Sporadic (Nonhereditary) Colorectal Cancer: Introduction
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Jemds.Com Case Report
Jemds.com Case Report RIGHT SIDED SIGMOID COLON AND REDUNDANT DESCENDING COLON ON CONVENTIONAL AND CT IMAGING Mandeep Singh1, Madhan Kumar2, Daisy Gupta3 1Junior Resident, Department of Radiodiagnosis, Government Medical College, Amritsar, Punjab, India. 2Junior Resident, Department of Radiodiagnosis, Government Medical College, Amritsar, Punjab, India. 3Assistant Professor, Department of Radiodiagnosis, Government Medical College, Amritsar, Punjab, India. HOW TO CITE THIS ARTICLE: Singh M, Kumar M, Gupta D. Right sided sigmoid colon and redundant descending colon on conventional and CT imaging. J. Evolution Med. Dent. Sci. 2018;7(44):5617-5620, DOI: 10.14260/jemds/2018/1073 CASE PRESENTATION Investigations A 62-year-old male presented with history of severe On Plain X-Ray Abdomen constipation, abdominal distension, haemorrhoids and blood No abnormal air-fluid levels were seen. There were no in stool in surgical OPD of Guru Nanak Dev Hospital, abnormal radio-opaque shadows seen. Bilateral psoas Amritsar. The patient was referred for barium studies of shadows and soft tissue shadows were identified as normal. colon, which showed a loop of colon in pelvic region (at normal location of ileal loops) and redundant and long On Barium Enema descending colon extending across midline to reach hepatic After filling the rectum, the contrast was identified as filling flexure on right and continuing as sigmoid colon on right side. the sigmoid colon, which was present anomalously towards Transverse colon and ascending colon were normal in length the right side. Filling of barium outlined the extension of and position. On CECT abdomen of the patient, a long colon from sigmoid on right side with coiling in right iliac segment of descending colon was identified. -
The Herbivore Digestive System Buffalo Zebra
The Herbivore Digestive System Name__________________________ Buffalo Ruminant: The purpose of the digestion system is to ______________________________ _____________________________. Bacteria help because they can digest __________________, a sugar found in the cell walls of________________. Zebra Non- Ruminant: What is the name for the largest section of Organ Color Key a ruminant’s Mouth stomach? Esophagus __________ Stomach Small Intestine Cecum Large Intestine Background Information for the Teacher Two Strategies of Digestion in Hoofed Mammals Ruminant Non‐ruminant Representative species Buffalo, cows, sheep, goats, antelope, camels, Zebra, pigs, horses, asses, hippopotamus, rhinoceros giraffes, deer Does the animal Yes, regurgitation No regurgitation regurgitate its cud to Grass is better prepared for digestion, as grinding Bacteria can not completely digest cell walls as chew material again? motion forms small particles fit for bacteria. material passes quickly through, so stool is fibrous. Where in the system do At the beginning, in the rumen Near the end, in the cecum you find the bacteria This first chamber of its four‐part stomach is In this sac between the two intestines, bacteria digest that digest cellulose? large, and serves to store food between plant material, the products of which pass to the rumination and as site of digestion by bacteria. bloodstream. How would you Higher Nutrition Lower Nutrition compare the nutrition Reaps benefits of immediately absorbing the The digestive products made by the bacteria are obtained via digestion? products of bacterial digestion, such as sugars produced nearer the end of the line, after the small and vitamins, via the small intestine. intestine, the classic organ of nutrient absorption. -
Does Liver Cirrhosis Affect the Surgical Outcome of Primary Colorectal
Cheng et al. World Journal of Surgical Oncology (2021) 19:167 https://doi.org/10.1186/s12957-021-02267-6 RESEARCH Open Access Does liver cirrhosis affect the surgical outcome of primary colorectal cancer surgery? A meta-analysis Yu-Xi Cheng†, Wei Tao†, Hua Zhang, Dong Peng* and Zheng-Qiang Wei Abstract Purpose: The purpose of this meta-analysis was to evaluate the effect of liver cirrhosis (LC) on the short-term and long-term surgical outcomes of colorectal cancer (CRC). Methods: The PubMed, Embase, and Cochrane Library databases were searched from inception to March 23, 2021. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of enrolled studies, and RevMan 5.3 was used for data analysis in this meta-analysis. The registration ID of this current meta-analysis on PROSPERO is CRD42021238042. Results: In total, five studies with 2485 patients were included in this meta-analysis. For the baseline information, no significant differences in age, sex, tumor location, or tumor T staging were noted. Regarding short-term outcomes, the cirrhotic group had more major complications (OR=5.15, 95% CI=1.62 to 16.37, p=0.005), a higher re- operation rate (OR=2.04, 95% CI=1.07 to 3.88, p=0.03), and a higher short-term mortality rate (OR=2.85, 95% CI=1.93 to 4.20, p<0.00001) than the non-cirrhotic group. However, no significant differences in minor complications (OR= 1.54, 95% CI=0.78 to 3.02, p=0.21) or the rate of intensive care unit (ICU) admission (OR=0.76, 95% CI=0.10 to 5.99, p=0.80) were noted between the two groups. -
The American Society of Colon and Rectal Surgeons' Clinical Practice
CLINICAL PRACTICE GUIDELINES The American Society of Colon and Rectal Surgeons’ Clinical Practice Guideline for the Evaluation and Management of Constipation Ian M. Paquette, M.D. • Madhulika Varma, M.D. • Charles Ternent, M.D. Genevieve Melton-Meaux, M.D. • Janice F. Rafferty, M.D. • Daniel Feingold, M.D. Scott R. Steele, M.D. he American Society of Colon and Rectal Surgeons for functional constipation include at least 2 of the fol- is dedicated to assuring high-quality patient care lowing symptoms during ≥25% of defecations: straining, Tby advancing the science, prevention, and manage- lumpy or hard stools, sensation of incomplete evacuation, ment of disorders and diseases of the colon, rectum, and sensation of anorectal obstruction or blockage, relying on anus. The Clinical Practice Guidelines Committee is com- manual maneuvers to promote defecation, and having less posed of Society members who are chosen because they than 3 unassisted bowel movements per week.7,8 These cri- XXX have demonstrated expertise in the specialty of colon and teria include constipation related to the 3 common sub- rectal surgery. This committee was created to lead inter- types: colonic inertia or slow transit constipation, normal national efforts in defining quality care for conditions re- transit constipation, and pelvic floor or defecation dys- lated to the colon, rectum, and anus. This is accompanied function. However, in reality, many patients demonstrate by developing Clinical Practice Guidelines based on the symptoms attributable to more than 1 constipation sub- best available evidence. These guidelines are inclusive and type and to constipation-predominant IBS, as well. The not prescriptive. -
Crohn's Disease of the Colon
Gut, 1968, 9, 164-176 Gut: first published as 10.1136/gut.9.2.164 on 1 April 1968. Downloaded from Crohn's disease of the colon V. J. McGOVERN AND S. J. M. GOULSTON From the Royal Prince Alfred Hospital, Sydney, Australia The fact that Crohn's disease may involve the colon never affected unless there had been surgical inter- either initially or in association with small bowel ference. There was no overt manifestation of mal- disease is now firmly established due largely to the absorption in any of these patients. evidence presented by Lockhart-Mummery and In 18 cases the colon alone was involved. Five had Morson (1960, 1964) and Marshak, Lindner, and universal involvement, five total involvement with Janowitz (1966). This entity is clearly distinct from sparing of the rectum, two involvement of the ulcerative colitis and other forms of colonic disease. descending colon only, two the transverse colon only, Our own experience with this disorder reveals many and in the other four there was variable involvement similarities with that published from the U.K. and of areas of large bowel (Fig. 2). the U.S.A. Thirty patients with Crohn's disease involving the large bowel were seen at the Royal CLINICAL FEATURES Prince Alfred Hospital during the last decade, the majority during the past five years. The criteria for The age incidence varied from 6 to 69 years when the inclusion were based on histological examination of patient was first seen, the majority being between the operative specimens in 28 and on clinical and radio- ages of 11 and 50. -
IV Lidocaine for Analgesia in Renal Colic
UAMS Journal Club Summary October 2017 Drs. Bowles and efield Littl Faculty Advisor: Dr. C Eastin IV Lidocaine for Analgesia in Renal Colic Clinical Bottom Line Low-dose IV lidocaine could present a valuable option for treatment of pain and nausea associated with renal colic as an adjunct or alternative to opioids as it has relative minimal cost, side effects, and addictive potential. However, the data does not show any difference in lidocaine as a replacement or an adjunct to morphine. Higher quality studies showing a benefit will be needed before we should consider routine use of lidocaine in acute renal colic. PICO Question P = Adult ED patients with signs/symptoms of renal colic I = IV Lidocaine (1.5 mg/kg) with or without IV Morphine (0.1 mg/kg) C = placebo with or without IV Morphine (0.1mg/kg) O = Pain, nausea, side effects Background Renal colic affects 1.2 million people and accounts for 1% of ED visits, with symptom control presenting one of the biggest challenges in ED management. Classic presentation of acute renal colic is sudden onset of pain radiating from flank to lower extremities and usually accompanied by microscopic hematuria, nausea, and vomiting. Opioid use +/- ketorolac remains standard practice for pain control, but the use of narcotics carries a significant side effect profile that is often dose- dependent. IV lidocaine has been shown to have clinical benefits in settings such as postoperative pain, neuropathic pain, refractory headache, and post-stroke pain syndrome. Given the side effects of narcotics, as well as the current opioid epidemic, alternatives to narcotics are gaining populatiry. -
Diagnostic Approach to Chronic Constipation in Adults NAMIRAH JAMSHED, MD; ZONE-EN LEE, MD; and KEVIN W
Diagnostic Approach to Chronic Constipation in Adults NAMIRAH JAMSHED, MD; ZONE-EN LEE, MD; and KEVIN W. OLDEN, MD Washington Hospital Center, Washington, District of Columbia Constipation is traditionally defined as three or fewer bowel movements per week. Risk factors for constipation include female sex, older age, inactivity, low caloric intake, low-fiber diet, low income, low educational level, and taking a large number of medications. Chronic constipa- tion is classified as functional (primary) or secondary. Functional constipation can be divided into normal transit, slow transit, or outlet constipation. Possible causes of secondary chronic constipation include medication use, as well as medical conditions, such as hypothyroidism or irritable bowel syndrome. Frail older patients may present with nonspecific symptoms of constipation, such as delirium, anorexia, and functional decline. The evaluation of constipa- tion includes a history and physical examination to rule out alarm signs and symptoms. These include evidence of bleeding, unintended weight loss, iron deficiency anemia, acute onset constipation in older patients, and rectal prolapse. Patients with one or more alarm signs or symptoms require prompt evaluation. Referral to a subspecialist for additional evaluation and diagnostic testing may be warranted. (Am Fam Physician. 2011;84(3):299-306. Copyright © 2011 American Academy of Family Physicians.) ▲ Patient information: onstipation is one of the most of 1,028 young adults, 52 percent defined A patient education common chronic gastrointes- constipation as straining, 44 percent as hard handout on constipation is 1,2 available at http://family tinal disorders in adults. In a stools, 32 percent as infrequent stools, and doctor.org/037.xml. -
Are You Ready for ICD-10-PCS? Expert Tips, Tools, and Guidance to Make the Transition Simple
Are You Ready for ICD-10-PCS? Expert Tips, Tools, and Guidance to Make the Transition Simple By Amy Crenshaw Pritchett February 19, 2014 1 Agenda In this webinar: Expand your understanding of ICD-10-PCS with can’t miss ICD-10-PCS coding conventions & guidelines. Understand the basic differences between ICD-9-CM Volume 3 and ICD-10-PCS. Learn code structure, organization, & characters: Step 1 to coding section “0” ICD-10-PCS? Pinpoint the body system. To build your ICD-10-PCS code, you must identify the root operation. Study 7 options when assigning your PCS code’s 5th character. Master how to determine the device value for your PCS code’s character. Raise your awareness of unique ICD-10-PCS challenges pertaining to documentation and specificity: Prepare physicians now for more detailed transfusion notes under ICD- 10-PCS. Discover why writing “Right Carotid Endarterectomy” won’t be enough. Know where to find ICD-10-PCS tools, techniques, and best practices. 2 Understanding ICD-10-PCS ICD-10-PCS is a major departure from ICD-9-CM procedure coding, requiring you to know which root word applies. Effective October 1, 2014, this procedure coding system will be used to collect data, determine payment, and support the electronic health record for all inpatient procedures performed in the US. 3 Gear Up for ICD-10-PCS This procedure coding system is starkly different from ICD-9-CM procedure coding: Every ICD-10-PCS code has seven characters, each character defining one aspect of the procedure performed. For instance, not correctly identifying your physician’s approach – the fifth character – and not being able to distinguish between similar root operations can throw off your claims accuracy! 4 Converting to ICD-10-PCS Have your inpatient coders and clinical documentation specialists begun preparing for ICD-10-PCS yet? That’s why we’re here today … to ease your transition from ICD-9-CM procedure coding to ICD-10-PCS. -
Acute Abdomen
Acute abdomen: Shaking down the Acute abdominal pain can be difficult to diagnose, requiring astute assessment skills and knowledge of abdominal anatomy 2.3 ANCC to discover its cause. We show you how to quickly and accurately CONTACT HOURS uncover the clues so your patient can get the help he needs. By Amy Wisniewski, BSN, RN, CCM Lehigh Valley Home Care • Allentown, Pa. The author has disclosed that she has no significant relationships with or financial interest in any commercial companies that pertain to this educational activity. NIE0110_124_CEAbdomen.qxd:Deepak 26/11/09 9:38 AM Page 43 suspects Determining the cause of acute abdominal rapidly, indicating a life-threatening process, pain is often complex due to the many or- so fast and accurate assessment is essential. gans in the abdomen and the fact that pain In this article, I’ll describe how to assess a may be nonspecific. Acute abdomen is a patient with acute abdominal pain and inter- general diagnosis, typically referring to se- vene appropriately. vere abdominal pain that occurs suddenly over a short period (usually no longer than What a pain! 7 days) and often requires surgical interven- Acute abdominal pain is one of the top tion. Symptoms may be severe and progress three symptoms of patients presenting in www.NursingMadeIncrediblyEasy.com January/February 2010 Nursing made Incredibly Easy! 43 NIE0110_124_CEAbdomen.qxd:Deepak 26/11/09 9:38 AM Page 44 the ED. Reasons for acute abdominal pain Visceral pain can be divided into three Your patient’s fall into six broad categories: subtypes: age may give • inflammatory—may be a bacterial cause, • tension pain. -
Acute Onset Flank Pain-Suspicion of Stone Disease (Urolithiasis)
Date of origin: 1995 Last review date: 2015 American College of Radiology ® ACR Appropriateness Criteria Clinical Condition: Acute Onset Flank Pain—Suspicion of Stone Disease (Urolithiasis) Variant 1: Suspicion of stone disease. Radiologic Procedure Rating Comments RRL* CT abdomen and pelvis without IV 8 Reduced-dose techniques are preferred. contrast ☢☢☢ This procedure is indicated if CT without contrast does not explain pain or reveals CT abdomen and pelvis without and with 6 an abnormality that should be further IV contrast ☢☢☢☢ assessed with contrast (eg, stone versus phleboliths). US color Doppler kidneys and bladder 6 O retroperitoneal Radiography intravenous urography 4 ☢☢☢ MRI abdomen and pelvis without IV 4 MR urography. O contrast MRI abdomen and pelvis without and with 4 MR urography. O IV contrast This procedure can be performed with US X-ray abdomen and pelvis (KUB) 3 as an alternative to NCCT. ☢☢ CT abdomen and pelvis with IV contrast 2 ☢☢☢ *Relative Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate Radiation Level Variant 2: Recurrent symptoms of stone disease. Radiologic Procedure Rating Comments RRL* CT abdomen and pelvis without IV 7 Reduced-dose techniques are preferred. contrast ☢☢☢ This procedure is indicated in an emergent setting for acute management to evaluate for hydronephrosis. For planning and US color Doppler kidneys and bladder 7 intervention, US is generally not adequate O retroperitoneal and CT is complementary as CT more accurately characterizes stone size and location. This procedure is indicated if CT without contrast does not explain pain or reveals CT abdomen and pelvis without and with 6 an abnormality that should be further IV contrast ☢☢☢☢ assessed with contrast (eg, stone versus phleboliths). -
The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Inherited Polyposis Syndromes Daniel Herzig, M.D
CLINICAL PRACTICE GUIDELINES The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Inherited Polyposis Syndromes Daniel Herzig, M.D. • Karin Hardimann, M.D. • Martin Weiser, M.D. • Nancy Yu, M.D. Ian Paquette, M.D. • Daniel L. Feingold, M.D. • Scott R. Steele, M.D. Prepared by the Clinical Practice Guidelines Committee of The American Society of Colon and Rectal Surgeons he American Society of Colon and Rectal Surgeons METHODOLOGY (ASCRS) is dedicated to ensuring high-quality pa- tient care by advancing the science, prevention, and These guidelines are built on the last set of the ASCRS T Practice Parameters for the Identification and Testing of management of disorders and diseases of the colon, rectum, Patients at Risk for Dominantly Inherited Colorectal Can- and anus. The Clinical Practice Guidelines Committee is 1 composed of society members who are chosen because they cer published in 2003. An organized search of MEDLINE have demonstrated expertise in the specialty of colon and (1946 to December week 1, 2016) was performed from rectal surgery. This committee was created to lead interna- 1946 through week 4 of September 2016 (Fig. 1). Subject tional efforts in defining quality care for conditions related headings for “adenomatous polyposis coli” (4203 results) to the colon, rectum, and anus, in addition to the devel- and “intestinal polyposis” (445 results) were included, us- opment of Clinical Practice Guidelines based on the best ing focused search. The results were combined (4629 re- available evidence. These guidelines are inclusive and not sults) and limited to English language (3981 results), then prescriptive. -
Gastrointestinal System History of “Abdominal Distension and Bloating”
Medicine Hx - Gastrointestinal System History of “Abdominal Distension and Bloating” A. Overview: Abdominal distension may be generalized or may be localized to a discrete mass or enlargement of an organ. The main causes of generalized abdominal distension are easily remembered by the five Fs: • Fat (obesity) • Faeces (constipation) • Fetus (pregnancy) • Flatus (gastrointestinal) • Fluid (ascites) A feeling of swelling (bloating) may be a result of excess gas or a hypersensitive intestinal tract (as occurs in the irritable bowel syndrome). Persistent swelling can be due to ascitic fluid accumulation . B. Differential diagnosis: DDx What support this diagnosis? “gastrointestinal” Risk Factors: Excessive Alcohol Consumption, Family History Of Cystic Fibrosis Or Malabsorption , Intestinal Surgery, Use Of Malabsorption Medication (Laxatives) Typical Symptoms: Bloating, Cramping ,Gas ,Fatty Stool, Muscle Wasting, Weight Loss Complication: Anemia , Gall Stone, Kidney Stones , Malnutrition “Hepatic ” Risk Factors: : Excessive Alcohol Consumption , Chronic Infection With Hepatitis B, C, Or D , Cystic Fibrosis Cirrhosis Typical Symptoms: Jaundice , Fatigue , Ascites , Swelling In Your Leg , Bleeding And Bruising Easily Complication: edema , Splenomegaly , Bleeding , “Cardiac” Risk Factors: Hypertension, Physical Activity, Diabetes, Smoking, Family History. Congestive Heart Typical Symptoms: Angina , Shortness Of Breath ,Fluid Retention failure And Swelling , Exercise Intolerance Complication: Kidney Damage , Heart Valve Problem, Liver Damage , Stroke “Renal” Nephrotic Syndrome Risk factors: Diabetes , Lupus , HIV , Hepatitis B And C, Some medications (NSAID) Typical Symptoms: Swelling , Foamy Urine , Weight Gain Complication: Blood Clots , Poor Nutrition , Acute Kidney Failure C. Questions to Ask the Patient with this presentation Questions What you think about … ! Onset Acute decompensation of liver cirrhosis, malignancy and Is it Sudden? portal or spelenic vein thrombosis ).