Colorectal disorders (PEARLS) Smarty PANCE (Latest 2023 / 2024) Actual Questions and Answers 100% Correct
- A 45 year old female presents with painful defecation, pruritus of the anus and occasional
blood. What is your diagnosis?
Answer: Internal hemorrhoids
- Significant *rectal pain, and pruritus but no bleeding*. Affects the lower 1/3 of anus (below
dentate line)
Answer: External hemorrhoids
- A 55-year-old patient with *rectal bleeding and tenesmus* (a feeling of incomplete
emptying after a bowel movement). What must you consider?
Answer: - Anorectal cancer
Whenever rectal bleeding occurs, even in patients with obvious hemorrhoids or known diverticular disease, coexisting cancer must be ruled out
- *Tearing rectal pain and bleeding* which occurs with or shortly after defecation, bright red
blood on toilet paper
Answer: Anal fissure
- What type of hemorrhoids are usually painless?
Answer: Internal hemorrhoids
- Treatment for fecal impaction?
Answer: Digital rectal /manual disimpaction - Diet with fiber stool softeners/laxatives for prevention
- What is the recommended treatment for a perianal cyst?
Answer: Surgical drainage
- Rectal mass rectal bleeding and tenesmus?
Answer: Rectal cancer (solitary tenesmus may occur with anal inflammation)
- The definition of constipation is less than how many bowel movements per week?
Answer: *less than 3* bowel movements per week
- *LLQ pain*, tenderness, abdominal distention, *fever* and *leukocytosis* in older
patients
Answer: Diverticulitis
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- Describe diverticulitis
Answer: Infection or perforation of a diverticulum
- What is diverticulosis?
Answer: Condition in which diverticula can be found within the colon, especially the sigmoid; diverticula are actually false diverticula in that only mucosa and submucosa herniate through the bowel musculature; true diverticula involve all layers of the bowel wall and are rare in the colon
- Describe the pathophysiology of diverticulosis?
Answer: Weakness in the bowel wall develops at points where nutrient blood vessels enter between antimesenteric and mesenteric taeniae; increased intraluminal pressures then cause herniation through these areas
- What is the pathophysiology of diverticulitis?
Answer: Obstruction of diverticulum by a fecalith leading to inflammation and
microperforation
- What are the signs/ symptoms diverticulitis?
Answer: LLQ pain (cramping or steady), change in bowel habits (diarrhea), fever, chills, anorexia, LLQ mass, nausea/vomiting, dysuria
- What are the associated lab findings of diverticulitis?
Answer: Increased WBCs
- What are the associated radiographic findings of diverticulitis?
Answer: On x-ray: ileus, partially obstructed colon, air-fluid levels, free air if perforated On abdominal/pelvic CT scan: swollen, edematous bowel wall; particularly helpful in diagnosing an abscess
- What are the associated barium enema findings of diverticulitis?
Answer: Barium enema should be avoided in acute cases
- Is colonoscopy safe in an acute setting of diverticulitis?
Answer: No, there is in- creased risk of perforation
- What are the possible complications of diverticulitis?
Answer: Abscess, diffuse peritonitis, fistula, obstruction, perforation, stricture
- What is the most common fistula with diverticulitis?
Answer: Colovesical fistula (to bladder)
- What is the best test for diverticulitis?
Answer: CT scan
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