Addicudo
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Q46 - A 75-year-old man with a history of constipation and episodic abdominal pain has diverticulosis. He is at increased risk for which of the following conditions?
(A) Angiodysplasia
(B) Carcinoma of the colon
(C) Gastrointestinal hemorrhage
(D) Granulomatous colitis
(E) Malabsorption
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| Moctopod
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(B) Colon cancer
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| ssrpk
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polyposis inc. the risk of cancer....
the most common presentation ius hematochezia!
i'll go wth (C) Gastrointestinal hemorrhage
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| Addicudo
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Correct !! Its G.I hemorrhage !
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| att
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the #1 cause of lower gi bleeding (hematochezia)is
1.diverticulosis
2.av malmorfation
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| ferekide
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c hemmorage
first cause of hematokezia
scnd cause is angiodisplasia....(also brs path mention it as the first)
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| chemamr
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agree with C (GI bleeding, lower)
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| Ms.Apara
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diverticulosis - colon ca
diverticulitis - gi bleeding
look in harrison
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| hgheith
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According to kaplan and goljan, the most common cause of diverticulitis is diverticulosis, and the #1 cause of hematochesia is diverticulosis (cancer was not one of the complications). A low fiber diet is a risk factor for both colon cancer and diverticulosis.
Also the sigmoid colon is the most common location for cancer, most common location for polyps and most common location for diverticuli.
Cancer and diverticulosis might be indirectly related, but not a cause of each other.
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| p53
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According to the Big Robbins 2004 low fiber diet isn't yet confirmed as a risk factor for the colon cancer, but it is obvious risk factor for the diverticulosis.
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| hgheith
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Are you sure about that p53? I found in Robbins 6th edition that one of the enviornmental factors is a low content of unabsorbable vegtable fiber.
The also go on to explain how this would lead to cancer: " It is theorized that reduced fiber content leads to decreased stool bulk, increased fecal retention in the bowel, and an altered bacterial flora of the intestine. Potentially toxic oxidative byproducts of carbs degraded by bacteria are therefore present in higher concentrations in the small sstools and are held in contact with the colonic mucosa for longer periods of time." It does mention that it is unproven, but is still considered a risk factor, and it makes sense.
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| Galaxum
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Thank hgheith for explaination.
For the Q46, If we woulnt have diverticulosis, a 75 yo pt having a medical history of constipation and episodic abdo pain may be at risk of colon cancer.
In this case, patient has diverticulosis......; with abdo pain, so that is evolution of diverticulitis(the most common site is sigmoid colon, so-called diverticulic sigmoiditis), classification of Hinchey from 1 to 4, from microabscess to perforation and adjacent fistula.
Certainly, hemorrhage is one of complications of diverticulitis with variable rate from 1 to 15%
how about colon cancer and diverticulosis?
Of course, they are roomates. in Harrison diverticulosis- colon cancer (Ms Apara), I have no idea. Howerver, in a lot of rechearch about diverticulosis in surgical journals, they cant prove diverticulosis causing colon cancer.
In my opinion, this is a kind of "Twilight" question. I'm sorry . But if forced to tick one, I must take hemorrhage.
thanks for sharing thinking
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| mesh
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both an increase in dietary fat and decrease in dietary fibre enhance the carcinogenicity of lithocolic acid in producing colon cancer....the former by increasing the amount...and later by increasing the exposure time of colonic epithelium to lithocolic acid...Goljan....
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| Galaxum
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Thank Mesh!
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| mesh
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u r welcome....
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| Addicudo
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Diverticulitis- Inflammation of a diverticulum, especially inflammation related to colonic diverticula, which may undergo perforation with abscess formation. Sometimes called left sided appendicitis.
Diverticulosis - A condition in which a person has small sacs or pouch in the walls of a canal or organ, such as the stomach or intestine.
Diverticulitis .. is just the inflammation of the diverticula .. dosent mean it has to be the colon for sure ... ?? So therefore would occour where ever there is a diverticula formation .. and a DIVERTICULA will PRECEED Diverticulosis ... ! Hence .. cant say that Diverticulosis - colon ca / diverticulitis - gi bleeding.
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| KrazyK
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Also regarding the "-osis/ cancer", "-itis/ GI bleed", I believe Goljan says that diverticulitis DOES NOT cause bleeding, due to the fibrosis in the inflammatory respose, where as diverticulosis does.
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| chemamr
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it was a nice discussion here 
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| SilatK
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C. G.I. HEMORRHAGE.
DIVERTICULITIS= INFLAMATION OF DIVERTICULOSIS.
DIVERTICULOSIS CAN CAUSE G.I. BLEEDING WHEN INFLAME.
When older patient complaints of lower -left flank pain always suspect diverticulosis.
I can't recall RX at this moment but I think is vasopressin and diet.
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