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colon lecture

colon lecture. John R Pender, M.D. Dept. of Surgery BSOM, East Carolina University. Patient. 58 y/o with wt loss and abd pain. symptoms. Wt loss Change in caliber of stools Blood in stool/ FOBT (fecal occult blood test) Anemia Abd pain constipation. Work up. H&P

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colon lecture

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  1. colon lecture John R Pender, M.D. Dept. of Surgery BSOM, East Carolina University

  2. Patient • 58 y/o with wt loss and abd pain

  3. symptoms • Wt loss • Change in caliber of stools • Blood in stool/ FOBT (fecal occult blood test) • Anemia • Abd pain • constipation

  4. Work up • H&P • CEA (carcinoembryonic antigen) • CBC • CXR • Colonoscopy • CT scan abd/pelvis

  5. Polyps • Sessile vs pedunculated • Hyperplastic • Adenoma • Malignant • Villous • tubulovillous

  6. Follow up after polypectomy • Q 6 months for first year, then @ 3 and 5 years. • Once clear at five years, repeat Q 5 years • HNPCC (hereditary nonpolyposis col ca) • Average # polyps ~80% cancer by 45% • FAP (familial adenomatous polyposis) • Cancer by age 40 ~100% • 5% cancer by age 20

  7. CHEMO? • 5-FU and leucovorin • Stage III (+/- poorly differentiated stage II) • colon • Sage II and III • rectal ca

  8. XRT • Not for colon • Only helps with local control in rectal cancer if T3 or greater • Does not improve survival

  9. Post operative surveillance

  10. Patient • 60y.o. with BRBPR • What do you do

  11. GI BLEED

  12. Patient • 45 y/o with left LQ pain, fever • What do you do

  13. w/u • CBC • U/A • AAS • CT • Contrast enema

  14. Diverticular Disease

  15. Iv fluid antibiotics npo Resuscitation Antibiotics Hartmann’s procedure Blind rectal pouch&colostomy Operation free air obstruction Abscess Uncontrolled sepsis Management

  16. Indications for Surgery • Perforation • Fistula • Abscess • Obstruction • Age < 40

  17. Patient • 30 y/o with anal pain • What do you do? • Examine pt.

  18. Differential of Anal pain • Hemorrhoids • abscess • Fissure • Fistula-in-ano • Codyloma • Puritis ani • Cancer • FB

  19. Hemorrhoid TX • First and second degree/ thrombosed • Sitz bath • Bulk laxative • topical analgesia • Acute thrombosed, third/fourth degree • Hemorrhoidectomy

  20. hemorrhoidectomy

  21. Fissure • cycle of sphincter spasm • Nitrates, Botox, digital stretch • Bulky laxative • Water • Sitz baths

  22. Fistula

  23. Patient 23 y/o with R LQ pain, fever what else do you want know? bowel habits

  24. operation • You operate for presumed appendicitis and find an inflamed cecum and terminal ileum with creeping fat. • What do you do?

  25. Crohn’s Mouth to anus Skip areas Perianal Granulomatous/full thickness Fistula, stricture Extraintesatinal dz Ulcerative Colitis COLON AND RECTUM ONLY Toxic megacolon Rectal bleeding Higher risk of colon cancer Inflammatory bowel diseases

  26. Indications for surgery • Obstruction • Bleeding • Abscess/perforation • cancer • Fistula • Megacolon unresponsive • Unresponsive/intolerance to medical management

  27. Associated SX • Erythema nodosum • Pyoderma gangrenosum • Aphthous ulcers • Episcleritis • Ankylosing spondylitis • Sclerosing cholangitis

  28. Patient • 80 y/o nursing home pt with distend abdomen, feculent emesis, obstipation • What do you do?

  29. w/u • IVF • NG • AAS • CBC, ect

  30. Differentialof colonic obstruction • Cancer • Adhesions • Hernia • Volvulus • Ogilvie’s pseudo-obstruction

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