Transcript Colonic Diseases - PHILIPPINE SOCIETY OF INSURANCE

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
Irritable Bowel Syndrome
Diverticular Diseases
Polyps
Normal Colon
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 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 Syndrome
Other signs/symptoms:
Passage of mucus
Bloating or feeing of abdominal distention
Gynecologic symptoms (dyspareunia)
Slightly tender abdomen
Irritable Bowel Syndrome
No effect on life longevity
No end organ damage result
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 Syndrome
Management
Reassurance
Dietary fiber
Antispasmodics
Anti-diarrhea agents
Prokinetics
Psychotropic medication
Diverticulosis
A small bulging sac which
protrudes from weak
spots of the colon wall
Diverticulosis
Signs and Symptoms
Cramping
 Bloating
 Flatulence
 Irregular defecation

Diverticulosis
Management
High fiber diet
 Left alone unless associated with
complication

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
• 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
• Ruptured artery
• Painless rectal bleeding
• Most have minor bleed
• Mostly stopped spontaneously
• 25% recurrence rate
• Available endoscopic therapy
• < 1% require surgical
intervention
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)
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%

Polyps
100% Malignant Potential

FAP (Familial Adenomatous Polyposis)


1% of all colorectal carcinoma
HNPCC (Hereditary Non-Polyposis
Colorectal Cancer)

2-6% of colorectal carcinoma
Polyps
Polyp features and the frequency of high-grade
dysplasia
Polyp (adenoma)
Frequency of high-grade dysplasia (%)
Tubular
2
Villous
31
Small-sized (<5 mm)
1
Medium-sized (6-10 mm)
5
Large-sized (>10mm)
21
Polyps
Polyps
Polyps
size
characteristic
location
frequency
Polyps
Management
Detected coincidentally during investigation of
other colonic diseases
Excision through biopsy forceps or snare
polypectomy
Surveillance colonoscopy if adenoma
Polyps
Screening Colonosocpy
Secondary prevention of Colorectal Carcinoma
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