Colon - everything in b/w

Colonoscopy

Exam Procedure 

1) Exam Prep “Bowel Prep” - patient drinks laxative 

2) Sedation - patient feels “twilight anesthesia”

3) Insert colonoscope

4) Evaluate and Treatment 

5) Recovery

Common Indications

- screening for colon cancer (starts @ 45 yrs)

- investigates for anemia, rectal bleeding 

CTC

Exam Procedure 

1) Bowel Prep

2) Colon inflation - catheter inserted- colon inflated w/CO2 

3) CT - supine and prone scan 

4) Image reconstruction

Appendicitis

Etiology

-luminal obstruction - appendiceal lumen blocked, pressure 

 builds, bacteria overgrowth, wall ischemic and inflamed

Clinical Manifestations

-pain migrates from periumbilical region-> RLQ worsened by cough/movement 

- anorexia

- tenderness @ McBurney's Point 

Treatment

- laparoscopic appendectomy

Diverticulosis

Risk Factors 

-low-fiber and high red meat intake, obesity 

Clinical Manifestations

-bloating, bowel changes 

Complications

-diverticulitis, diverticular bleeding, common cause of GI bleeding in older adults

Diverticulitis

Clinical Manifestation

- LLQ abdominal pain (common), leukocytosis

- painless hematochezia - diverticular bleeding 

Classification/Severity 

- uncomplicated: localized inflammation w/out abscess, 

  perforation, fistula, obstruction - outpatient 

- complicated: one or more of following: abscess, free air,

  peritonitis etc. - inpatient/hospitalization

Treatment

- abscess >3 cm managed w/ percutaneous drainage 

Management

-colonoscopy after acute diverticulitis episode - colonoscopy
performed 6-8 weeks after full resolution

Ulcerative Colitis (UC)

Etiology

-genetic, environmental, immune

Clinical Manifestations

- bloody diarrhea            - arthritis, eye and liver inflammation

-Tenesmus (feeling of incomplete excavation)

Treatment 

- therapies to reduce remission

Prognosis and Complications

-chronic and incurable

-increases colorectal cancer risk

Crohn Colitis

Clinical Manifestations

- abdominal pain, malnutrition, fever/fatigue, perianal disease

Ischemic Colitis (IC)

Etiology

- occlusion

- non-occlusive hypoperfusion (more common) -hypotension

Risk Factors

-atherosclerosis

-atrial fibrillation 

Clinical Manifestations

- develop within hours of hypoperfusion event 

- crampy abdominal pain (often left-sided)

- urgent desire to defecate

- severe disease - sepsis and shock 

Treatment/Management 

- mild-moderate disease :bowel rest, IV fluids 

- severe: colectomy

Irritable Bowel Syndrome (IBS)

Etiology 

-altered gut-brain axis regulation - disorder of gut-brain interaction (DGBI)

-hypersensitivity, abnormal GI motility, post-infectious IBS

Clinical Manifestations

- fluctuates in intensity (flares and remissions)

-abdominal pain/discomfort - improves w/ defecation 

-diarrhea, constipation, both 

Colorectal Cancer

Risk Factors

- non-modifiable: age>50

-modifiable: low fiber, high in red/processed meat 

Clinical Manifestations

- early stage = no symptoms

-blood in stool, iron deficiency anemia

-right sided cancer: causes anemia

-left sided cancer: causes bowel obstruction

Diagnosis

-Colonoscopy (gold standard)

-lab tests: carcinoembryonic antigen (CEA) 

Screening/Prevention

- helps detects polyps early 

-colonoscopy every 10 yrs (start @ age 45)

- fecal immunochemical test (FIT)

-stool DNA testing

Large Bowel Obstructions (LBO)

Etiology

- colorectal cancer (most common cause in adults)

- volvulus, diverticular disease 

Clinical Manifestations

-abdominal distension (prominent feature)

-constipation/obstipation

- tympanic abdomen

Volvulus of the Colon

Clinical Manifestations

- abdominal distension, obstipation, tympanic abdomen

Complications

- bowel ischemia, recurrence (if sigmoid not surgically fixed)

Treatment

- sigmoid volvulus: endoscopic decompression (flexible
  sigmoidoscopy)

-cecal volvulus - right hemicolectomy

-ischemia/perforation - emergency laparotomy

Hemorrhoids

Risk Factors

-chronic constipation/straining      -low fiber diet

-prolonged sitting                             -aging 

Clinical Manifestations

- bright red rectal bleeding (on toilet paper/coating stool)

- mucus discharge 

- pruritus (itching)

Treatment - sitz bath or rubber band ligation (RBL) at doctors 

office (non-surgical)