Colonic%20Diseases

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Colonic Diseases

• Ismael A. Lapus Jr. M.D.
• Internal Medicine-Gastroenterology
• September 11, 2008

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Colonic Diseases

• Careful history and physical examination
• Diagnostic modalities
• Stool exam with occult blood
• Barium enema
• CT scan
• Virtual colonoscopy
• Video colonoscopy

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Colonic Diseases

• Irritable Bowel Syndrome
• Diverticular Diseases
• Polyps

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Normal Colon
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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

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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

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Irritable Bowel Syndrome

• Other signs/symptoms
• Passage of mucus
• Bloating or feeing of abdominal distention
• Gynecologic symptoms (dyspareunia)
• Slightly tender abdomen

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Irritable Bowel Syndrome

• No effect on life longevity
• No end organ damage result

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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)

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Irritable Bowel Syndrome

• Management
• Reassurance
• Dietary fiber
• Antispasmodics
• Anti-diarrhea agents
• Prokinetics
• Psychotropic medication

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Diverticulosis
A small bulging sac which protrudes from weak
spots of the colon wall
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(No Transcript)
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Diverticulosis

• Signs and Symptoms
• Cramping
• Bloating
• Flatulence
• Irregular defecation

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Diverticulosis

• Management
• High fiber diet
• Left alone unless associated with complication

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Diverticulosis

• Health Burden
• Prevalence is age dependent
• lt 5 by age 40
• gt 30 by age 60
• gt 65 by age 85
• 70 - asymptomatic
• 15-25 - diverticulitis
• 5-15 - bleeding

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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)

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Diverticular bleed

• Ruptured artery
• Painless rectal bleeding
• Most have minor bleed
• Mostly stopped spontaneously
• 25 recurrence rate
• Available endoscopic therapy
• lt 1 require surgical intervention

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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)

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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

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Polyps

• 100 Malignant Potential
• FAP (Familial Adenomatous Polyposis)
• 1 of all colorectal carcinoma
• HNPCC (Hereditary Non-Polyposis Colorectal
  Cancer)
• 2-6 of colorectal carcinoma

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Polyps

• Polyp features and the frequency of high-grade
  dysplasia

Polyp (adenoma) Frequency of high-grade dysplasia ()
Tubular 2
Villous 31
Small-sized (lt5 mm) 1
Medium-sized (6-10 mm) 5
Large-sized (gt10mm) 21
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Polyps
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Polyps
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Polyps
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size characteristic location frequency
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Polyps

• Management
• Detected coincidentally during investigation of
  other colonic diseases
• Excision through biopsy forceps or snare
  polypectomy
• Surveillance colonoscopy if adenoma

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Polyps

• Screening Colonosocpy
• Secondary prevention of Colorectal Carcinoma

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THANK YOU!