Colorectal Disease

SUGGESTED READINGS COLORECTAL DISEASE

Current Surgical Diagnosis & Treatmetnt, 12th Edition, Ch. 30.

OBJECTIVES COLORECTAL DISEASE

1. Discuss the factors that predispose the development of carcinoma of the colon.

2. Identify the common symptoms of carcinoma of the colon, rectum and anus.

3. Discuss the appropriate laboratory and x-ray studies of the diagnosis and treatment of carcinoma of the colon, rectum and anus.

4. Discuss the role of radiotherapy and chemotherapy in management of patients with carcinoma of the colon, rectum and anus.

5. Define the postoperative follow-up of curative cancer resection necessary to detect recurrent and new cancer.

6. Discuss the role of CEA in the diagnosis and follow-up of patients with carcinoma of the colon.

7. Using TNM classification, discuss the staging and five-year survival of carcinoma of the colon and rectum.

8. Describe the clinical findings of diverticular disease, differentiating the symptoms and signs if diverticulitis and diverticulosis, including signs of inflammation and bleeding.

9. Discuss the complications of diverticular disease, including bleeding, obstruction, perforation, and fistula formation.

10. Discuss operative therapy for diverticular disease i.e. performed emergently or electively.

11. Discuss nonoperative management of diverticular disease.

12. Describe the role of vascular anatomy in the development of diverticulosis.

13. Describe the role of dietary fiber in the etiology and treatment of diverticular disease.

14. Differentiate ulcerative colitis and Crohn’s disease of the colon in terms of history, x-ray findings, prognosis and risk of cancer.

CASE HISTORIES COLORECTAL DISEASE

1. A 67-year-old white male presents to you with guaiac positive stools. An air contrast barium enema study reveals a 2.5 cm polyp at the splenic flexure. Discuss appropriate management. Discuss the association between polyp size and risk of carcinoma.

2. A 61-year-old white male presents to the surgical clinic with a three-month history of blood streaking of the stool with a decrease in the caliber of stools. He also describes a seven-pound weight loss. His past medical history is unremarkable except for a cholecystectomy four years ago. He takes no medication. Physical exam reveals a healthy male in no acute distress. Abdominal exam is unremarkable. Rectal exam reveals no masses and guaiac positive stool. Laboratory studies reveal a normal hemoglobin and hematocrit and renal panel. Liver functions are normal. CEA is 27. Discuss further evaluation and likely diagnosis.

3. A 69-year-old white male presents with a 6 cm carcinoma of the sigmoid colon and obstructive symptoms. Work-up reveals widespread metastatic disease in both lungs and the right lobe of the liver.

4. A 52-year-old white female with recurrent crampy abdominal pain and intermittent diarrhea is noted on barium enema to have moderately severe left-sided diverticular disease with significant spasm. Discuss further evaluation and therapy options.

5. A 64-year-old white male presents with a complaint of passing air in his urine. Discuss further evaluation and therapy options.

6. A 79-year-old white female with a long history of diverticular disease presents to the emergency room with an acute abdomen. Emergency surgical exploration reveals a free perforation of a sigmoid diverticular abscess with fecal spillage. Discuss treatment options.

7. A 39-year-old white male with a four-year history of medically managed ulcerative colitis presents with a sharp decrease in the number of stools. He is accustomed to having three to four slightly bloody stools per day but has had no bowel movements over the last three days. Physical exam reveals the patient to be obtunded, febrile and with a distended tender abdomen. Abdominal series reveals the transverse colon to be dilated to 10 cm. Discuss likely diagnosis and therapy options.

8. A 41-year-old white male with a three-year history of Crohn's disease presents with his fourth episode of small bowel obstruction. An upper GI series reveals a string sign in the mid ileum. Discuss further evaluation and therapy options.

9. A 44-year-old white female with a four-year history of Crohn's disease presents with a draining sinus tract in the left lower quadrant of the abdominal wall. An upper GI study reveals enterocutaneous fistula. TPN is started but there is no change after two weeks of TPN with the patient remaining NPO. Discuss further treatment options.

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