> For the complete documentation index, see [llms.txt](https://thisispiggy.gitbook.io/my-wiki/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://thisispiggy.gitbook.io/my-wiki/02-step-2/surgery/02-colorectal.md).

# 02 Colorectal

## Colon Cancer

* screening
  * asx screen
  * postmenopausal man with iron deficiency anemia
  * change in caliber of stool, alternate constipation/diarrhea, weight loss
* diagnosis: colonoscopy
  * Cancer: CT scan to stage, radiation, chemo (Folfox)
    * FAP: thousands of polyps. Prophylactic colectomy
  * 1 polyp
    * pedunculated good. Tubular
    * sessile bad. Villous
    * few polyps, benign: 5 yrs screen
    * premalignant, CIS: 3 yrs screen
    * dysplastic, a lot: 1 yr screen
  * nothing: screening every 10 years

## IBD

### UC

* path: superficial mucosa
* pt: bloody bowel, rectal pain, weight loss
* diagnosis: colonoscopy, continuous inflammation, no skip lesions
* treatment: medically until 8 yrs after diagnosis (colon cancer screen every year), see surgery, prophylactic colectomy. Cured

### Crohn's

* path: Transmural, connect to others and cause fistula
* pt: fistula, fecal soiling (stool coming out other places)
* diagnosis: fistula
* treatment: fistulotomy. Can't use surgery

## Hemorrhoids

* path: internal/external
* symptoms
  * internal: bleed, no pain
  * external: hurt/itch, no bleed
* diagnosis: visual inspection for external. Anoscopy for internal. Don't need flex sig or colonoscopy
* treatment: 
  * sitz bath, preparation H
  * banding internal hemorrhoids. Resect external hemorrhoids. Can leave with scar

## Anal Fissure

* path: tight sphincter
* pt: pain on defecation, lasts for hours, get constipated and then hurts
* diagnosis: see
* treatment: nitroglycerin paste, sitz bath, lateral internal sphincteromy

## Anal Cancer

* path: HPV = SCC
* pt: anoreceptive sex, men, STD
* diagnosis: anal pap, biopsy
* treatment: have to use chemo/radiation. Can't resect. Nigro protocol

## Pilonydal Cyst

* path: not sure. Abscessed hair follicle
* pt: congenital disease, hairy butt
* diagnosis: clinical
* treatment: IND, OR resection