ASGE Recognized Industry Associate (ARIA) Training Program for Regeneron and Sanofi | June 2023-GI Tract in Disease_Large Intestine_Lower GI Bleeding_Colorectal Cancer

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This document discusses various diseases and conditions related to the gastrointestinal (GI) tract, focusing on colorectal cancer, lower GI bleeding, and diverticulosis.<br /><br />Colorectal cancer is a common cancer that affects the colon or rectum. The natural history of this cancer involves the progression from hyperproliferation to adenomatous polyps, high-grade dysplasia, and eventually invasive cancer. Clinical presentation can vary from asymptomatic to symptoms and signs suggestive of cancer, or emergent cases with obstruction or peritonitis. Screening for colorectal cancer is recommended for individuals aged 45 and above, those with a family history or inherited colorectal cancer syndrome, and those with inflammatory bowel disease. Screening tests include fecal occult blood tests, flexible sigmoidoscopy, colonoscopy, CT colonography, and stool DNA tests. Diagnosis is typically done through colonoscopy.<br /><br />The treatment for localized colorectal cancer involves surgical resection, while metastatic tumors require chemotherapy and palliative care.<br /><br />Lower GI bleeding refers to bleeding that originates beyond the ligament of Treitz. Symptoms include hematochezia (bright red blood per rectum), melena (black, tarry stools), symptomatic anemia, lightheadedness, syncope, shortness of breath, and chest pain. Causes of lower GI bleeding can include anatomic, vascular, inflammatory, or malignant conditions. Management typically involves volume resuscitation and the exclusion of upper GI bleeding through tests such as nasogastric lavage and upper endoscopy. The bleeding source can be identified and treated through colonoscopy with techniques such as hemoclipping, argon plasma coagulation, or epinephrine injection.<br /><br />Diverticulosis is the presence of outpouchings in the colon, which usually remains asymptomatic. Complications of diverticulosis include diverticulitis and diverticular bleeding. Diverticulitis is inflammation of a diverticulum that may present with left-sided abdominal pain, fever, and an elevated white blood cell count. Diagnosis is typically done using computed tomography (CT) scans. Treatment depends on the severity and can involve antibiotics, image-guided intervention, or surgery. Diverticular bleeding occurs when an artery erodes into the base of a diverticulum, causing painless rectal bleeding. Treatment options include colonoscopy, angiography, or surgery.<br /><br />Hemorrhoids are swollen veins in the anal canal and can cause discomfort. Diagnosis can be done through rectal examination, anoscopy, or colonoscopy. Treatment options include conservative measures to avoid constipation, as well as topical steroids, sitz baths, rubber band ligation, sclerotherapy, or surgery (hemorrhoidectomy).

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John Martin, MD, FASGE

Keywords

colorectal cancer

lower GI bleeding

diverticulosis

screening tests

colonoscopy

metastatic tumors

hematochezia

melena

diverticulitis

hemorrhoids