Colorectal CA (short case) Flashcards
HPI of Pt with colorectal CA
50-yr old female presents to the family practice clinic with CC of “not feeling herself” for the last 2-3 months. Gradual onset. She is extremely fatigued, “can barely get through the day.” She has noticed she is more exhausted by the end of the day. Getting more sleep does not help. She denies changes to her sleep habits. She denies fevers, chills, night sweats. She denies recent illnesses. She denies pain. She denies fevers. She denies changes in her appetite. She denies N/V. She denies abdominal pain.
- She is tired and pale
- She has also noticed new development of Constipation Last BM was 3 days ago.
- She denies blood in her stool
Colorectal CA: ddx
- Anemia: IDA
- IBS
- constipation
- depression
- hypothroidism
- hepatitis
- lupus
- UC
- Ovarian CA
- Crohn’s dz
- UTI
- celiac disease
- metastatic cancer
PE:
-Digital Rectal Exam findings?
- Good sphincter tone.
- *Heme occult is positive.
Labs:
CBC:
- Hgb: 9.1 (normal in females is 12-16 so hers is low)
- WBC: 7.25
- Platelets: 279 (normal 150-400)
- HCT: 27.6 (normal is 36%-47%)
- TSH: 1.2
- MCV: 7.7 (slightly low) (normal 8-10 aka 80-100)
- RDW= variation in size of cells→ higher the # the more varying sizes (higher # is commonly seen with IDA)
- MCV: 80-100 normal , her MCV=77 (*microcytic)
How is IDA classified?
iron deficiency anemia is classically microcytic
Pt had an unexplained rectal bleed on DRE.. what must be ordered?
We have an UNEXPLAINED occult rectal bleed→ MUST GET COLONOSCOPY. This is cancer until proven otherwise
the Pt underwent a Colonoscopy which revealed colon CA. The surgeons were able to remove whole thing with good margins. What steps are next (tx/management)?
-Pt must take iron AND vitamin C supplements
Common complaints/ S/E associated with iron supplements
Educate the Pt regarding iron supplements:
- Dark tarry stools are normal
- Common GI complaints: constipation, GI distress, must give vitamin C with iron supplements–>Pt should be taking 325 mg tablet of iron BID and Vit C tablet with it
Anemia Review:
-Common Sx?
Pale, fatigue, SOB, cravings for non food items (dirt and ice), brittle hair and nails, Smooth and glossy tongue. **Angular Chellitis, Most Ppl say they are really tired and cold all the time. Vague Sx.
Microcytic anemias
- IDA
- Anemia of chronic dz (starts out normocytic→ microcytic)
- Thalassemia
Macrocytic anemias
- B12 deficiency
- Thiamine deficiency: alcoholics
- Folate deficiency
- Cirrhosis→ high MCV
Normocytic anemias: etiology?
- Sudden hemorrhage (ie gunshot wound, GI bleed, trauma MVA, surgery)
- Pt with high NSAID use has PUD (they are anemic and # of chronic diseases (there MCV was on the low end of normal)
IDA:
-lab findings?
- serum iron–>low
- ferritin–> low
- Transferrin (binds to iron and circulates it)–>high (liver will produce more transferrin in IDA)
- TIBC–> high
Anemia of chronic disease:
lab findings?
Ferritin–> high
Colorectal CA:
-pathophys
Progression of adenomatous polyp into malignancy (adenocarcinoma) usually occurs within 10-20 yrs
–3rd leading cause of CA deaths
