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Polyps
- An abnormal growth of soft tissue projecting from a mucous membrane
- They may be flat, sessile or pedunculated
- 95% of adenocarcinoma of the colon are thought to come from polyps
Clinical Presentation
- Surveillance
- According to the American Cancer society all patients of average risk should begin screening at age 45 with
- Fecal occult blood test every year
- One of the following
- Colonoscopy every 10 years
- CT colonography (virtual colonoscopy) every 5 years
- Flexible sigmoidoscopy (FSIG) every 5 year
- According to the American Cancer society all patients of average risk should begin screening at age 45 with
- Bright red blood per rectum
Lab & Studies
- CT colonography (virtual colonoscopy) every 5 years
- Flexible sigmoidoscopy (FSIG) every 5 years
- Colonoscopy
Treatment
- Resection at the time of colonoscopy
- Surgical resection for lesions > 2-3 cm
- Patients with a history of polypectomy should have more frequent follow up, but the exact recommendation is unclear.
Neoplasms
Risk Factors
- History of colon polyps
- History of Crohn’s disease or ulcerative colitis
- Increasing age
- Family history of colorectal cancer
- African Americans are at an increased risk compared with caucasian
Clinical Presentation
- If the lesion is found on the right side
- Iron deficiency anemia
- Fatigue
- If the lesion is found on the left side
- Abdominal pain
- Constipation
- Diarrhea
- Bloody stool
- If lesion is found in the rectum
- Tenesmus – feeling that you need to pass stool when your bowels are empty
- Hematochezia – passing of blood in the stool
Labs, Studies & Physical Exam Findings
- Usually normal physical exam
- CBC
- Iron panel
- Fecal occult blood test
- Carcinoembryonic antigen (CEA) – Not for screening, but for monitoring
- Barium enema
- CT/MRI
- Colonoscopy is the gold standard
Treatment
- Adjuvant chemotherapy
- Radiation
- Surgical resection
Constipation
- More common in women
- More common in people with psychosocial disorders
Clinical Presentation
- Less than two bowel movements per week
- Excessive straining
- Need for digital manipulation
- Decreased appetite
- Abdominal pain
- Bloating
Labs, Studies and Physical Exam Findings
- You may be able to palpate stool in the LLQ
- CBC
- BMP
- Thyroid panel
- Fecal occult blood
- Colonoscopy
- Barium enema
Treatment
- Fiber supplements
- Mineral oil
- Osmotic or stimulant laxatives
- Digital disimpaction
- Enema
Fecal impaction
- A solid mass of fecal material secondary to chronic constipation
Clinical Presentation
- Chronic constipation
- Overflow diarrhea – liquid stool leaks around the solid mass from higher in the bowel
Treatment
- Laxatives
- Water or oil enema
- Manual disimpaction
- Prevention of a second occurrence
- Increase in fiber
- Increase fluids
- Daily exercise
- Regular bowel habits
- Avoid opiates
Anal Fissures
- Ulcers near the rectum
- Very painful
- Most commonly found in the posterior midline
- If found off the midline it may be indicative of Crohn’s, TB, Syphilis or Cancer
Clinical Presentation
- Extreme pain especially during a bowel movement
- Bright red blood in the stool
Labs, Studies and Physical Exam Findings
- Visualization of the ulcers on physical exam
Treatment
- Increase in fiber
- Stool softeners
- Sitz baths
- Topical nitroglycerin
- Botox injection into the anal sphincter
- Sphincterotomy
Rectal Abscess and Fistula
- An abscess forms when a gland gets blocked
- A fistula is the tract that forms from the abscessed anal gland to the skin
Clinical Presentation
- PAIN
- Purulent discharge from fistula
Labs, Studies and Physical Exam Findings
- Tender, red, swollen area
- The opening of the fistula may be seen on physical exam
- A fistula probe may be used to explore the fistula
Treatment
- Surgical drainage of fistula
- Surgical repair of the fistula
Hemorrhoids
- Internal or external rectal veins which normally act as a cushion to help control stool but can become inflamed, enlarged or prolapsed.
- The dentate line divides internal from external
Clinical Presentation
- #1 Cause of bright red blood per rectum
- A protrusion from the anus
- Pain – especially if thrombosed though normally internal hemorrhoids are painless
Labs, Studies and Physical Exam Findings
- Often visible on physical exam
- Anoscopy
Treatment
- High fiber diet
- Increase in fluids
- Sitz bath
- Grade I-III (Hemorrhoids may be manually reduced)
- Sclerotherapy
- Rubber band ligation
- Electrocoagulation
- Grade IV (Can not be manually reduced) or thrombosed
- Surgical excision