Clinical Approach - Colorectal Dz

Question 1

How can you tell when a pt w rectal bleeding has pathology located more proximal to the anus?

Answer 1

problem in anus = bright red blood coating stool, on toilet paper, or dripping into toilet
dark blood/mixed blood with stool = pathology in rectum or more proximal

Question 2

How should a digital rectal exam be performed?

Answer 2

feel coccyx, then levator ani muscle, feel sacral hollow, prostate in male or tip of cervix in female
always palpate sphincteric mechanism

Question 3

What is anoscopy?

Answer 3

short scope looks at distal rectum and anal canal

essential for defining hemorrhoids

Question 4

What is proctoscopy?

Answer 4

inspects rectum up to recto-sigmoid junction
can visualize and biopsy
economical

Question 5

What is fiber-optic endoscopy?

Answer 5

asses distal colon, or entire colon

= flexoid sigmoidoscopy

Question 6

What is a barium enema?

Answer 6

gives good outline of bowel

might miss polyps, biopsy and intervention not possible

Question 7

What is virtual colonoscopy?

Answer 7

reconstruction of colon structure using CT and computer 3D modeling
similar accuracy to colonoscopy but not invasive
but cannot biopsy or intervene

Question 8

What are the possible complications of diverticulosis?

Answer 8

diverticulitis - neck becomes obstructed and perfs
abscess - drain
peritonitis from perf - surgery!
fistula - most often to bladder - surgery!

Question 9

What is the clinical presentation of diverticulitis?

Answer 9

LLQ pain, fever, constipation or diarrhea

Question 10

What separates internal and external hemorrhoids?

Answer 10

the dentate line