polyps are fleshy outgrowths of the intestinal mucosa that can be categorized as hyperplastic, adenoma, or "polyposis" syndromes, each with their own unique etiologies and morphologies. hyperplastic polyps are most common, making up about 90% of epithelial polyps, and are less than 5mm in diameter. they are asymptomatic, found via endoscopy, and are generally considered benign. adenoma polyps are precancerous and make up 10% of epithelial polyps and are from 1.5-10mm (most are smaller and the larger ones have a greater potential to be cancerous). polyposis syndromes are inherited conditions that result in a multitude of intestinal polyps that have a high chance of progressing to adenocarcinoma. for example, nearly 100% of patients with familial polyposis syndrome have adenocarcinoma by age 40. gardner's syndrome is another polyposis syndrome with osteomas, soft tissue tumors, and sebaceous cysts. peutz-jeghers syndrome is yet another with mucocutaneous pigmentation and polyps in the form of harartomas in the GI tract.
adenocarcinoma is a cancer that can affect the GI tract that is the third most common cancer, after lung and breast / prostate. in males it more commonly affects the rectum and in females the colon. etiological factors include diet low in fiber and high in animal protein, prolonged transit time, rancid oils / fats, while protective factors can include selenium, vitamin C and E, carotene, antioxidants. most patients present asymptomatically, or have a positive occult blood test, but late stage adenocarcinoma can result in a variety of symptoms including weight loss, malaise, anorexia, jaundice, and ascites. if adenocarcinoma is in the right colon, the patient might be more prone to developing anemia symptoms, bleeding, and vague abdominal discomfort. if adenocarcinoma is in the left colon, patients might develop diarrhea / constipation, tenesmus, hematochezia / occult blood. finally, adenocarcinoma of the rectum will cause blood with each bowel movement. diagnosis is usually missed on PE, but aided by CBC, livery enzyme tests, carcinoembryonic antigen tests, as well as a colonoscopy and double contrast barium enema.
hemorrhoids are clusters of vascular, connective, or musclar tissue that affects the epithelium of the anal canal. they are precipitated by laxity of rectal muscles or pelvic congestion- not surprisingly, 1/3 of truck drivers suffer from hemorrhoids. if the hemorrhoid is in the anal canal, patients would likely present with painless rectal bleeding, but may also have perianal itching/irritation/pain, or more acute pain if the hemorrhoid is thrombosed. external hemorrhoids are more prone to thrombosis and thus more acute pain which is triggered by exertion, diarrhea, etc. and can last 1-2 weeks or until the thrombosis is resolved, after which a skin tag remains where the hemorrhoid once was.
anal fissures are acute tears in the anal mucosa most commonly from either constipation or diarrhea. fistulas are new tracts that open up from the anal canal to the perianal or ischiorectal area (recall that this was a complication of crohn's), associated with leukemia, diverticulitis, foreign body reactions, actinomycosis, and chlamydia. fissures and fistulas cause throbbing pain that occurs most of the day, worsened with pressure from sitting, or movement, and especially from bowel movements. the draining of a fistula, or the formation of a new fistula tract may spontaneously resolve the pain.
a couple more anorectal disorders: pruritis ani is intense itching of the perianal area, usually brought on by allergies, pinworms, or dermatological disorders. proctalgia fugax is episodes of intense rectal pain that lasts seconds to minutes, with no symptoms in between episodes. it is associated with MS, low fiber diets and IBS, and is treated with kegel exercises.
questions
polyps...
1. what are the types of polyps?
2. how big are hyperplastic polyps?
3. what percentage of epithelial polyps are hyperplastic vs. adenomatous polyps?
4. what is the symptom picture and prognosis for hyperplastic polyps?
5. how big are adenomatous polyps?
6. how long do adenomatous polyps take to develop?
7. 90% of adenomatous polyps are...
8. polyposis syndromes are classified as...
9. polyposis syndromes always end up in...
10. what is familial polyposis?
11. what is gardner's syndrome?
12. what is peutz-jeghers syndrome?
13. what are some etiological mechanisms of polyps?
14. what is a type of skin lesion that is associated with polyps and how closely is it associated?
15. what is a type of medical procedure that can increase risk of polyps?
16. what are the signs and symptoms of polyps?
17. how is the diagnosis of polyps made?
adenocarcinomas...
18. how common is adenocarcinoma of the GI tract?
19. which parts of the GI tract does adenocarcinoma affect in males and females?
20. what are some etiological factors for adenocarcinoma?
21. what are some factors that might prevent adenocarcinoma?
22. what are the risk factors for adenocarcinoma?
23. what are the early signs and symptoms for adenocarcinoma?
24. what are the signs and symptoms for adenocarcinoma that develops in the right colon?
25. what are the signs and symptoms for adenocarcinoma that develops in the left colon?
26. what are the signs and symptoms for adenocarcinoma that develops in the rectum?
27. what are the signs and symptoms for late stage adenocarcinoma?
28. what are the best lab tests to perform for adenocarcinoma?
29. what are the imaging tests that can aid in the diagnosis of adenocarcinoma?
30. what are the differential diagnoses for adenocarcinoma?
hemorrhoids...
31. what are hemorrhoids?
32. hemorrhoids result from...
33. hemorrhoids are common in what occupation?
34. what is the imaging technique used to diagnose hemorrhoids and what does it find?
35. what are the treatments for hemorrhoids?
36. what are the signs and symptoms of internal hemorrhoids?
37. what are the signs and symptoms of external hemorrhoids?
38. describe the progression and quality of the thrombotic pain in external hemorrhoids.
anal fissures/fistulas...
39. what is an anal fissure?
40. 87% of people with anal fissures are between what ages?
41. what is the etiology of anal fissures?
42. what are anal fistulas?
43. what are anal fistulas associated with?
44. what are the signs and symptoms of anal fissures/fistulas?
45. describe the quality of pain with an anal fistula.
46. what are some differential diagnoses for anal fissures/fistulas?
pruritis ani, proctalgia fugax...
47. what is pruritis ani?
48. what are the most common etiologies for pruritis ani?
49. what is proctalgia fugax?
50. what condition in particular has a high incidence of proctalgia fugax?
51. what are some risk factors for proctalgia fugax?
52. what age group does proctalgia fugax usually affect?
53. describe the quality of pain in proctalgia fugax.
54. what is the treatment for proctalgia fugax?
answers
1. hyperplastic, adenomas, polyposis syndromes.
2. less than 5mm in diameter.
3. about 90% are hyperplastic, 10% adematous.
4. asymptomatic, found on endoscopy, benign on pathology report.
5. more than 10mm.
6. 5-10 years.
7. less than 1.5mm and have small potential for malignancy.
8. familial inherited (autosomal dominant), non familial.
9. colon cancer.
10. a rare hereditary disease that manifests in childhood with a colon carpeted with polyps, diarrhea / bleeding, and generally leads to carcinoma by age 40.
11. similar to familial polyposis, with osteomas, benign soft tissue tumors, sebaceous cysts.
12. similar to familial polyposis with more distribution and accompanied by mucocutaneous pigmentation and harartomas in stomach, colon, small intestine.
13. adaptative response to cigarette smoke, alcohol intake, ulcerative colitis.
14. 10-70% of individuals with skin tags have polyps.
15. irradiation of the pelvis.
16. asymptomatic, or bleeding (occult blood possible)
abdominal pain due to obstruction
change in bowel habits
watery diarrhea with large villous adenomas
17. barium x-ray, colonoscopy after routine exam.
18. 3rd most common cancer after lung, prostate/breast.
19. females: colon. males: rectum.
20. low fiber diet
high animal protein (grain fed animals that don't exercise)
prolonged transit time
rancid oils / fats
[fiber, fat, animal, transit]
21. selenium, vitamin C, vitamin E, carotene, antioxidants. [sell the vitamins to the anti carrot people]
22. over 40 years old
familial polyposis
low cholesterol with standard american diet
crohn's / ulcerative colitis
septicemia from strep bovis infection
[AC 40 familial SAD inflammatory septicemia] [ack- 40 sad families with toilets on fire?!?]
23. asymptomatic, or positive occult blood.
24. microcytic / hypochromic anemia symptoms
vague abdominal discomfort or palpable mass (later)
bleeding
[anemia, vague pain, bleeding]
25. diarrhea / constipation
tenesmus with BM
pain due to obstruction
hematochezia or positive occult blood
[diarrhea, tenesmus, pain, blood]
26. blood with each bowel movement.
27. weight loss, malaise, anorexia, jaundice, ascites.
28. CBC, liver enzymes, CEA, occult blood.
29. sigmoidoscopy / colonoscopy, double contrast barium enema.
30. diverticula, ischemic colitis, IBD, benign polyps, hemorrhoids.
31. clusters of vascular tissue, connective tissue, and musclar tissue.
32. laxity of rectal musculature, pelvic congestion/stagnation
33. 1/3 truck drivers.
34. anoscope reveals bluish color from veins.
35. lancing or sclerosing via electrodes.
36. bleeding with BM
perianal itching / irritation / pain
acute pain from thrombosed hemorrhoid or spasm
37. pain from thrombsed hemorrhoid
skin tags
38. thrombosis results from exertion, straining, diarrhea, or other event, pain lasts 7-14 days and resolves when thrombosis resolves.
39. an acute tear in the mucosa of the anal canal.
40. 20-60.
41. hard stool
chronic diarrhea
constipation
childbirth
cathartics
intercourse or examination
STD's
[poop cccc sex]
42. opened perianal or ischiorectal absesses that drain spontaneously.
43. leukemia, diverticulitis, foreign body reactions, actinomycosis, chlamydia.
44. burning/cutting rectal pain
pain / blood / spasm with BM
mucoid discharge
pruritis
45. throbbing pain throughout most of the day that is made worse by sitting, moving, BM, coughing and might resolve spontaneously with draining of abscess or formation of new fistula.
46. diverticular disease
foreign bodies
herpes simplex
hidradentis suppuritiva
HIV
inflammatory bowel
47. intense perianal itching
48. allergies, pinworms, dermatologic disorders
49. benign anorectal pain, thought to be associated with spasm of anal sphincter.
50. MS.
51. low fiber
IBS
52. 50% are 30-60.
53. sudden onset pain localized to rectum that lasts seconds to minutes, asymptomatic between episodes.
54. kegel exercises.
No comments:
Post a Comment