Polyps
Are neoplastic, hamartomas, or inflammatory
Neoplastic polyps are MC adenomatous
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Adenomas can be classified as:
Surgical Conditions of the Large Intestine - USMLE Step 2 CK Exam
Tubular (these accept the aboriginal abeyant for malignancy)
Tubulovillous
Villous (these accept the accomplished accident of malignancy)
Signs and Symptoms:
MC presents with alternate belly bleeding
Diagnosis:
Colonoscopy or sigmoidoscopy
Treatment:
Polypectomy
General Information:
Up to bisected of the citizenry has diverticula
The accident increases afterwards 50yr of age
Only 1/10 bodies are appropriate back diverticula are present
A TRUE diverticula is rare, and includes abounding Bowel bank herniation
A apocryphal diverticula is best common, and involves alone a breach of the mucosa
The MCC is a low-fiber diet which causes an added civil burden (this is hypothesis)
Diverticulosis
This is the attendance of assorted apocryphal diverticula
Signs and Symptoms:
Most bodies are asymptomatic, with diverticula begin alone on colonoscopy or added beheld procedures
May accept alternate bouts of LLQ belly pain
Changes in Bowel habits is common
Rarely, accommodating may present with lower GI hemorrhage
Diagnosis:
Colonoscopy
Barium bang can additionally be acclimated for diagnosis
Treatment:
If accommodating is asymptomatic, the alone analysis should be to access cilia and abatement fat in the diet
If accommodating has GI hemorrhage, circulatory analysis is acceptable (IV fluids, aliment of hemodynamic stability)
Diverticulitis
Inflammation of the diverticula due to infection
There are abounding accessible complications, such as abscess, addendum into added tissues, or peritonitis
Signs and Symptoms:
LLQ pain
Constipation OR diarrhea
Bleeding
Fever
Anorexia
Diagnosis:
CT demonstrating edema of the ample intestine
DO NOT accomplish a colonoscopy or barium bang in an astute case, this ability aggravate the problem
Complications:
Perforation
Abscesses
Fistula formation
Obstructions
Treatment:
If there is an abscess, percutaneous arising is required
Most patients are managed able-bodied with fluids and antibiotics
For breach or obstruction, anaplasty is required
Obstruction of the ample Intestine
Most accepted armpit of colon obstruction is the arced colon
Common causes include:
Adhesions
Adenocarcinoma
Volvulus
Fecal impaction
Signs and Symptoms:
Nausea/vomiting
Abdominal affliction with cramps
Abdominal distention
Diagnosis:
XRAY - bold a beefy adjacent colon, air-fluid levels, and an absence of gas in the rectum
Treatment:
If there is astringent pain, sepsis, chargeless air, or signs of peritonitis there charge be an burning laparotomy
Laparotomy if cecal bore is >12cm
Volvulus
Twisting and circling of the ample intestine
Can account ischemia, gangrene, perforation
The MC armpit is the arced colon
Occurs best frequently in earlier patients
Signs and Symptoms:
High-pitched Bowel sounds
Distention
Tympany
Diagnosis:
XRAY - "kidney bean" actualization (ie. Dilated loops of Bowel with accident of haustra)
Barium bang bold a "bird's beak" actualization - credibility to the armpit of circling of the bowel
Treatment:
Sigmoidoscopy or colonoscopy acts as analysis and treatment
If this doesn't work, laparotomy is warranted
Cancer of the Colon
Colon blight is the 2nd MCC of blight deaths
Believed that a low-fiber, high-fat diet increases the risk
There are abounding abiogenetic factors that accord to colon cancer, such as Lynch affection and HNPCC
Lynch Syndrome:
LS 1 is an autosomal ascendant predisposition to colon blight that is usually right-sided
LS2 is the aforementioned as LS 1 with the accession of cancers alfresco the colon, such as in the endometrium, stomach, pancreas, baby bowel, and ovaries
Screening:
Screening should alpha at 40yr in bodies with no accident factors
If a ancestors affiliate has had blight of the colon, screening should alpha 10yr above-mentioned to back they were diagnosed (assuming this is beneath than 40yr)
Should accept annual stool abstruse tests
Colonoscopy every 10yr
And a sigmoidoscopy every 3-5yrs
Diagnosis:
Obtain preoperative CEA (allows you to chase the progression or recession of the disease)
Endoscopy + barium enema
Treatment:
Surgical resection + LN dissection
If ache is metastatic, add 5-FU to the post-operative regimen
Follow-up:
CEA levels every 3 months for 3 years
Perform a colonoscopy at 6 and 12 months, again annual for 5 years
If a ceremony is suspected, a CT should be performed
Surgical Conditions of the Large Intestine - USMLE Step 2 CK Exam
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