2024-2025 Colorectal Disorders (PEARLS) (Smarty PANCE) with Answers (127 Solved Questions)

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Colorectaldisorders(PEARLS)SmartyPANCE100% VERIFIED ANSWERS2024/2025A 45 year old female presents withpainful defecation, pruritus of the anus andoccasional blood. What is your diagnosis?Internal hemorrhoidsSignificantrectal pain, and pruritus but no bleeding. Affects the lower 1/3 of anus(below dentate line)External hemorrhoidsA 55-year-old patient withrectal bleeding and tenesmus(a feeling of incompleteemptying after a bowel movement). What must you consider?Anorectal cancerWhenever rectal bleedingoccurs, even in patients with obvious hemorrhoids or knowndiverticular disease, coexisting cancer must be ruled outTearing rectal pain and bleedingwhich occurs with or shortly after defecation,bright red blood on toilet paperAnal fissureWhat type ofhemorrhoids are usually painless?Internal hemorrhoids

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Treatment for fecal impaction?Digital rectal /manual disimpaction-Diet with fiber stool softeners/laxatives forpreventionWhat is the recommended treatment for a perianal cyst?Surgical drainageRectal mass rectal bleeding and tenesmus?Rectal cancer (solitary tenesmus may occur with anal inflammation)The definition of constipation is less than how many bowel movements perweek?less than 3bowel movements per weekLLQ pain, tenderness, abdominal distention,feverandleukocytosisin olderpatientsDiverticulitisDescribe diverticulitisInfection or perforation of a diverticulumWhat is diverticulosis?Condition in which diverticula can be found within the colon, especially the sigmoid;diverticula are actually false diverticula in that only mucosa and submucosa herniatethrough the bowel musculature; true diverticula involve all layers of the bowel wallandare rare in the colonDescribe the pathophysiology of diverticulosis?

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Weakness in the bowel wall develops at points where nutrient blood vessels enterbetween antimesenteric and mesenteric taeniae; increased intraluminal pressures thencause herniation through these areasWhat is the pathophysiology of diverticulitis?Obstruction of diverticulum by a fecalith leading to inflammation and microperforationWhat are the signs/ symptoms diverticulitis?LLQ pain (cramping or steady), change in bowel habits (diarrhea), fever, chills, ano-rexia, LLQ mass, nausea/vomiting, dysuriaWhat are the associated lab findings of diverticulitis?Increased WBCsWhat are the associated radiographic findings of diverticulitis?On x-ray: ileus, partially obstructed colon, air-fluid levels, free air if perforated Onabdominal/pelvic CT scan: swollen, edematous bowel wall; particularly helpful indiagnosing an abscessWhat are the associated barium enema findings of diverticulitis?Barium enema should be avoided in acute casesIs colonoscopy safe in an acute setting of diverticulitis?No, there is increased risk of perforationWhat are the possible complications of diverticulitis?Abscess, diffuse peritonitis, fistula, obstruction,perforation, strictureWhat is the most common fistula with diverticulitis?Colovesical fistula (to bladder)

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What is the best test for diverticulitis?CT scanWhat is the initial therapy of diverticulitis?IV fluids, NPO, broad-spectrum antibiotics with anaerobic coverage, NG suction (asneeded for emesis/ileus)When is surgery warranted for diverticulitis?Obstruction, fistula, free perforation, abscess not amenable to percutaneous drainage,sepsis, deterioration with initial conservative treatmentWhat isthe lifelong risk of recurrence after: First episode of diverticulitis?33%What are the indications for elective resection in diverticulitis?Case by case decisions, but usually after two episodes of diverticulitis; should beconsidered after the first episode in a young, diabetic, or immunosuppressed patient orto rule out cancerWhat surgery is usually performed ELECTIVELY for recurrent bouts ofdiverticulitis?One-stage operation: resection of involved segment and primary anastomosis (withpreoperativebowel prep)What type of surgery is usually performed for an acute case of diverticulitis with acomplication (e.g., perforation, obstruction)?Hartmann's procedure: resection of the involved segment with an end colostomy andstapled rectal stump (will need subsequent re-anastomosis of colon usually after 2-3postoperative months)

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What is the treatment of diverticular abscess?Percutaneous drainage; if abscess is not amenable to percutaneous drainage, thensurgical approach for drainage is necessaryHow common is massive lower GI bleeding with diverticulitis?Very rare! Massive lower GI bleeding is seen with diverticulosis, not diverticulitisWhat are the most common causes of massive lower GI bleeding in adults?Diverticulosis (especially right sided), vascular ectasiaWhat must you rule out in any patient with diverticulitis/ diverticulosis?Colon cancerWhat is an anal fissure?Tear or fissure in the anal epitheliumWhat is the most common site of anal fissure?Posterior midline (comparatively low blood flow)What is the cause of anal fissure?Hard stool passage (constipation), hyperactive sphincter, disease process (e.g., Crohn'sdisease)What are the signs/symptoms of anal fissure?Pain in the anus, painful (can be excruciating) bowel movement, rectal bleeding, bloodon toilet tissue after bowel movement, sentinel tag, tear in the anal skin, extremelypainful rectal exam, sentinel pile, hypertrophic papillaWhat is a sentinel pile?

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