Curbside Consultation of the Colon
49 Clinical Questions
Herausgeber: Cash, Brookes
Curbside Consultation of the Colon
49 Clinical Questions
Herausgeber: Cash, Brookes
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Curbside Consultation of the Colon: 49 Clinical Questions provides quick and direct answers to the thorny questions commonly posed during a "curbside consultation" between colleagues.
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Curbside Consultation of the Colon: 49 Clinical Questions provides quick and direct answers to the thorny questions commonly posed during a "curbside consultation" between colleagues.
Hinweis: Dieser Artikel kann nur an eine deutsche Lieferadresse ausgeliefert werden.
Hinweis: Dieser Artikel kann nur an eine deutsche Lieferadresse ausgeliefert werden.
Produktdetails
- Produktdetails
- Verlag: CRC Press
- Seitenzahl: 214
- Erscheinungstermin: 15. September 2008
- Englisch
- Abmessung: 254mm x 178mm x 12mm
- Gewicht: 413g
- ISBN-13: 9781556428319
- ISBN-10: 1556428316
- Artikelnr.: 23068314
- Verlag: CRC Press
- Seitenzahl: 214
- Erscheinungstermin: 15. September 2008
- Englisch
- Abmessung: 254mm x 178mm x 12mm
- Gewicht: 413g
- ISBN-13: 9781556428319
- ISBN-10: 1556428316
- Artikelnr.: 23068314
Brooks D. Cash, MD, FACP, FACG is the Chief of Gastroenterology and the Colon Health Initiative at the National Naval Medical Center in Bethesda, Maryland. Dr. Cash received his medical degree from the Uniformed Services University of Medicine (USUHS) in Bethesda, and completed his internal medicine residency and gastroenterology fellowship training at the National Naval Medical Center. Board certified in gastroenterology, he currently serves as an Associate Professor of Medicine at USUHS. Active in research, his main areas of interest are wide ranging and consist primarily of functional gastrointestinal disorders, acid peptic disorders, and colorectal cancer screening. He currently oversees multiple ongoing protocols in all of these areas and, as a leader in the field of CT colonography, he currently oversees multiple studies designed to clarify and expand the practice of this new technology. He is the author of numerous book chapters, review articles, and peer-reviewed manuscripts; is actively involved in committee work for various gastroenterology professional societies; and serves on the editorial boards of multiple professional journals.
CONTENTS Dedication Acknowledgments About the Editor Contributing Authors Preface Foreword by Carol Burke
MD Introduction Section I: COLON CANCER SCREENING Question 1 A 46-Year-Old African American Man Who Has No Alarm Features or Symptoms Requests a Screening Colonoscopy. Is This Appropriate? Jason Taylor
MD; and Philip Schoenfeld
MD
MSEd
MSc (Epi) Question 2 What Pathologic Analysis Do I Need to Pursue in a 38-Year-Old Man With Cecal Cancer Whose Family History Is Suspicious for Hereditary Nonpolyposis Colon Cancer? B. Joe Elmunzer
MD; and Philip Schoenfeld
MD
MSEd
MSc (Epi) Question 3 How Do You Respond to Patients Wanting to Take Aspirin
Calcium
or Other Medications as Prophylaxis for Colorectal Cancer? Is There Any Evidence That They Work? Amit Singal
MD
and Philip Schoenfeld
MD
MSEd
MSc (Epi) Question 4 My Patient Had a 3-cm
Sessile Tubulovillous Adenoma on the Sigmoid That I Removed Piecemeal. The Pathology Lab Can't Verify Clear Margin. What Should I Recommend to the Patient? Brennan Spiegel
MD
MSHS
and Inder Singh
MD Question 5 The Board of Directors of My Hospital Wants to Know the Current Colorectal Cancer Screening Options and Will Go With Whatever I Recommend. What Does the Evidence Say Is the Best Colorectal Cancer Screening Regimen? Brennan Spiegel
MD
MSHS
and Inder Singh
MD Question 6 My Patient Had a 13-mm Tubular Adenoma Removed From Her Colon. What Kind of Surveillance Do I Need To Recommend? Would It Change Things if She Were 80 Years Old Without Co-Morbidities? Brooks D. Cash
MD
FACP
FACG Question 7 I Have a Patient Whose Brother
Mother
and Maternal Uncle All Had Colon Cancer Diagnosed Before the Age of 45. Does My Patient Have Hereditary Nonpolyposis Colorectal Cancer Syndrome
and
if He Does
What Should I Advise? Brooks D. Cash
MD
FACP
FACG Question 8 What Do I Need to Tell My Inflammatory Bowel Disease Patients About Their Risk for Colon Cancer and How Should I Perform Surveillance Colonoscopy in These Patients? Francis A. Farraye
MD
MSc Question 9 What Do I Tell the Surgeons Who Insist on Annual Colonoscopies for Patients With Cured Colon Cancer
Even for Those 5 to 10 Years Past Therapy? Brooks D. Cash
MD
FACP
FACG Question 10 The Pathologists Keep Sending Me Reports About Serrated Adenomas. What Is a Serrated Adenoma and What Do I Tell My Patients in Terms of Follow-up? Christopher S. Huang
MD; Francis A. Farraye
MD
MSc
and Michael J. O'Brien
MD
MPH Question 11 My Patient Was Found to Have About 50 Hyperplastic Polyps Ranging From 5 to 15 mm. What Condition Do I Need to Think About and How Should I Manage This Patient? Christopher S. Huang
MD; Francis A. Farraye
MD
MSc; and Michael J. O'Brien
MD
MPH Section II: CONSTIPATION Question 12 What Should I Suspect When I See Melanosis Coli and What Is Its Clinical Relevance? Erica Roberson
MD
and Arnold Wald
MD Question 13 What Should Be the Sequence of Investigations for a Patient Who Is Being Considered for Colectomy Due to Chronic Constipation? Erica Roberson
MD
and Arnold Wald
MD Question 14 What Do I Tell My Primary Care Colleagues About Chronic Constipation and the Risk of Colorectal Cancer? Erica Roberson
MD
and Arnold Wald
MD Question 15 What Diagnostic Tests Are Recommended for the Evaluation of Chronic Constipation and What Is Their Yield? Erica Roberson
MD
and Arnold Wald
MD Question 16 How Efficacious Are the Therapies for Chronic Constipation? I Have Heard About Several New Drugs for Constipation-Have They Been Shown to Be Cost Effective? Erica Roberson
MD
and Arnold Wald
MD Question 17 When Should a Patient Complaining of Chronic Constipation Be Sent for Anorectal Manometry? Erica Roberson
MD
and Arnold Wald
MD Question 18 A Patient Asks About Biofeedback Therapy for Her Constipation Symptoms and Wants to Know What Is Involved. What Do I Tell Her? Erica Roberson
MD
and Arnold Wald
MD Question 19 What Are the Emerging Therapeutic Agents for Constipation and How Do They Modulate Colonic Motility? Brooks D. Cash
MD
FACP
FACG Question 20 What Do I Tell My Colleagues Who Are Concerned About Neuropathic Changes From Laxative Use? Richard Saad
MD Section III: DIARRHEA Question 21 What Colonic Infections Are Associated With AIDS? Brian Mulhall
MD Question 22 We See Many Patients With Bone Marrow Transplants. How Do We Recognize and Treat Graft-Versus-Host Disease in the Colon? How Do We Make Sure We Are Not Missing CMV Colitis? Brian Mulhall
MD Question 23 Many of My Patients Want To Go With Natural Therapies. Where Do Probiotics Fit in the Management of Irritable Bowel Syndrome? Brooks D. Cash
MD
FACP
FACG Question 24 What Is the Evidence for Antibiotics as a Therapy for Irritable Bowel Syndrome? Brian Mulhall
MD Question 25 A Patient in the Midst of an Inflammatory Bowel Disease Flare Also Was Positive for Clostridium difficile. How Often Does This Happen and What's the Best Way to Manage This Scenario? Brian Mulhall
MD Question 26 The Nursing Staff Doesn't Know What to Do for a 72-Hour Stool Collection as Part of a Diarrhea Workup. What Do I Need to Tell Them to Get the Answers I Need? Brian Mulhall
MD Question 27 I Want to Use Alosetron for a Woman With IBS-D. What Do I Need to Tell Her About the Risks and Outcomes Associated With Ischemic Colitis and This Medicine? What Is the Best Way to Document This Discussion? Richard Saad
MD Question 28 For Patients Who Report Persistent Diarrhea
What Is Considered Chronic
When Do I Need to Begin a Workup
and What Does That Workup Involve? Richard Saad
MD Question 29 My Patient With Collagenous Colitis Developed a Black Tongue With Bismuth. What Other Therapeutic Options Do I Have? Richard Saad
MD Section IV: PERIANAL DISORDERS Question 30 What Are the Treatment Options for a Patient With Metastatic Colon Cancer Who Has a Malignant Sigmoid Stricture? Brooks D. Cash
MD
FACP
FACG Question 31 What Should I Be Doing With My Patients Who Have Anal Fissures? Brian E. Lacy
MD
PhD Question 32 What Is Pruritus Ani and How Is It Managed? Brian E. Lacy
MD
PhD Question 33 What Is Proctalgia Fugax and How Is It Managed? Brian E. Lacy
MD
PhD Question 34 What Types of Procedures and Therapies Can I Use on Hemorrhoids Before Sending a Patient to the Surgeon? Brian E. Lacy
MD
PhD Question 35 What Tips Can I Give My Surgical Colleagues Who Are Seeing Patients With Pouchitis? L. Campbell Levy
MD
and Corey A. Siegel
MD Question 36 A 74-Year-Old Man Who Is Status Post External Radiation Therapy for Prostate Cancer Now Presents With Hematochezia. What Should I Do Next? Can I Keep This From Recurring? Brian E. Lacy
MD
PhD Question 37 What Should Be the Sequence of Investigations for a Patient With Rectal Adenocarcinoma? Brian E. Lacy
MD
PhD Question 38 What Is Solitary Rectal Ulcer Syndrome? Brian E. Lacy
MD
PhD Question 39 What Is Rectal Prolapse? Brian E. Lacy
MD
PhD Section V: COLON POTPOURRI Question 40 The Emergency Room Is Calling About a Patient With Pneumatosis Coli. What Do I Need To Do? Inku Hwang
MD Question 41 What Is the Appropriate Evaluation for Fecal Incontinence? Inku Hwang
MD Question 42 The Admitting Housestaff Can't Figure Out Where to Admit Patients With Diverticulitis. What Can I Tell Them About This Condition? Inku Hwang
MD Question 43 What Should Be my Response to Patients Who Ask About Antibiotic Prophylaxis for Their Colonoscopies? If They Are Persistent
and Do Not Have an Indication
Is it OK to Acquiesce? Inku Hwang
MD Question 44 The Diabetes Clinic Wants a Lecture on the Effects of Diabetes on Colonic Motility. What Can I Tell Them in 5 Minutes or Less? Inku Hwang
MD Question 45 What Are the Adverse Effects of Nonsteroidal Anti-Inflammatory Drugs on the Colon and How Can They Be Mitigated? Scott L. Itzkowitz
DO
FACP Question 46 When Do I Need to Refer a Patient With Diverticular Bleeding for a Colectomy and What Tests Should Be Done Before This Happens? Scott L. Itzkowitz
DO
FACP Question 47 What Do I Tell a Patient Who I Just Diagnosed With Stage IIB Colon Cancer Regarding Treatment and Prognosis? Scott L. Itzkowitz
DO
FACP Question 48 The Ward Team Has a Patient With a Distended Abdomen and Increasing Gas-Filled Loops of Bowel on X-Ray. How Can I Help Them Recognize and Treat Colonic Pseudo-Obstruction (Ogilvie's Syndrome)? Scott L. Itzkowitz
DO
FACP Question 49 What Are the Various Manifestations of E. coli Infection of the Colon and How Should It Be Treated? Scott L. Itzkowitz
DO
FACP Index
MD Introduction Section I: COLON CANCER SCREENING Question 1 A 46-Year-Old African American Man Who Has No Alarm Features or Symptoms Requests a Screening Colonoscopy. Is This Appropriate? Jason Taylor
MD; and Philip Schoenfeld
MD
MSEd
MSc (Epi) Question 2 What Pathologic Analysis Do I Need to Pursue in a 38-Year-Old Man With Cecal Cancer Whose Family History Is Suspicious for Hereditary Nonpolyposis Colon Cancer? B. Joe Elmunzer
MD; and Philip Schoenfeld
MD
MSEd
MSc (Epi) Question 3 How Do You Respond to Patients Wanting to Take Aspirin
Calcium
or Other Medications as Prophylaxis for Colorectal Cancer? Is There Any Evidence That They Work? Amit Singal
MD
and Philip Schoenfeld
MD
MSEd
MSc (Epi) Question 4 My Patient Had a 3-cm
Sessile Tubulovillous Adenoma on the Sigmoid That I Removed Piecemeal. The Pathology Lab Can't Verify Clear Margin. What Should I Recommend to the Patient? Brennan Spiegel
MD
MSHS
and Inder Singh
MD Question 5 The Board of Directors of My Hospital Wants to Know the Current Colorectal Cancer Screening Options and Will Go With Whatever I Recommend. What Does the Evidence Say Is the Best Colorectal Cancer Screening Regimen? Brennan Spiegel
MD
MSHS
and Inder Singh
MD Question 6 My Patient Had a 13-mm Tubular Adenoma Removed From Her Colon. What Kind of Surveillance Do I Need To Recommend? Would It Change Things if She Were 80 Years Old Without Co-Morbidities? Brooks D. Cash
MD
FACP
FACG Question 7 I Have a Patient Whose Brother
Mother
and Maternal Uncle All Had Colon Cancer Diagnosed Before the Age of 45. Does My Patient Have Hereditary Nonpolyposis Colorectal Cancer Syndrome
and
if He Does
What Should I Advise? Brooks D. Cash
MD
FACP
FACG Question 8 What Do I Need to Tell My Inflammatory Bowel Disease Patients About Their Risk for Colon Cancer and How Should I Perform Surveillance Colonoscopy in These Patients? Francis A. Farraye
MD
MSc Question 9 What Do I Tell the Surgeons Who Insist on Annual Colonoscopies for Patients With Cured Colon Cancer
Even for Those 5 to 10 Years Past Therapy? Brooks D. Cash
MD
FACP
FACG Question 10 The Pathologists Keep Sending Me Reports About Serrated Adenomas. What Is a Serrated Adenoma and What Do I Tell My Patients in Terms of Follow-up? Christopher S. Huang
MD; Francis A. Farraye
MD
MSc
and Michael J. O'Brien
MD
MPH Question 11 My Patient Was Found to Have About 50 Hyperplastic Polyps Ranging From 5 to 15 mm. What Condition Do I Need to Think About and How Should I Manage This Patient? Christopher S. Huang
MD; Francis A. Farraye
MD
MSc; and Michael J. O'Brien
MD
MPH Section II: CONSTIPATION Question 12 What Should I Suspect When I See Melanosis Coli and What Is Its Clinical Relevance? Erica Roberson
MD
and Arnold Wald
MD Question 13 What Should Be the Sequence of Investigations for a Patient Who Is Being Considered for Colectomy Due to Chronic Constipation? Erica Roberson
MD
and Arnold Wald
MD Question 14 What Do I Tell My Primary Care Colleagues About Chronic Constipation and the Risk of Colorectal Cancer? Erica Roberson
MD
and Arnold Wald
MD Question 15 What Diagnostic Tests Are Recommended for the Evaluation of Chronic Constipation and What Is Their Yield? Erica Roberson
MD
and Arnold Wald
MD Question 16 How Efficacious Are the Therapies for Chronic Constipation? I Have Heard About Several New Drugs for Constipation-Have They Been Shown to Be Cost Effective? Erica Roberson
MD
and Arnold Wald
MD Question 17 When Should a Patient Complaining of Chronic Constipation Be Sent for Anorectal Manometry? Erica Roberson
MD
and Arnold Wald
MD Question 18 A Patient Asks About Biofeedback Therapy for Her Constipation Symptoms and Wants to Know What Is Involved. What Do I Tell Her? Erica Roberson
MD
and Arnold Wald
MD Question 19 What Are the Emerging Therapeutic Agents for Constipation and How Do They Modulate Colonic Motility? Brooks D. Cash
MD
FACP
FACG Question 20 What Do I Tell My Colleagues Who Are Concerned About Neuropathic Changes From Laxative Use? Richard Saad
MD Section III: DIARRHEA Question 21 What Colonic Infections Are Associated With AIDS? Brian Mulhall
MD Question 22 We See Many Patients With Bone Marrow Transplants. How Do We Recognize and Treat Graft-Versus-Host Disease in the Colon? How Do We Make Sure We Are Not Missing CMV Colitis? Brian Mulhall
MD Question 23 Many of My Patients Want To Go With Natural Therapies. Where Do Probiotics Fit in the Management of Irritable Bowel Syndrome? Brooks D. Cash
MD
FACP
FACG Question 24 What Is the Evidence for Antibiotics as a Therapy for Irritable Bowel Syndrome? Brian Mulhall
MD Question 25 A Patient in the Midst of an Inflammatory Bowel Disease Flare Also Was Positive for Clostridium difficile. How Often Does This Happen and What's the Best Way to Manage This Scenario? Brian Mulhall
MD Question 26 The Nursing Staff Doesn't Know What to Do for a 72-Hour Stool Collection as Part of a Diarrhea Workup. What Do I Need to Tell Them to Get the Answers I Need? Brian Mulhall
MD Question 27 I Want to Use Alosetron for a Woman With IBS-D. What Do I Need to Tell Her About the Risks and Outcomes Associated With Ischemic Colitis and This Medicine? What Is the Best Way to Document This Discussion? Richard Saad
MD Question 28 For Patients Who Report Persistent Diarrhea
What Is Considered Chronic
When Do I Need to Begin a Workup
and What Does That Workup Involve? Richard Saad
MD Question 29 My Patient With Collagenous Colitis Developed a Black Tongue With Bismuth. What Other Therapeutic Options Do I Have? Richard Saad
MD Section IV: PERIANAL DISORDERS Question 30 What Are the Treatment Options for a Patient With Metastatic Colon Cancer Who Has a Malignant Sigmoid Stricture? Brooks D. Cash
MD
FACP
FACG Question 31 What Should I Be Doing With My Patients Who Have Anal Fissures? Brian E. Lacy
MD
PhD Question 32 What Is Pruritus Ani and How Is It Managed? Brian E. Lacy
MD
PhD Question 33 What Is Proctalgia Fugax and How Is It Managed? Brian E. Lacy
MD
PhD Question 34 What Types of Procedures and Therapies Can I Use on Hemorrhoids Before Sending a Patient to the Surgeon? Brian E. Lacy
MD
PhD Question 35 What Tips Can I Give My Surgical Colleagues Who Are Seeing Patients With Pouchitis? L. Campbell Levy
MD
and Corey A. Siegel
MD Question 36 A 74-Year-Old Man Who Is Status Post External Radiation Therapy for Prostate Cancer Now Presents With Hematochezia. What Should I Do Next? Can I Keep This From Recurring? Brian E. Lacy
MD
PhD Question 37 What Should Be the Sequence of Investigations for a Patient With Rectal Adenocarcinoma? Brian E. Lacy
MD
PhD Question 38 What Is Solitary Rectal Ulcer Syndrome? Brian E. Lacy
MD
PhD Question 39 What Is Rectal Prolapse? Brian E. Lacy
MD
PhD Section V: COLON POTPOURRI Question 40 The Emergency Room Is Calling About a Patient With Pneumatosis Coli. What Do I Need To Do? Inku Hwang
MD Question 41 What Is the Appropriate Evaluation for Fecal Incontinence? Inku Hwang
MD Question 42 The Admitting Housestaff Can't Figure Out Where to Admit Patients With Diverticulitis. What Can I Tell Them About This Condition? Inku Hwang
MD Question 43 What Should Be my Response to Patients Who Ask About Antibiotic Prophylaxis for Their Colonoscopies? If They Are Persistent
and Do Not Have an Indication
Is it OK to Acquiesce? Inku Hwang
MD Question 44 The Diabetes Clinic Wants a Lecture on the Effects of Diabetes on Colonic Motility. What Can I Tell Them in 5 Minutes or Less? Inku Hwang
MD Question 45 What Are the Adverse Effects of Nonsteroidal Anti-Inflammatory Drugs on the Colon and How Can They Be Mitigated? Scott L. Itzkowitz
DO
FACP Question 46 When Do I Need to Refer a Patient With Diverticular Bleeding for a Colectomy and What Tests Should Be Done Before This Happens? Scott L. Itzkowitz
DO
FACP Question 47 What Do I Tell a Patient Who I Just Diagnosed With Stage IIB Colon Cancer Regarding Treatment and Prognosis? Scott L. Itzkowitz
DO
FACP Question 48 The Ward Team Has a Patient With a Distended Abdomen and Increasing Gas-Filled Loops of Bowel on X-Ray. How Can I Help Them Recognize and Treat Colonic Pseudo-Obstruction (Ogilvie's Syndrome)? Scott L. Itzkowitz
DO
FACP Question 49 What Are the Various Manifestations of E. coli Infection of the Colon and How Should It Be Treated? Scott L. Itzkowitz
DO
FACP Index
CONTENTS Dedication Acknowledgments About the Editor Contributing Authors Preface Foreword by Carol Burke
MD Introduction Section I: COLON CANCER SCREENING Question 1 A 46-Year-Old African American Man Who Has No Alarm Features or Symptoms Requests a Screening Colonoscopy. Is This Appropriate? Jason Taylor
MD; and Philip Schoenfeld
MD
MSEd
MSc (Epi) Question 2 What Pathologic Analysis Do I Need to Pursue in a 38-Year-Old Man With Cecal Cancer Whose Family History Is Suspicious for Hereditary Nonpolyposis Colon Cancer? B. Joe Elmunzer
MD; and Philip Schoenfeld
MD
MSEd
MSc (Epi) Question 3 How Do You Respond to Patients Wanting to Take Aspirin
Calcium
or Other Medications as Prophylaxis for Colorectal Cancer? Is There Any Evidence That They Work? Amit Singal
MD
and Philip Schoenfeld
MD
MSEd
MSc (Epi) Question 4 My Patient Had a 3-cm
Sessile Tubulovillous Adenoma on the Sigmoid That I Removed Piecemeal. The Pathology Lab Can't Verify Clear Margin. What Should I Recommend to the Patient? Brennan Spiegel
MD
MSHS
and Inder Singh
MD Question 5 The Board of Directors of My Hospital Wants to Know the Current Colorectal Cancer Screening Options and Will Go With Whatever I Recommend. What Does the Evidence Say Is the Best Colorectal Cancer Screening Regimen? Brennan Spiegel
MD
MSHS
and Inder Singh
MD Question 6 My Patient Had a 13-mm Tubular Adenoma Removed From Her Colon. What Kind of Surveillance Do I Need To Recommend? Would It Change Things if She Were 80 Years Old Without Co-Morbidities? Brooks D. Cash
MD
FACP
FACG Question 7 I Have a Patient Whose Brother
Mother
and Maternal Uncle All Had Colon Cancer Diagnosed Before the Age of 45. Does My Patient Have Hereditary Nonpolyposis Colorectal Cancer Syndrome
and
if He Does
What Should I Advise? Brooks D. Cash
MD
FACP
FACG Question 8 What Do I Need to Tell My Inflammatory Bowel Disease Patients About Their Risk for Colon Cancer and How Should I Perform Surveillance Colonoscopy in These Patients? Francis A. Farraye
MD
MSc Question 9 What Do I Tell the Surgeons Who Insist on Annual Colonoscopies for Patients With Cured Colon Cancer
Even for Those 5 to 10 Years Past Therapy? Brooks D. Cash
MD
FACP
FACG Question 10 The Pathologists Keep Sending Me Reports About Serrated Adenomas. What Is a Serrated Adenoma and What Do I Tell My Patients in Terms of Follow-up? Christopher S. Huang
MD; Francis A. Farraye
MD
MSc
and Michael J. O'Brien
MD
MPH Question 11 My Patient Was Found to Have About 50 Hyperplastic Polyps Ranging From 5 to 15 mm. What Condition Do I Need to Think About and How Should I Manage This Patient? Christopher S. Huang
MD; Francis A. Farraye
MD
MSc; and Michael J. O'Brien
MD
MPH Section II: CONSTIPATION Question 12 What Should I Suspect When I See Melanosis Coli and What Is Its Clinical Relevance? Erica Roberson
MD
and Arnold Wald
MD Question 13 What Should Be the Sequence of Investigations for a Patient Who Is Being Considered for Colectomy Due to Chronic Constipation? Erica Roberson
MD
and Arnold Wald
MD Question 14 What Do I Tell My Primary Care Colleagues About Chronic Constipation and the Risk of Colorectal Cancer? Erica Roberson
MD
and Arnold Wald
MD Question 15 What Diagnostic Tests Are Recommended for the Evaluation of Chronic Constipation and What Is Their Yield? Erica Roberson
MD
and Arnold Wald
MD Question 16 How Efficacious Are the Therapies for Chronic Constipation? I Have Heard About Several New Drugs for Constipation-Have They Been Shown to Be Cost Effective? Erica Roberson
MD
and Arnold Wald
MD Question 17 When Should a Patient Complaining of Chronic Constipation Be Sent for Anorectal Manometry? Erica Roberson
MD
and Arnold Wald
MD Question 18 A Patient Asks About Biofeedback Therapy for Her Constipation Symptoms and Wants to Know What Is Involved. What Do I Tell Her? Erica Roberson
MD
and Arnold Wald
MD Question 19 What Are the Emerging Therapeutic Agents for Constipation and How Do They Modulate Colonic Motility? Brooks D. Cash
MD
FACP
FACG Question 20 What Do I Tell My Colleagues Who Are Concerned About Neuropathic Changes From Laxative Use? Richard Saad
MD Section III: DIARRHEA Question 21 What Colonic Infections Are Associated With AIDS? Brian Mulhall
MD Question 22 We See Many Patients With Bone Marrow Transplants. How Do We Recognize and Treat Graft-Versus-Host Disease in the Colon? How Do We Make Sure We Are Not Missing CMV Colitis? Brian Mulhall
MD Question 23 Many of My Patients Want To Go With Natural Therapies. Where Do Probiotics Fit in the Management of Irritable Bowel Syndrome? Brooks D. Cash
MD
FACP
FACG Question 24 What Is the Evidence for Antibiotics as a Therapy for Irritable Bowel Syndrome? Brian Mulhall
MD Question 25 A Patient in the Midst of an Inflammatory Bowel Disease Flare Also Was Positive for Clostridium difficile. How Often Does This Happen and What's the Best Way to Manage This Scenario? Brian Mulhall
MD Question 26 The Nursing Staff Doesn't Know What to Do for a 72-Hour Stool Collection as Part of a Diarrhea Workup. What Do I Need to Tell Them to Get the Answers I Need? Brian Mulhall
MD Question 27 I Want to Use Alosetron for a Woman With IBS-D. What Do I Need to Tell Her About the Risks and Outcomes Associated With Ischemic Colitis and This Medicine? What Is the Best Way to Document This Discussion? Richard Saad
MD Question 28 For Patients Who Report Persistent Diarrhea
What Is Considered Chronic
When Do I Need to Begin a Workup
and What Does That Workup Involve? Richard Saad
MD Question 29 My Patient With Collagenous Colitis Developed a Black Tongue With Bismuth. What Other Therapeutic Options Do I Have? Richard Saad
MD Section IV: PERIANAL DISORDERS Question 30 What Are the Treatment Options for a Patient With Metastatic Colon Cancer Who Has a Malignant Sigmoid Stricture? Brooks D. Cash
MD
FACP
FACG Question 31 What Should I Be Doing With My Patients Who Have Anal Fissures? Brian E. Lacy
MD
PhD Question 32 What Is Pruritus Ani and How Is It Managed? Brian E. Lacy
MD
PhD Question 33 What Is Proctalgia Fugax and How Is It Managed? Brian E. Lacy
MD
PhD Question 34 What Types of Procedures and Therapies Can I Use on Hemorrhoids Before Sending a Patient to the Surgeon? Brian E. Lacy
MD
PhD Question 35 What Tips Can I Give My Surgical Colleagues Who Are Seeing Patients With Pouchitis? L. Campbell Levy
MD
and Corey A. Siegel
MD Question 36 A 74-Year-Old Man Who Is Status Post External Radiation Therapy for Prostate Cancer Now Presents With Hematochezia. What Should I Do Next? Can I Keep This From Recurring? Brian E. Lacy
MD
PhD Question 37 What Should Be the Sequence of Investigations for a Patient With Rectal Adenocarcinoma? Brian E. Lacy
MD
PhD Question 38 What Is Solitary Rectal Ulcer Syndrome? Brian E. Lacy
MD
PhD Question 39 What Is Rectal Prolapse? Brian E. Lacy
MD
PhD Section V: COLON POTPOURRI Question 40 The Emergency Room Is Calling About a Patient With Pneumatosis Coli. What Do I Need To Do? Inku Hwang
MD Question 41 What Is the Appropriate Evaluation for Fecal Incontinence? Inku Hwang
MD Question 42 The Admitting Housestaff Can't Figure Out Where to Admit Patients With Diverticulitis. What Can I Tell Them About This Condition? Inku Hwang
MD Question 43 What Should Be my Response to Patients Who Ask About Antibiotic Prophylaxis for Their Colonoscopies? If They Are Persistent
and Do Not Have an Indication
Is it OK to Acquiesce? Inku Hwang
MD Question 44 The Diabetes Clinic Wants a Lecture on the Effects of Diabetes on Colonic Motility. What Can I Tell Them in 5 Minutes or Less? Inku Hwang
MD Question 45 What Are the Adverse Effects of Nonsteroidal Anti-Inflammatory Drugs on the Colon and How Can They Be Mitigated? Scott L. Itzkowitz
DO
FACP Question 46 When Do I Need to Refer a Patient With Diverticular Bleeding for a Colectomy and What Tests Should Be Done Before This Happens? Scott L. Itzkowitz
DO
FACP Question 47 What Do I Tell a Patient Who I Just Diagnosed With Stage IIB Colon Cancer Regarding Treatment and Prognosis? Scott L. Itzkowitz
DO
FACP Question 48 The Ward Team Has a Patient With a Distended Abdomen and Increasing Gas-Filled Loops of Bowel on X-Ray. How Can I Help Them Recognize and Treat Colonic Pseudo-Obstruction (Ogilvie's Syndrome)? Scott L. Itzkowitz
DO
FACP Question 49 What Are the Various Manifestations of E. coli Infection of the Colon and How Should It Be Treated? Scott L. Itzkowitz
DO
FACP Index
MD Introduction Section I: COLON CANCER SCREENING Question 1 A 46-Year-Old African American Man Who Has No Alarm Features or Symptoms Requests a Screening Colonoscopy. Is This Appropriate? Jason Taylor
MD; and Philip Schoenfeld
MD
MSEd
MSc (Epi) Question 2 What Pathologic Analysis Do I Need to Pursue in a 38-Year-Old Man With Cecal Cancer Whose Family History Is Suspicious for Hereditary Nonpolyposis Colon Cancer? B. Joe Elmunzer
MD; and Philip Schoenfeld
MD
MSEd
MSc (Epi) Question 3 How Do You Respond to Patients Wanting to Take Aspirin
Calcium
or Other Medications as Prophylaxis for Colorectal Cancer? Is There Any Evidence That They Work? Amit Singal
MD
and Philip Schoenfeld
MD
MSEd
MSc (Epi) Question 4 My Patient Had a 3-cm
Sessile Tubulovillous Adenoma on the Sigmoid That I Removed Piecemeal. The Pathology Lab Can't Verify Clear Margin. What Should I Recommend to the Patient? Brennan Spiegel
MD
MSHS
and Inder Singh
MD Question 5 The Board of Directors of My Hospital Wants to Know the Current Colorectal Cancer Screening Options and Will Go With Whatever I Recommend. What Does the Evidence Say Is the Best Colorectal Cancer Screening Regimen? Brennan Spiegel
MD
MSHS
and Inder Singh
MD Question 6 My Patient Had a 13-mm Tubular Adenoma Removed From Her Colon. What Kind of Surveillance Do I Need To Recommend? Would It Change Things if She Were 80 Years Old Without Co-Morbidities? Brooks D. Cash
MD
FACP
FACG Question 7 I Have a Patient Whose Brother
Mother
and Maternal Uncle All Had Colon Cancer Diagnosed Before the Age of 45. Does My Patient Have Hereditary Nonpolyposis Colorectal Cancer Syndrome
and
if He Does
What Should I Advise? Brooks D. Cash
MD
FACP
FACG Question 8 What Do I Need to Tell My Inflammatory Bowel Disease Patients About Their Risk for Colon Cancer and How Should I Perform Surveillance Colonoscopy in These Patients? Francis A. Farraye
MD
MSc Question 9 What Do I Tell the Surgeons Who Insist on Annual Colonoscopies for Patients With Cured Colon Cancer
Even for Those 5 to 10 Years Past Therapy? Brooks D. Cash
MD
FACP
FACG Question 10 The Pathologists Keep Sending Me Reports About Serrated Adenomas. What Is a Serrated Adenoma and What Do I Tell My Patients in Terms of Follow-up? Christopher S. Huang
MD; Francis A. Farraye
MD
MSc
and Michael J. O'Brien
MD
MPH Question 11 My Patient Was Found to Have About 50 Hyperplastic Polyps Ranging From 5 to 15 mm. What Condition Do I Need to Think About and How Should I Manage This Patient? Christopher S. Huang
MD; Francis A. Farraye
MD
MSc; and Michael J. O'Brien
MD
MPH Section II: CONSTIPATION Question 12 What Should I Suspect When I See Melanosis Coli and What Is Its Clinical Relevance? Erica Roberson
MD
and Arnold Wald
MD Question 13 What Should Be the Sequence of Investigations for a Patient Who Is Being Considered for Colectomy Due to Chronic Constipation? Erica Roberson
MD
and Arnold Wald
MD Question 14 What Do I Tell My Primary Care Colleagues About Chronic Constipation and the Risk of Colorectal Cancer? Erica Roberson
MD
and Arnold Wald
MD Question 15 What Diagnostic Tests Are Recommended for the Evaluation of Chronic Constipation and What Is Their Yield? Erica Roberson
MD
and Arnold Wald
MD Question 16 How Efficacious Are the Therapies for Chronic Constipation? I Have Heard About Several New Drugs for Constipation-Have They Been Shown to Be Cost Effective? Erica Roberson
MD
and Arnold Wald
MD Question 17 When Should a Patient Complaining of Chronic Constipation Be Sent for Anorectal Manometry? Erica Roberson
MD
and Arnold Wald
MD Question 18 A Patient Asks About Biofeedback Therapy for Her Constipation Symptoms and Wants to Know What Is Involved. What Do I Tell Her? Erica Roberson
MD
and Arnold Wald
MD Question 19 What Are the Emerging Therapeutic Agents for Constipation and How Do They Modulate Colonic Motility? Brooks D. Cash
MD
FACP
FACG Question 20 What Do I Tell My Colleagues Who Are Concerned About Neuropathic Changes From Laxative Use? Richard Saad
MD Section III: DIARRHEA Question 21 What Colonic Infections Are Associated With AIDS? Brian Mulhall
MD Question 22 We See Many Patients With Bone Marrow Transplants. How Do We Recognize and Treat Graft-Versus-Host Disease in the Colon? How Do We Make Sure We Are Not Missing CMV Colitis? Brian Mulhall
MD Question 23 Many of My Patients Want To Go With Natural Therapies. Where Do Probiotics Fit in the Management of Irritable Bowel Syndrome? Brooks D. Cash
MD
FACP
FACG Question 24 What Is the Evidence for Antibiotics as a Therapy for Irritable Bowel Syndrome? Brian Mulhall
MD Question 25 A Patient in the Midst of an Inflammatory Bowel Disease Flare Also Was Positive for Clostridium difficile. How Often Does This Happen and What's the Best Way to Manage This Scenario? Brian Mulhall
MD Question 26 The Nursing Staff Doesn't Know What to Do for a 72-Hour Stool Collection as Part of a Diarrhea Workup. What Do I Need to Tell Them to Get the Answers I Need? Brian Mulhall
MD Question 27 I Want to Use Alosetron for a Woman With IBS-D. What Do I Need to Tell Her About the Risks and Outcomes Associated With Ischemic Colitis and This Medicine? What Is the Best Way to Document This Discussion? Richard Saad
MD Question 28 For Patients Who Report Persistent Diarrhea
What Is Considered Chronic
When Do I Need to Begin a Workup
and What Does That Workup Involve? Richard Saad
MD Question 29 My Patient With Collagenous Colitis Developed a Black Tongue With Bismuth. What Other Therapeutic Options Do I Have? Richard Saad
MD Section IV: PERIANAL DISORDERS Question 30 What Are the Treatment Options for a Patient With Metastatic Colon Cancer Who Has a Malignant Sigmoid Stricture? Brooks D. Cash
MD
FACP
FACG Question 31 What Should I Be Doing With My Patients Who Have Anal Fissures? Brian E. Lacy
MD
PhD Question 32 What Is Pruritus Ani and How Is It Managed? Brian E. Lacy
MD
PhD Question 33 What Is Proctalgia Fugax and How Is It Managed? Brian E. Lacy
MD
PhD Question 34 What Types of Procedures and Therapies Can I Use on Hemorrhoids Before Sending a Patient to the Surgeon? Brian E. Lacy
MD
PhD Question 35 What Tips Can I Give My Surgical Colleagues Who Are Seeing Patients With Pouchitis? L. Campbell Levy
MD
and Corey A. Siegel
MD Question 36 A 74-Year-Old Man Who Is Status Post External Radiation Therapy for Prostate Cancer Now Presents With Hematochezia. What Should I Do Next? Can I Keep This From Recurring? Brian E. Lacy
MD
PhD Question 37 What Should Be the Sequence of Investigations for a Patient With Rectal Adenocarcinoma? Brian E. Lacy
MD
PhD Question 38 What Is Solitary Rectal Ulcer Syndrome? Brian E. Lacy
MD
PhD Question 39 What Is Rectal Prolapse? Brian E. Lacy
MD
PhD Section V: COLON POTPOURRI Question 40 The Emergency Room Is Calling About a Patient With Pneumatosis Coli. What Do I Need To Do? Inku Hwang
MD Question 41 What Is the Appropriate Evaluation for Fecal Incontinence? Inku Hwang
MD Question 42 The Admitting Housestaff Can't Figure Out Where to Admit Patients With Diverticulitis. What Can I Tell Them About This Condition? Inku Hwang
MD Question 43 What Should Be my Response to Patients Who Ask About Antibiotic Prophylaxis for Their Colonoscopies? If They Are Persistent
and Do Not Have an Indication
Is it OK to Acquiesce? Inku Hwang
MD Question 44 The Diabetes Clinic Wants a Lecture on the Effects of Diabetes on Colonic Motility. What Can I Tell Them in 5 Minutes or Less? Inku Hwang
MD Question 45 What Are the Adverse Effects of Nonsteroidal Anti-Inflammatory Drugs on the Colon and How Can They Be Mitigated? Scott L. Itzkowitz
DO
FACP Question 46 When Do I Need to Refer a Patient With Diverticular Bleeding for a Colectomy and What Tests Should Be Done Before This Happens? Scott L. Itzkowitz
DO
FACP Question 47 What Do I Tell a Patient Who I Just Diagnosed With Stage IIB Colon Cancer Regarding Treatment and Prognosis? Scott L. Itzkowitz
DO
FACP Question 48 The Ward Team Has a Patient With a Distended Abdomen and Increasing Gas-Filled Loops of Bowel on X-Ray. How Can I Help Them Recognize and Treat Colonic Pseudo-Obstruction (Ogilvie's Syndrome)? Scott L. Itzkowitz
DO
FACP Question 49 What Are the Various Manifestations of E. coli Infection of the Colon and How Should It Be Treated? Scott L. Itzkowitz
DO
FACP Index