Colon Disorders and Surveillance - CRASH! Medical Review Series

[@nikarphar]

Deep respect to you for making these videos and making them available for free !

[@helenavlckova5199]

Thank you dr. Bolin for incredible lectures, as a medical student I appreciate the incredible amount of useful information crammed into every single one. Also, you seriously cracked me up on about 31:22 on Gardner's syndrome.

[@woloabel]

Saturday, October 29, 2022. Gastroenterology: Colon Disorders (Colopathy) and Surveillance (Colonoscopy/Endoscopy): Diverticular Pathology: 1) Diverticulosis is the Outpouching of the Colonic Intestinal Mucosa. SSx: 1) Incidental Diagnosis, 2) Asymptomatic, 3) Left Lower Quadrant (LLQ) is rare; 4) Afebrile; Dx should entail documentation and Subject should be informed of such Finding; Tx does not include any 1) Acute Measures. 2) Instructing the Subject of the Risks of a Low Fiber Diet, a Western Society Standard and encouraging a High-Fiber Diet (20-25 Grams per Day) as in Over-the-Counter Bulking Agents (Psyllium) 3) High Risk of Diverticulitis otherwise; 2) Diverticulitis is the Infection of Colonic Diverticula (usually due to blockage of indigestible products [Hulls, Corn, Gum et al). SSx: 1) Fever, 2) LLQ Pain, and/or 3) Periumbilical Pain/Tenderness. Dx: 1) Abdominal CT with Oral Contrast. 2) Routine Laboratories ( 1) CBC, 2) BMP) as for any Febrile Process (Leukocytosis Aetiology). 3) A Colonoscopy increases the Risk of Perforation, and Any Barium Modality is Contraindicated because of Peritoneal Spillage is Likely (Acute Peritonitis is Possible). Tx is 1) Admission 2) Antibiotic Therapy: Ciprofloxacin, a Fluoroquinolone Antibiotic and Metronidazole, A Nucleic Acid Synthesis Inhibitor, a Nitroimidazole Antimicrobial (Effective due to Selectivity for Anaerobes and Protozoa); 3) Fiber-Sufficient Diet, and 4) Recommendation and Indication of this Same Regimen on an Out-patient Setting; 3) Constipation (Lack of Motility of the Pars Colonis (Colon Segment) is the Loss of Evacuation Function of the Colon (Less than 3 Bowel Movement Per Week is rather indicative of Constipation). The diagnosis has a Subjective Component, however. SSx: 1) Decreased Frequency in Bowel Movement; 2) Hard or Lumpy Stool Texture; 3) Straining. Dx is on Clinical Grounds. Ax/Causes: 1) Dehydration, 2) Sedentary Habitus/Condition; 3) Diabetes Mellitus, 4) Iron Supplementation; 5) Drugs (Opiates, Calcium Channel Blockers (CCBs), Anticholinergics, Antiacids, Sympathomimetics as in Pseudoephedrine); 6) Hypothyroidism (Decreased Mood and Affect, Weight Gain; 7) Neurologic Disorders. Tx is understandably Symptomatic and based on Aetiology. If Drugs, 1) Minimizing the Drug Consumption or Change of Drug Regimen (NSAIDs); 2) Adequate Hydration; 3) Psyllium; 4) Instruction of Short-term Laxative Consumption (Docusate or Bisacodyl); 5) Thyroid Stimulating Hormone (TSH) and Thyroxine (T4) Tests if Hypothyroidism is Suspected. DDx: 1) Irritable Bowel Syndrome (IBS) is Chronic and Painful Diarrhea with Constipation, alleviated with Bowel Movement (Has a Psychogenic/Neurological Component in Mechanism). 4) Colon Cancer (Malignancy Localized to the Colon), namely Adenocarcinoma is an Idiopathic Genetic Aetiology and is Common and most Prevalent in US, Epidemiology wise (Prevalence of 5-6%) with Risk Factors (RFx) being 1) Red Meat Consumption, 2) High Fat Diet, and 3) Cigarette Smoking along with 4) a Familial Component. Risk of Occurrence is Observed with Preventative Measures (No Smoking, High Fruits and Vegetable Consumption and Minimal Consumption of Red Meat) such as Colonoscopy. SSx are dependent on the Location of Tumor or Organ Involvement. In General, Left Side Neoplasia will be 1) Heme Positive in Stool Study (Occult and Visible Hemorrhage), 2) Narrower Caliber, and 3) Anemia while Right Sided Tumors will also be 1) Heme Positive (Occult Hemorrhage), 2) Brown Stool, 3) Normal Caliber, and 4) Anemia. Dx is via Colonoscopy (When accompanied by the aforementioned Symptoms/Signs); and 2) Biopsy (all Malignancy must be diagnosed via Pathology). Tx is Surgical if Localized Neoplasia (Non-Metastatic, usually if Detection is Early in Pathogenesis of Adenocarcinoma) where Resection of the Affected site is Standard. If the Neoplasia is Widespread and/or Metastatic, 2) Chemotherapy with IV 5-Fluorouracil (5-FU), Antineoplastic Agent/Nucleoside Metabolic Inhibitor (Antimetabolite) and others (Capecitabine, Irinotecan and Oxaliplatin). 6) Colon Surveillance: 1) In Adults 50 and Over, Colonoscopy is Indicated (Thereafter every 10 Years). 2) If a Poly is Relevant, then Repeat every 3-5 years. 3) With a Positive History of Premature Colon Cancer in Family (< 50), then Colonoscopy should be performed earlier (10 years less than Age of Colon Cancer Relevant). 4) Hereditary Non-Polyposis Syndrome (HNPS/Lynch's Syndrome) has a Genetic Mutation known as HNPCC; Dx is via History (1) 3 or > Relatives with Colon Cancer, 2) in 2 or > Generations and at least 3) one with Premature Colon Cancer. Colonoscopy in HNPS starts at 25 Years of Age and is Repeated every 1 to 2 Years. Neoplasia of Colon: 1) Colon Polyps are Mucosal Outgrowths (Reactive Tissue Growth). Dx: Colonoscopy/Biopsy/Pathology. Morphology: 1) Non-Malignant (Hyperplasia), 2) Pre-Malignant (Tubular, Tubulovillous, Villous (Most Dysplasia), and Sessile Serrated), 3) Hamartoma, and 4) Inflammatory; 2) Genetic Pre-Malignancy Colon Syndromes have a Genetic Aetiology of APC Mutation and are marked by Polyposis Pathology: 5) Familial Adenomatous Polyposis (FAP) is Hundreds of Polyp Formation in the Colon. SSx is usually Asymptomatic and only manifests once Malignancy has Developed. Dx is via History Exclusively where FHx is Significant for a Member who had Colon Cancer at => 40 Years (75-80%). Dx: 1) Genetic Testing for APC Mutation (if a Polyp is Present, Total Colectomy). 2) Early Flexible Sigmoidoscopy is warranted (at 12 Years [Repeat 1-2 y]); 3) Colonoscopy if Polyp is Relevant; 4) > 100 Polyps is Diagnostic and Merits Treatment; Tx is via Surgery with a Total Colectomy with Ileoanal Pull-Through. 6) Gardner's Syndrome (GS) is a FAP variant and has Soft-Tissue Neoplasia Predilection: Lipomas, Osteomas (Mandible and usually Incidental Finding via X-Ray Radiography), Cysts, Fibromas et al. SSx Likely: 1) GI Hemorrhage, 2) Osteomas, 3) Multiple Lipomas, 4) Supernumerary Teeth (Impactations); 5) Epidermal Inclusion Cyst(s); Dx is via Colonoscopy with Biopsy. Tx: 1) Sulindac, a NSAID Analgesic (COX Non-Specific), can induce Polyp Regression. 2) Surgery is an option if Refractory. 3) Colonoscopy q 1-2 Years. Mx is identical to FAP. Juvenile Polyposis (JP) is an Anomalous/Malformation of Tissue Endemic to the Site of Growth (Non-neoplastic and Low Association with Malignancy). There is a Genetic Component (APC Mutation Association) as FAP or HNPCC but no genuine Neoplastic Manifestation of Adenoma/Carcinoma. SSx: 1) Asymptomatic; 2) Painless Lower GI Bleeding in a Pediatric Subject (Most Common GI Bleeding Cause in Subjects > 1 Y); A Technetium Scan will be Negative (Mekell's Diverticulum is Positive); Dx will be via Biopsy (Adenoma Negative); Tx: No immediate Treatment. However, Close Monitoring is Recommended. 6) Other Colon Cancer and Associations with Polyposis Pathology: 1) Peutz-Jegher's Syndrome (PJS) has a Genetic Aetiology (Autosomal Dominant STK11 gene Mutation [Tumor Suppressor Gene]) and is Hyperpigmentation of Various Organs, namely Hands and Feet and/or Buccal/Oral Mucosa (Association with Colon Cancer). SSx: 1) Bowel Obstruction (Small Intestine Hamartomata/Polps), 2) Hyperpigmented Macules (Spots). Dx is made Clinically. Tx is reserved for Complications thereof. 2) Turcot's Syndrome (TS) is a Neoplastic Syndrome (Brain tumor-polyposis syndrome/Glioma-Polyposis Syndrome) with an Increased Risk for Colon Cancer (Association with Brain Cancer [Gliomas]). Ax: 1) APC Gene Association or 2) MMR Gene. SSx: 1) Cafe-Au-Lait Skin Pigmentation Pattern. 2) Gliomas (Amnesia, Seizures, Dyskinesia), 3) Polyps (GI Bleeding). 4) Hyperpigmented, Flat Patches/Lesions on the Skin; Dx: Genetic Testing; Tx: Symptomatic Treatment. Goodness, Neoplasia is a world of it own yet medically blatant as in these Associations. My first Aetiology of Malignancy Diagnosis, Peutz-Jegher's Syndrome, was Spared today, but DNA Assessment is just mysterious and complex, herein warranted further. MD Paul Bolin, du hast recht. Man kann Gesundheit schuetzen aber nicht wollen tun wahrscheinlich. Heil!

[@moshfeqkhan4576]

Excellent Dr Paul

[@giobasta6918]

I love your videos! Keep this up!

[@najlaatchalabi6470]

I feel that I want to great you after each lecture... coz I feel like its live lecture from excellent profetinal lecturer... I did not undrestand medicine before like when I hear you... Thank you

[@munvanezadavid6240]

thanks a lot Dr.

[@fatemaatia4385]

very useful videos ,thank u

[@dodokwak]

thank you.

[@vagus2736]

Wow, finally understand all the genetics related to Colon Cancer

[@richardmartinez-yp8ff]

Wow, finally understand all the genetics related to Colon Cancer

[@AlphabetNumbers]

Nice bro ❤❤

[@sujah100]

niz one :)

[@richardmartinez-yp8ff]

niz one :)