (strangulated hernia, volvulus, intussusception)
- Metabolic disorders
> Hypothyroidism
> DM2
- Neurological disorders
- Mechanical obstruction
> Masses
> Tumors
- Medications
- Anorectal disorders
> Prolapse
- Dietary lifestyle
> Low fiber
- Iatrogenic
> Prior surgery
What are the limitations of cathartic herbs in the treatment of constipation?
- Should not be used for more than 10 days
- Could become dependent on them
- Could aggravate constipation
- Could cause an electrolyte imbalance
- C/I in pregnancy
> May provoke uterine contractions - C/I in lactation
> Triggers laxation in breast-feeding infants
Why would we be concerned with sudden onset constipation?
- Could indicate more significant pathology
> Anorectal disorders
> Diverticular disease
> Colon cancer (biggest concern)
Why does the Western (SAD) diet often result in constipation?
- Very low in fiber
What role does ignoring stool urge have on constipation?
- Repeatedly ignoring the need to defecate leads to a loss of bowel movement reflex
What are the homeopathic remedies for constipation?
- Aesculus
- Aloe
- Alumen
- Alumina
- Bryonia
- Calcarea carbonica
- Causticum
- Graphites
- Lachesis
- Lycopodium
- Magnesia muriaticum
- Natrum muriaticum
- Nux vomica
- Opium
- Phosphorus
- Platina
- Plumbum metallicum
- Silicea
- Sulphur
- Veratrum album
How do BUN levels change when secondary to colon bleeding?
- May be elevated to 30-50 mg/dL
- BUN:Creatinine ratio greater than 36:1 likely represents blood loss from an upper GI source
What is the DDx for colorectal bleeding?
- Angiodysplasia (AV malformation)
- Carcinoma
- Colonic diverticula
- Ischemic diverticula
- Trauma
- Anal fissure
- Colitis (UC, Crohn’s, infective hemorrhoids)
- Meckel’s diverticulum
- Radiation proctitis
- Polyps
Which imaging is the best for diverticulitis?
- Abdominal CT
What are the key dietary principles for prevention of diverticulosis?
- Diet rich in fruits, vegetables, legumes, and nuts
- Avoid seeds
- Whole grains in moderation
- Overall fiber goal of 50g or more daily non-grain based
- Decrease grain-fed meats and processed foods
- Increase exercise and water (64 oz daily)
- Increase omega 3 EFA intake
- Elimination diet/food sensitivity testing
What therapies are available for acute diverticulitis?
- Bowel rest
- IV antibiotics
- Merperidine better than morphine
- Abdominal castor oil pack (with heat) for 60 minutes TID
- Probiotics 50-100 billion qd
- Water fasting
- Acute Diverticulitis Formula (Yarnell)
What are the treatment protocols for diverticulosis?
- Increased fruits, vegetables, legumes, and nuts
- Whole grains in moderation
- Overall fiber goal of 50g or more daily non-grain based
- Decrease grain-fed meats and processed foods
- Increase exercise and water (64 oz daily)
- Increase omega 3 EFA intake
- Elimination diet/food sensitivity testing
- Spasmolytic herbs
What are the treatment protocols for diverticulitis?
Mild
- Rest
- Liquid diet
- Oral antibiotics
- Soft, low-fiber diet and daily psyllium
Severe
- Should be admitted to hospital
- IV fluids and antibiotics
- Bed rest
- Nothing by mouth until symptoms subside
What herbal remedies are available for colorectal cancers?
- Avena sativa
- Baptisia tinctifora
- Berberis aquifolium
- Conium maculatum
- Echinacea spp.
- Gentiana lutea
- Larrea divaricata
- Phytolacca decandra
- Rumex crispus
- Taraxacum officinale
- Trifolium pratense
- Viola odorata
- Viscum album
- Hoxsey-like formulas
What are the recommendations for the colorectal screening schedule?
Tests that detect cancer and precancerous polyps
- Flexible sigmoidoscopy (FSIG) every 5 years, or
- Colonoscopy every 10 years, or
- Double contrast barium enema (DCBE) every 5 years, or
- CT colonography (CTC) every 5 years
Tests that primarily detect cancer
- Annual guaiac-based fecal occult blood test with high test sensitivity for caner, or
- Annual fecal immunochemical test with high sensitivity for cancer, or
- Stool DNA tests, with high sensitivity for cancer, interval uncertain
- All positive screening exams should be followed up with colonoscopy
- Exams that are designed to detect both early cancer and precancerous polyps should be encouraged
