Latest - (Latest / 1. A 45 year old female presents wit...

Colorectal disorders (PEARLS) Smarty PANCE (Latest /

• A 45 year old female presents with painful defecation, pruritus of the anus and occasional

blood. What is your diagnosis?

Answer: Internal hemorrhoids

• Significant *rectal pain, and pruritus but no bleeding*. Affects the lower 1/3 of anus (below

dentate line)

Answer: External hemorrhoids

• A 55-year-old patient with *rectal bleeding and tenesmus* (a feeling of incomplete

emptying after a bowel movement). What must you consider?

Answer: - Anorectal cancer

Whenever rectal bleeding occurs, even in patients with obvious hemorrhoids or known diverticular disease, coexisting cancer must be ruled out

• *Tearing rectal pain and bleeding* which occurs with or shortly after defecation, bright red

blood on toilet paper

Answer: Anal fissure

• What type of hemorrhoids are usually painless?

Answer: Internal hemorrhoids

• Treatment for fecal impaction?

Answer: Digital rectal /manual disimpaction - Diet with fiber stool softeners/laxatives for prevention

• What is the recommended treatment for a perianal cyst?

Answer: Surgical drainage

• Rectal mass rectal bleeding and tenesmus?

Answer: Rectal cancer (solitary tenesmus may occur with anal inflammation)

• The definition of constipation is less than how many bowel movements per week?

Answer: *less than 3* bowel movements per week

• *LLQ pain*, tenderness, abdominal distention, *fever* and *leukocytosis* in older

patients

Answer: Diverticulitis

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• Describe diverticulitis

Answer: Infection or perforation of a diverticulum

• What is diverticulosis?

Answer: Condition in which diverticula can be found within the colon, especially the sigmoid; diverticula are actually false diverticula in that only mucosa and submucosa herniate through the bowel musculature; true diverticula involve all layers of the bowel wall and are rare in the colon

• Describe the pathophysiology of diverticulosis?

Answer: Weakness in the bowel wall develops at points where nutrient blood vessels enter between antimesenteric and mesenteric taeniae; increased intraluminal pressures then cause herniation through these areas

• What is the pathophysiology of diverticulitis?

Answer: Obstruction of diverticulum by a fecalith leading to inflammation and

microperforation

• What are the signs/ symptoms diverticulitis?

Answer: LLQ pain (cramping or steady), change in bowel habits (diarrhea), fever, chills, anorexia, LLQ mass, nausea/vomiting, dysuria

• What are the associated lab findings of diverticulitis?

Answer: Increased WBCs

• What are the associated radiographic findings of diverticulitis?

Answer: On x-ray: ileus, partially obstructed colon, air-fluid levels, free air if perforated On abdominal/pelvic CT scan: swollen, edematous bowel wall; particularly helpful in diagnosing an abscess

• What are the associated barium enema findings of diverticulitis?

Answer: Barium enema should be avoided in acute cases

• Is colonoscopy safe in an acute setting of diverticulitis?

Answer: No, there is in- creased risk of perforation

• What are the possible complications of diverticulitis?

Answer: Abscess, diffuse peritonitis, fistula, obstruction, perforation, stricture

• What is the most common fistula with diverticulitis?

Answer: Colovesical fistula (to bladder)

• What is the best test for diverticulitis?

Answer: CT scan

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