Colon Flashcards
(25 cards)
- What are common non-GI diseases that include constipation as a symptom?
a. Metabolic Disorders: Hypothyroidism, DM2
b. Neurological Disorders
c. Mechanical Obstruction (Masses, Tumors)
d. Medications
e. Anorectal Disorders (Prolapse, Hemorrhoids)
f. Iatrogenic (Prior Surgery)
- Limitations of cathartic herbs (aka cathartic botanical laxatives) in the treatment of constipation?
a. Cathartic herbs can promote further atony in the colon, but still useful for severe atonic constipation
b. Should not be used for more than 10 days
c. Consequence of Overuse:
i. Dependence/Aggravation of constipation
ii. Electrolyte imbalance
d. Cx in pregnancy
i. May provoke uterine contractions
e. Cx with Lactation
i. Triggers laxation in breast-feeding infants
- Why would we be concerned with sudden onset constipation?
a. Our biggest concern is Colon Cancer
b. But can also be a symptom of an anorectal disorder or diverticular disease
Anorectal D/o’s;
- Hemorrhoids,
- Tears,
- Fistulas,
- Abscesses that affect the anal region
- Why does the Western (S.A.D.) diet often result in constipation?
a. Doesn’t involve much fiber, such as bran, seeds, veggies, fruits: the recommended fiber per day is 24-38 g, while SAD provides 5-14 g (highly inadequate)
b. High in processed foods: pastries, white bread, white (refined) rice, white flour, pre-packed fiberless foods
c. Low in water intake
d. High on animal products and hydrogenated fats: pizza, potato chips, whole milk, fatty meats, cheese, ice cream
e. High concentration of sugar
f. Low in antioxidant content
g. Includes overeating and frequent snacking
h. Contains indigestible additives and hard-to-digest refined compounds
i. High in gluten content
j. SAD is seriously deficient in vitamin and minerals
- What role does ignoring stool urge have on constipation?
It only aggravates it further
- Know the homeopathic remedies for constipation
a. Aesculus:
b. Aloe:
c. Alumen:
d. Alumina:
e. Bryonia:
f. Calcarea carbonica:
g. Causticum:
h. Graphites:
i. Lachesis:
j. Lycopodium:
k. Magnesia muriaticum:
- Bleeding from Colon PDF: Review the changes to BUN levels secondary to colon bleeding.
a. With upper GI blood loss blood urea nitrogen levels may be elevated to 30-50 mg/dL.
b. BUN:Creatinine ratio greater than 36:1 likely represents blood loss from an upper GI source.
- DDX for colorectal bleeding (Lower GI bleeding)
From Uptodate:
a. Anatomic (diverticulosis)
b. Vascular (angiodysplasia, ischemic, radiation-induced)
c. Inflammatory (inflammatory bowel disease, infectious)
d. Neoplastic
e. In a review of several large studies that included 1559 patients with acute hematochezia, the following bleeding sources were identified [10]:
i. Diverticulosis – 5 to 42 percent
ii. Ischemia – 6 to 18 percent
iii. Anorectal (hemorrhoids, anal fissures, rectal ulcers) – 6 to 16 percent
iv. Neoplasia (polyps and cancers) – 3 to 11 percent
v. Angiodysplasia – 0 to 3 percent
vi. Postpolypectomy – 0 to 13 percent
vii. Inflammatory bowel disease – 2 to 4 percent
viii. Radiation colitis – 1 to 3 percent
ix. Other colitis (infectious, antibiotic associated, colitis of unclear etiology) – 3 to 29 percent
x. Small bowel/upper GI bleed – 3 to 13 percent
xi. Other causes – 1 to 9 percent
xii. Unknown cause – 6 to 23 percent
- Know which imaging is the best in diverticulitis
a. 1. Abdominal radiographs
i. May indicate
ii. A displaced colon
iii. Extraluminal gas
iv. Colonic mucosal abnormalities
v. More helpful in excluding other potential causes of left lower quadrant pain.
b. 2. Abdominal CT: replacing a lot of earlier approaches
i. Test of choice
ii. May demonstrate
1. Bowel wall thickening
2. Abscess formation
3. Diverticula
c. 3. Diagnostic barium enema
i. Safe when carefully performed
ii. Findings include
1. Spiculation of the mucosa
2. Spasm
3. Frank perforation
4. Abscess
5. Findings specific for diverticulitis, may be hard to distinguish from carcinoma
iii. CT and barium enema are complementary
iv. Neither is 100% sensitive or specific.
d. 4. Endoscopic examination
i. Contraindicated with diverticulitis (be cautious around acute attacks)
ii. Theoretical potential to exacerbate perforation
iii. Can detect diverticulosis before or between attacks
- Understand key dietary principles in diverticulosis prevention
a. Diverticulosis Prevention
i. Also for Asymptomatic diverticulosis
ii. Diet rich in fruits, vegetables, legumes, nuts. Avoid seeds
iii. Whole grains in moderation
iv. Overall fiber goal: 50 g+ daily non-grain based fiber
v. Decrease grain-fed meats and processed foods
vi. Increase Exercise & water (64 oz daily)
vii. Increase Omega 3 EFA intake
viii. Elimination diet/food sensitivity testing
ix. Spasmolytic herbs (See herbal therapies)
b. Eating principles:
i. » acute (diverticulitis):
1. Increase fluids
2. Short fruit or vegetable juice fast progressing to soft semisolid foods: mashed sweet potatoes or yams, steamed carrots, squash, bananas, melons, apricots
3. Progress to grated raw vegetables as tolerated, then add cooked grains, well-chewed, and soft protein such as tofu, fish
ii. » chronic:
1. Elimination/rotation diet, rotation diet, rotation diet expanded
2. High fiber, high complex carbohydrate, unrefined diet
3. To protect against diverticulosis: increase cellulose and hemicellulose fiber
c. Consume foods rich in vitamin A, Vitamin B-complex foods, acidophilus
d. Avoid:
i. food intolerances
ii. meat, alcohol, hot sauces, spicy foods, fried foods, fatty foods, rich foods, salty foods, coffee, caffeine, sweet foods and sugar
- Know acute diverticulitis therapies
a. General Supplemental Protocol
i. Ground flaxseed 2 Tbsp qd
ii. Vitamin B-complex 50-100 mg qd
iii. Folic acid 1 mg qd
iv. Vitamin C 1 g qd
v. Probiotics (take at end of meals)
vi. 5 billion or more
vii. Vitamin E 800 I.U. qd
- Treatment protocols for diverticulosis/diverticulitis
a. Acute Diverticulitis Tx
i. Note: Signs of internal bleeding or acute abdomen require immediate hospitalization. Otherwise:
ii. Abdominal castor oil pack (with heat) for 60 minutes TID
iii. Probiotics 50-100 billion live organism QD
iv. Water fasting
v. Acute Diverticulitis Formula (Yarnell): tincture that has been successful, well worth having on hand
vi. Monitor every 12 hours, if no improvement within 48 hours: hospitalize.
vii. If you don’t feel comfortable treating, refer
b. Hydro
i. Constitutional hydrotherapy
ii. Vinegar pack: alternating vinegar/hot water 50:50, with cold compress to abdomen
iii. Warm castor oil packs (Larrea tridentata infused is excellent)
iv. Chaparell great to mix in w/ castor oil, according to Eric Yarnell
c. Homeopathy
i. Belladonna: distended, hot, tender swollen; cutting pain across abdomen; headache, fever; extremely sensitive to touch, bed clothes, heat but patient wants to lie in cool room; tenderness of abdominal walls
iii. Iris tenax: fearful pain in ileocecal region, great tenderness to pressure on one spot; deathly sensation in stomach pit
iv. Lachesis: cutting or tearing pain right side of abdomen; cannot bear anything around waist, patient lies on back with clothing lifted from abdomen; abdomen tympanic; external heat; hard, bloated; inguinal glands swollen and painful;
- Know herbal therapies for colorectal cancers
a. Botanicals for general cancer and neoplasm
i. Avena sativa: nervous debility of convalescence
ii. Baptisia tinctoria: for tumors or malignant conditions
iii. Berberis aquifolium: dyscrasia due to cancerous cachexia
iv. Conium maculatum (toxic): pain of cancer
v. Echinacea spp.: increases interferon production, purifies blood
vi. Gentiana lutea: bitter: promotes appetite, improves digestion in chronic debility
vii. Larrea divaricata: (Mexican folklore)
viii. Phytolacca decandra (toxic): carcinoma, adenoma; hard, swollen lymph nodes
ix. Rumex crispus: early stages of cancer; to prevent
x. Taraxacum officinale: loss of appetite, weak digestion
xi. Trifolium pratense: alterative; purifies blood, cancerous diathesis; with daily use: patients are slower in developing carcinoma after excision
xii. Viola odorata: malignant disease, neoplasm in alimentary canal; after tumor extirpation to protect from metastases. Combines well with Galium aparine
xiii. Viscum album (toxic): tumor-inhibiting effects reported, main use as follow-up therapy after surgery or radiation. Extracts available: Iscador (Weleda), Phenesol (Madaus), Helixior
xiv. Hoxsey Like Formula
- Recommendations for colorectal screening schedule
CDC says: screening starts at 50 yo Fecal Occult Blood Test (gFOBT): every yr Flexible Sigmoidoscopy: every 5 yrs Colonoscopy: every 10 yrs
American CA society says,
screening starts at 50 yo if at average risk and Same test as above.
USE 1 OF THESE TESTS:
Fecal Immunochemical Test (FIT->Every year)
Stool DNA Test->Every 3 yrs (Mainly for Ca)
Double contrast barium enema-Every 5 yrs.
CT Colonography->Every 5 yrs (If positive f/u w/Colonoscopy
- Homeopathic remedies for colorectal CA & Polyps
POLYPS: calcerea carbonica calcarea phosphorica conium maculatum formica rufa nitric acid phosphorus
CA hydrastic canadensis alumen ruta graveolens sepia
Causes of acute constipation:
bowel obstruction,
adynamic ileus,
medications
- Understand key dietary principles in diverticulosis prevention
i. Also for Asymptomatic diverticulosis
ii. Diet rich in fruits, vegetables, legumes, nuts. Avoid seeds
iii. Whole grains in moderation
iv. Overall fiber goal: 50 g+ daily non-grain based fiber
v. Decrease grain-fed meats and processed foods
vi. Increase Exercise & water (64 oz daily)
vii. Increase Omega 3 EFA intake
viii. Elimination diet/food sensitivity testing
ix. Spasmolytic herbs
Eating principles in acute diverticulosis prevention
i. » acute (diverticulitis):
1. Increase fluids
2. Short fruit or vegetable juice fast progressing to soft semisolid foods: mashed sweet potatoes or yams, steamed carrots, squash, bananas, melons, apricots
3. Progress to grated raw vegetables as tolerated, then add cooked grains, well-chewed, and soft protein such as tofu, fish
Eating principles in Chronic diverticulosis prevention
ii. » chronic:
1. Elimination/rotation diet, rotation diet, rotation diet expanded
2. High fiber, high complex carbohydrate, unrefined diet
3. To protect against diverticulosis: increase cellulose and hemicellulose fiber
c. Consume foods rich in vitamin A, Vitamin B-complex foods, acidophilus
Foods to avoid in diverticulosis prevention
d. Avoid:
i. food intolerances
ii. meat, alcohol, hot sauces, spicy foods, fried foods, fatty foods, rich foods, salty foods, coffee, caffeine, sweet foods and sugar
Treatment protocols for “Acute” diverticulosis/diverticulitis
i. Note: Signs of internal bleeding or acute abdomen require immediate hospitalization.
Otherwise:
ii. Abdominal castor oil pack (with heat) for 60 minutes TID
iii. Probiotics 50-100 billion live organism QD
iv. Water fasting
v. Acute Diverticulitis Formula (Yarnell): tincture that has been successful, well worth having on hand
vi. Monitor every 12 hours, if no improvement within 48 hours: hospitalize.
vii. If you don’t feel comfortable treating, refer
Hydro Tx for diverticulosis/diverticulitis
i. Constitutional hydrotherapy
ii. Vinegar pack: alternating vinegar/hot water 50:50, with cold compress to abdomen
iii. Warm castor oil packs (Larrea tridentata infused is excellent)
iv. Chaparell great to mix in w/ castor oil, according to Eric Yarnell
Homeopathy tx for diverticulosis/diverticulitis
i. Belladonna: distended, hot, tender swollen; cutting pain across abdomen; headache, fever; extremely sensitive to touch, bed clothes, heat but patient wants to lie in cool room; tenderness of abdominal walls
iii. Iris tenax: fearful pain in ileocecal region, great tenderness to pressure on one spot; deathly sensation in stomach pit
iv. Lachesis: cutting or tearing pain right side of abdomen; cannot bear anything around waist, patient lies on back with clothing lifted from abdomen; abdomen tympanic; external heat; hard, bloated; inguinal glands swollen and painful;
CDC Recommendations for colorectal screening schedule
CDC says: screening starts at 50 yo Fecal Occult Blood Test (gFOBT): every yr Flexible Sigmoidoscopy: every 5 yrs Colonoscopy: every 10 yrs
