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EUROSPAN GROUP Curbside Consultation of the Colon 49 Clinical Questio by Brooks D. Cash
Are you looking for concise, practical answers to questions that are often left unanswered by traditional medical searches? Are you seeking brief, evidence-based advice for complicated cases or complications? 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.Dr. Brooks D. Cash has designed this unique reference, which offers expert advice, preferences, and opinions on tough clinical questions commonly associated with the colon. The unique Q&A format provides quick access to current information related to the colon with the simplicity of a conversation between two colleagues. Numerous images, diagrams, and references are included to enhance the text and to illustrate the treatment of the colon.Curbside Consultation of the Colon: 49 Clinical Questions provides information basic enough for residents while also incorporating expert advice that even high-volume clinicians will appreciate. Gastroenterologists, fellows and residents in training, surgical attendings, and surgical residents will benefit from the user-friendly and casual format and the expert advice contained within.Some of the questions that are answered:What is the appropriate evaluation for fecal incontinence?What colonic infections are associated with AIDS?What are the current colorectal cancer screening and surveillance recommendations?What is the best way to manage chronic constipation?Where do probiotics fit into the management of IBS?How should diverticulitis be managed?What is colonic pseudo-obstruction and how is it managed? ContentsDedicationAcknowledgmentsAbout the EditorContributing AuthorsPrefaceForeword by Carol Burke, MDIntroductionSECTION I: COLON CANCER SCREENINGQuestion 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, MDQuestion 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, MDQuestion 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, FACGQuestion 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, FACGQuestion 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, MScQuestion 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, FACGQuestion 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, MPHQuestion 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, MPHSECTION 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, MDQuestion 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, MDQuestion 14 What Do I Tell My Primary Care Colleagues About Chronic Constipation and the Risk of Colorectal Cancer?Erica Roberson, MD, and Arnold Wald, MDQuestion 15 What Diagnostic Tests Are Recommended for the Evaluation of Chronic Constipation and What Is Their Yield?Erica Roberson, MD, and Arnold Wald, MDQuestion 16 How Efficacious Are the Therapies for Chronic Constipation? I Have Heard About Several New Drugs for Constipation-Have They BeenShown to Be Cost Effective?Erica Roberson, MD, and Arnold Wald, MDQuestion 17 When Should a Patient Complaining of Chronic Constipation Be Sent for Anorectal Manometry?Erica Roberson, MD, and Arnold Wald, MDQuestion 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, MDQuestion 19 What Are the Emerging Therapeutic Agents for Constipation and How Do They Modulate Colonic Motility?Brooks D. Cash, MD, FACP, FACGQuestion 20 What Do I Tell My Colleagues Who Are Concerned About Neuropathic Changes From Laxative Use?Richard Saad, MDSECTION III: DIARRHEAQuestion 21 What Colonic Infections Are Associated With AIDS?Brian Mulhall, MDQuestion 22 We See Many Patients With Bone Marrow Transplants. How Do We Recognize and Treat Graft-Versus-Host Disease in the Colon? How DoWe Make Sure We Are Not Missing CMV Colitis?Brian Mulhall, MDQuestion 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, FACGQuestion 24 What Is the Evidence for Antibiotics as a Therapy for Irritable Bowel Syndrome?Brian Mulhall, MDQuestion 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, MDQuestion 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, MDQuestion 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, MDQuestion 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, MDQuestion 29 My Patient With Collagenous Colitis Developed a Black Tongue With Bismuth. What Other Therapeutic Options Do I Have?Richard Saad, MDSECTION IV: PERIANAL DISORDERSQuestion 30 What Are the Treatment Options for a Patient With Metastatic Colon Cancer Who Has a Malignant Sigmoid Stricture?Brooks D. Cash, MD, FACP, FACGQuestion 31 What Should I Be Doing With My Patients Who Have Anal Fissures?Brian E. Lacy, MD, PhDQuestion 32 What Is Pruritus Ani and How Is It Managed?Brian E. Lacy, MD, PhDQuestion 33 What Is Proctalgia Fugax and How Is It Managed?Brian E. Lacy, MD, PhDQuestion 34 What Types of Procedures and Therapies Can I Use on Hemorrhoids Before Sending a Patient to the Surgeon?Brian E. Lacy, MD, PhDQuestion 35 What Tips Can I Give My Surgical Colleagues Who Are Seeing Patients With Pouchitis?L. Campbell Levy, MD, and Corey A. Siegel, MDQuestion 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, PhDQuestion 37 What Should Be the Sequence of Investigations for a Patient With Rectal Adenocarcinoma?Brian E. Lacy, MD, PhDQuestion 38 What Is Solitary Rectal Ulcer Syndrome?Brian E. Lacy, MD, PhDQuestion 39 What Is Rectal Prolapse?Brian E. Lacy, MD, PhDSECTION V: COLON POTPOURRI Question 40 The Emergency Room Is Calling About a Patient With Pneumatosis Coli. What Do I Need To Do?Inku Hwang, MDQuestion 41 What Is the Appropriate Evaluation for Fecal Incontinence?Inku Hwang, MDQuestion 42 The Admitting Housestaff Can't Figure Out Where to Admit Patients With Diverticulitis. What Can I Tell Them About This Condition?Inku Hwang, MDQuestion 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, MDQuestion 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, MDQuestion 45 What Are the Adverse Effects of Nonsteroidal Anti-Inflammatory Drugs on the Colon and How Can They Be Mitigated?Scott L. Itzkowitz, DO, FACPQuestion 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, FACPQuestion 47 What Do I Tell a Patient Who I Just Diagnosed With Stage IIB Colon Cancer Regarding Treatment and Prognosis?Scott L. Itzkowitz, DO, FACPQuestion 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, FACPQuestion 49 What Are the Various Manifestations of E. coli Infection of the Colon and How Should It Be Treated?Scott L. Itzkowitz, DO, FACPIndex