ASGE Recognized Industry Associate (ARIA) Training Program OPEN | March 2023-9_GI Tract in Disease_Large Intestine_Lower GI Bleeding_Colorectal Cancer

9_GI Tract in Disease_Large Intestine_Lower GI Bleeding_Colorectal Cancer_Diverticulosis

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The document discusses various diseases and conditions related to the gastrointestinal tract, specifically focusing on colorectal cancer, lower gastrointestinal bleeding, and diverticulosis. Colorectal cancer is one of the most common cancers in the US, primarily affecting the colon and rectum. The natural history of colorectal cancer involves the development of adenomatous polyps, high-grade dysplasia, and eventually invasive cancer. Clinical presentation can vary from asymptomatic to presenting with obstruction or peritonitis. Screening for colorectal cancer is recommended for individuals aged 45 and older, those with a family history or inherited colorectal cancer syndrome, and those with inflammatory bowel disease.<br /><br />Lower gastrointestinal bleeding commonly originates beyond the ligament of Treitz and can present with symptoms such as bright red blood per rectum (hematochezia), black, tarry stools (melena), anemia, lightheadedness, and chest pain. Causes of lower gastrointestinal bleeding can be anatomical, vascular, inflammatory, or due to malignancy, with common causes including diverticulosis, angiodysplasia, ischemic colitis, and colon cancer. Management includes volume resuscitation and excluding upper gastrointestinal bleeding through techniques such as nasogastric lavage and upper endoscopy. Colonoscopy with hemostasis procedures like hemoclipping and argon plasma coagulation can be used to treat bleeding diverticulum, post-polypectomy bleeding, angiodysplasia, hemorrhoids, and radiation proctitis.<br /><br />Diverticulosis refers to outpouchings of the colonic mucosa and submucosa, typically found incidentally on diagnostic tests. Complications of diverticulosis include diverticulitis and diverticular bleeding. Diverticulitis is inflammation of a diverticulum and can present with left-sided abdominal pain, fever, and elevated white blood cell count. Diagnosis of diverticulitis is typically done through computed tomography (CT) scan, and treatment may involve antibiotics and, in complicated cases, interventional radiology or surgery. Diverticular bleeding occurs when an artery erodes into the base of a diverticulum, resulting in painless rectal bleeding. Treatment options for diverticular bleeding include colonoscopy, angiography, and surgery.<br /><br />The document also briefly mentions hemorrhoids, which are swollen veins in the anal canal. They can be internal or external and can be caused by factors such as advanced age, pregnancy, pelvic tumors, prolonged sitting, straining, and chronic constipation. Diagnosis is typically done through rectal examination, anoscopy, or colonoscopy. Treatment options range from conservative measures such as avoiding constipation and sitz baths to procedures like rubber band ligation, sclerotherapy, and surgery (hemorrhoidectomy).

Keywords

gastrointestinal tract

colorectal cancer

lower gastrointestinal bleeding

diverticulosis

adenomatous polyps

invasive cancer

screening

diverticulitis

hemorrhoids

chronic constipation