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Colonic Diseases. Ismael A. Lapus Jr. M.D. Internal Medicine-Gastroenterology September 11, 2008. Colonic Diseases. Careful history and physical examination Diagnostic modalities Stool exam with occult blood Barium enema CT scan Virtual colonoscopy Video colonoscopy. Colonic Diseases.

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Colonic diseases

Colonic Diseases

Ismael A. Lapus Jr. M.D.

Internal Medicine-Gastroenterology

September 11, 2008


Colonic diseases1
Colonic Diseases

Careful history and physical examination

Diagnostic modalities

  • Stool exam with occult blood

  • Barium enema

  • CT scan

  • Virtual colonoscopy

  • Video colonoscopy


Colonic diseases2
Colonic Diseases

Irritable Bowel Syndrome

Diverticular Diseases

Polyps



Irritable bowel syndrome
Irritable Bowel Syndrome

  • Common gastrointestinal disorder characterized by recurrent abdominal pain or discomfort and a disturbance in bowel habit (constipation or diarrhea) IN THE ABSENCE OF ORGANIC PATHOLOGY

  • No specific test

  • No unique physiologic factors as a cause of IBS

  • Often necessitates several diagnostic test (upper and lower endoscopy, ultrasound/CT-scan of the abdomen)

  • Chronic functional disorder

  • 70% affected are women


Irritable bowel syndrome1
Irritable Bowel Syndrome

Rome II diagnostic criteria for IBS

At least 12 weeks , which need NOT be consecutive , in the preceding 12 months of abdominal discomfort or pain that has two out of the following three features

  • Relieved with defecation; and/or

  • Onset associated with change in frequency of stool; and/or

  • Onset associated with a change in form (appearance) of stool


Irritable bowel syndrome2
Irritable Bowel Syndrome

Other signs/symptoms:

Passage of mucus

Bloating or feeing of abdominal distention

Gynecologic symptoms (dyspareunia)

Slightly tender abdomen


Irritable bowel syndrome3
Irritable Bowel Syndrome

No effect on life longevity

No end organ damage result


Irritable bowel syndrome4
Irritable Bowel Syndrome

Health Care Burden

  • IBS accounts to 12% of patients seen in primary setting

  • Largest diagnostic group seen by gastroenterologist

  • Considerable cost to society (direct medical expenses and indirect cost such as absenteeism)


Irritable bowel syndrome5
Irritable Bowel Syndrome

Management

Reassurance

Dietary fiber

Antispasmodics

Anti-diarrhea agents

Prokinetics

Psychotropic medication


Diverticulosis
Diverticulosis

A small bulging sac which protrudes from weak spots of the colon wall


Diverticulosis1
Diverticulosis

Signs and Symptoms

  • Cramping

  • Bloating

  • Flatulence

  • Irregular defecation


Diverticulosis2
Diverticulosis

Management

  • High fiber diet

  • Left alone unless associated with complication


Diverticulosis3
Diverticulosis

Health Burden

  • Prevalence is age dependent

    • < 5% by age 40

    • > 30% by age 60

    • > 65% by age 85

  • 70% - asymptomatic

  • 15-25% - diverticulitis

  • 5-15% - bleeding


Diverticulitis
Diverticulitis

  • Inflammation of diverticula

  • Nothing per mouth and antibiotics

  • 70-100% successful

  • Surgical management

  • failure of above conservative treatment or development of further complication (i.e. Abscess, fistula, perforation, peritonitis, obstruction)


Diverticular bleed
Diverticular bleed

  • Ruptured artery

  • Painless rectal bleeding

  • Most have minor bleed

  • Mostly stopped spontaneously

  • 25% recurrence rate

  • Available endoscopic therapy

  • < 1% require surgical intervention


Polyps
Polyps

  • Protuberance into the lumen from a normally flat colonic mucosa

  • Usually asymptomatic

  • Altered bowel habit, bleeding, obstruction

  • Classified as

    • Non-adenomatous - non cancerous (hyperplastic, inflammatory)

    • Adenomatous - pre cancerous (FAP, HNPP, villous, tubular, tubulovillous)


Polyps1
Polyps

Adenomatous Polyp

  • Two-thirds of all colonic polyp

  • Approximately 30% of population over age 50 have one or more adenomas

  • Cumulative cancer risk is only 5%


Polyps2
Polyps

100% Malignant Potential

  • FAP (Familial Adenomatous Polyposis)

    • 1% of all colorectal carcinoma

  • HNPCC (Hereditary Non-Polyposis Colorectal Cancer)

    • 2-6% of colorectal carcinoma


Polyps3
Polyps

Polyp features and the frequency of high-grade dysplasia





size

characteristic

location

frequency


Polyps7
Polyps

Management

Detected coincidentally during investigation of other colonic diseases

Excision through biopsy forceps or snare polypectomy

Surveillance colonoscopy if adenoma


Polyps8
Polyps

Screening Colonosocpy

Secondary prevention of Colorectal Carcinoma



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