site of most diverticulosis
sigmoid colon
tx diverticulosis
high fiber diet (25-40 g/day)
adequate fluids
complication of macroperf in diverticulitis
free air, peritonitis
complications of diverticulitis (4)
abscess- walled off perforation
fistula- to the bladder or vagina
obstruction- due to inflammation
perforation
progressive, steady/aching LLQ pain, fever, tachycardia (from pain)
N/V, constipation, diarrhea, urinary sx
complicated diverticulitis
rigid abd with guarding, rebound tenderness, & absent bowel sounds
peritonitis
lab findings for diverticulitis? (3)
CBC- leukocytosis w/ left shift
stool for fecal occult
DRE for rectal mass
test of choice for diverticulitis dx?
CT scan
CT findings for diverticulitis (4)
fat stranding
bowel wall thickening
diverticulosis
the 4 complications (abscess, fistula, obst., perf)
flex sig/colonoscopy/BE use in diverticulitis?
contraindicated in acute diverticulitis due to perf. risk
tx uncomplicated diverticulitis (4)
metronidazole 500 mg PO TID
Cipro 500 mg PO BID 10-14 days both
clear liquid diet 2-3 days
colonoscopy 4-6 wks after episode
indications for hospitalization with diverticulitis (4)
toxic appearance
inability for PO
comorbidities (elderly, immunocomp.)
complication
inpt tx diverticulitis (4)
NPO (1-2 days)
IV fluids
Demerol
IV abx w/ G- and anaerobic coverage
indications for inpt emergent surgery for diverticulitis
peritonitis
failure to improve w/in 3-4 days
most common cause of acute lower GI bleed in the U.S.
diverticular bleeding
sx of diverticular bleeding (3)
painless bleeding
occult blood
hematochezia
pathology & common site of diverticular bleeding
artery is draped over length of diverticulum which is easily exposed to injury
usually Right side
diagnostics for diverticular bleeding (2)
1st: EGD/NG to r/o UGI source
2nd: Flex Sig or Colonoscopy
locate the source of the bleeding
non-neoplastic, benign colon polyps
hyperplastic
non-neoplastic, inflammatory colon polyps
psuedopolyps
neoplastic colon polyps
adenomas
most common adenoma
tubular adenoma
highest cancer risk adenoma
villous adenoma
high risk adenoma characteristics (3)
> 10 mm
high grade dysplasia on pathology
villous component
follow up for 1-2 small adenomas?
5 years
indications for follow up on adenomas w/in 3 years?
10+ adenomas
f/u for large adenoma or one that had to be removed in pieces
6 mo
common site of CRC
left side
risk factors for CRC (many)
personal or FH adenoma, colon CA, FAP/HNPCC
Age > 50
IBD (colitis longer than 8-10 years)
obesity, excess EtOH, smoking, Type II DM, AA
asymptomatic; or: abd pain, change in bowel habits, hematochezia or fecal occult, weakness/fatigue, anorexia, wt. loss, iron deficiency anemia
colorectal cancer
PE: physical wasting, wt. loss, signs of volume loss, pallor, LAD, abd distension, ascites, mass, organomegaly, + fecal occult, rectal mass
colorectal cancer
classic imaging finding of CRC
apple core lesion
lab findings for CRC (4)
microcytic anemia
elevated alk phos
apple core lesion on CT
carcinoembryogenic antigen (CEA) for monitoring reoccurrence
stage A CRC on Dukes-Astler-Coller
negative nodes, confined to mucosa
Stage C1 of Dukes-Astler-Coller
positive nodes, extension through the muscularis propria
CRC screening (3)
Colonscopy- best choice
Combo Flex Sig & BE- if you have to
Fecal immunochemical test- preferred CRC detection test
when to begin CRC screening?
50 y/o, w/o risk factors
familial adenomatous polyps (FAP) etiology
autosomal dominant, APC mutation
indications for prophylactic colectomy in FAP (2)
> 1 cm
villous pathology
extracolonic manifestations of FAP (4)
osteomas
dental abn
adrenal masses
epidermoid cysts & fibromas
early onset right-sided CRC (40-45 y/o)
HNPCC
HNPCC colon CA common site
proximal right sided
HNPCC associated CA (many)
ovary, gastric, small bowel, hepatobiliary, pancreas, renal pelvis, ureter
HNPCC diagnostic criteria
3-2-1
CRC or other assoc. CA in 3 relatives
occurrence in 2 successive generations
Diag. by age 50 in at least 1 pt in hx
HNPCC screening
annual colonscopy at 20-25 or 10 years prior to earliest age of onset in FH
