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