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Colo rectal bleeding

Università degli Studi di Torino Azienda Sanitaria Ospedaliera Molinette S.Giovanni Battista di Torino Torino, 31 Marzo – 1 Aprile 2006. Colo rectal bleeding. Colorectal Bleeding: A Multidisciplinary Approach First Joint Meeting with Mayo Clinic and University of Minnesota.

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Colo rectal bleeding

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  1. Università degli Studi di Torino Azienda Sanitaria Ospedaliera Molinette S.Giovanni Battista di Torino Torino, 31 Marzo – 1 Aprile 2006 Colo rectal bleeding Colorectal Bleeding:A Multidisciplinary ApproachFirst Joint Meeting with Mayo Clinic and University of Minnesota Colo rectal bleeding (minor Chronic) Dott. Edoardo Formento Dott.ssa Elisabetta Radice

  2. Patients evaluation and diagnosis • Clinical History • Physical exam • Anoscopy • Rigid Sigmoidoscopy • Flexible Sigmoidoscopy Colo rectal bleeding (minor Chronic) Colorectal Bleeding: a Multidisciplinary Approach – Turin, March 2006

  3. Clinical History Age Family history for cancer Kind of bleeding Colour Quantity Frequency Relation to defecation Symptoms associated Constipation Diarrhea Abdominal pain Anorexia Weight loss Addominal mass Colo rectal bleeding (minor Chronic) Clinical History Colorectal Bleeding: a Multidisciplinary Approach – Turin, March 2006 1

  4. Addominal and Perineal exam Addominal mass Inguinal linfglands Perineal exam Colo rectal bleeding (minor Chronic) Physical exam Colorectal Bleeding: a Multidisciplinary Approach – Turin, March 2006 2

  5. Inspection Perineal Dermatosis Prolapsing haemorrhoids Rectal prolapse Solitary rectal ulcer Anal cancers Sexual transmitted diseases Anal Fissures Colo rectal bleeding (minor Chronic) Physical exam Colorectal Bleeding: a Multidisciplinary Approach – Turin, March 2006 2

  6. Rectal digital examination Anal canal Rectal ampulla till 8-10 cm (better then endo us?) Anorectal spaces Anal sphincter complex Pelvic mass Colo rectal bleeding (minor Chronic) Physical exam Colorectal Bleeding: a Multidisciplinary Approach – Turin, March 2006 2

  7. Anoscopy Anal canal Dentate line Anoderm Colo rectal bleeding (minor Chronic) Anoscopy Colorectal Bleeding: a Multidisciplinary Approach – Turin, March 2006 3

  8. Rigid sigmoidoscopy Indications • assesment in youg people with bleeding (under 40 years old) • to mesure the exact distance of a rectal tumor from the anal verge • to give the precise location of the lesion on the wall • follow up of patients treated for rectal adenomas and rectal cancer • follow up of patients with aspecific proctitis Colo rectal bleeding (minor Chronic) Rigid Sigm. Colorectal Bleeding: a Multidisciplinary Approach – Turin, March 2006 4

  9. Flexible sigmoidoscopy Preparation ( 2 enemac 4 and 2 hours bifore) Reaches the splenic flexure 80% (M.Sleisenger, Gastrointestinal and liver disease, 2002) Why? 33% right colon cancer diagnosed for anemia 30% “ “ “ “ “ addominal mass 36% “ “ “ “ “ rapid loss weight 1% “ “ “ “ “ massive haemorrhage (S.Kelly ,Queen Alexandra Hospital, Porthsmouth 2003) Colo rectal bleeding (minor Chronic) Flexible Sigm. Colorectal Bleeding: a Multidisciplinary Approach – Turin, March 2006 5

  10. Flexible sigmoidoscopy Indications • All patients age > 40 years old • All patients age < 40 years old: • With an adenoma or carcinoma of the colon in their history out follow-up. • With a carcinoma in any other organ; as in colorectal cancer HNPCC associated (endometrio, gastric and small bowel carcinoma). • With positive family history for colon cancer: relative of 1st degree (if 45-55 years old risk > 3, if 45 years old risk > 4). If relative of 2nd degree the risk increases more less. • With proctocolite already diagnosed. Colo rectal bleeding (minor Chronic) Flexible Sigm. Colorectal Bleeding: a Multidisciplinary Approach – Turin, March 2006 5

  11. Rectal bleeding unit Positions for ispection Left lateral Jackknife Trolley for proctology Anoscopy Sigmoidoscopy Rubber band ligation Biopsy Videocolonoscopy Colo rectal bleeding (minor Chronic) Colorectal Bleeding: a Multidisciplinary Approach – Turin, March 2006

  12. Colorectal bleeding (minor chronic) Colo rectal bleeding (minor Chronic) Colorectal Bleeding: a Multidisciplinary Approach – Turin, March 2006

  13. Conclusions 1 The goal of the meeting is to demonstrate the importance for the surgeons who treat the rectal bleeding (haemorrhoids and colorectal adenoma and carcinoma) to use the modern flexible sigmoidoscope and colonscope. For assessment and treatment. Colo rectal bleeding (minor Chronic) Colorectal Bleeding: a Multidisciplinary Approach – Turin, March 2006

  14. Conclusions 2 Unit of Physiology 1970 Sir Alan Parks St. Mark’s Hospital European school of colorectal surgery Unit of Rectal Bleeding 1980 Stan Goldberg S.Nivatvongs University of Minnesota American School of Colorectal Surgery Colo rectal bleeding (minor Chronic) Colorectal Bleeding: a Multidisciplinary Approach – Turin, March 2006

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