Colorectal disorders
(PEARLS) Smarty PANCE
100% VERIFIED ANSWERS
2024/2025
A 45 year old female presents with painful defecation, pruritus of the anus and
occasional blood. What is your diagnosis?
Internal hemorrhoids
Significant rectal pain, and pruritus but no bleeding. Affects the lower 1/3 of anus
(below dentate line)
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?
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
Anal fissure
What type of hemorrhoids are usually painless?
Internal hemorrhoids

Treatment for fecal impaction?
Digital rectal /manual disimpaction - Diet with fiber stool softeners/laxatives for
prevention
What is the recommended treatment for a perianal cyst?
Surgical drainage
Rectal 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 per
week?
less than 3 bowel movements per week
LLQ pain, tenderness, abdominal distention, fever and leukocytosis in older
patients
Diverticulitis
Describe diverticulitis
Infection or perforation of a diverticulum
What 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 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?

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?
Obstruction of diverticulum by a fecalith leading to inflammation and microperforation
What are the signs/ symptoms diverticulitis?
LLQ pain (cramping or steady), change in bowel habits (diarrhea), fever, chills, ano-
rexia, LLQ mass, nausea/vomiting, dysuria
What are the associated lab findings of diverticulitis?
Increased WBCs
What are the associated radiographic findings of diverticulitis?
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?
Barium enema should be avoided in acute cases
Is colonoscopy safe in an acute setting of diverticulitis?
No, there is increased risk of perforation
What are the possible complications of diverticulitis?
Abscess, diffuse peritonitis, fistula, obstruction, perforation, stricture
What is the most common fistula with diverticulitis?
Colovesical fistula (to bladder)

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What is the best test for diverticulitis?
CT scan
What is the initial therapy of diverticulitis?
IV fluids, NPO, broad-spectrum antibiotics with anaerobic coverage, NG suction (as
needed for emesis/ileus)
When is surgery warranted for diverticulitis?
Obstruction, fistula, free perforation, abscess not amenable to percutaneous drainage,
sepsis, deterioration with initial conservative treatment
What is the 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 be
considered after the first episode in a young, diabetic, or immunosuppressed patient or
to rule out cancer
What surgery is usually performed ELECTIVELY for recurrent bouts of
diverticulitis?
One-stage operation: resection of involved segment and primary anastomosis (with
preoperative bowel prep)
What type of surgery is usually performed for an acute case of diverticulitis with a
complication (e.g., perforation, obstruction)?
Hartmann's procedure: resection of the involved segment with an end colostomy and
stapled rectal stump (will need subsequent re-anastomosis of colon usually after 2-3
postoperative months)

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What is the treatment of diverticular abscess?
Percutaneous drainage; if abscess is not amenable to percutaneous drainage, then
surgical approach for drainage is necessary
How common is massive lower GI bleeding with diverticulitis?
Very rare! Massive lower GI bleeding is seen with diverticulosis, not diverticulitis
What are the most common causes of massive lower GI bleeding in adults?
Diverticulosis (especially right sided), vascular ectasia
What must you rule out in any patient with diverticulitis/ diverticulosis?
Colon cancer
What is an anal fissure?
Tear or fissure in the anal epithelium
What 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's
disease)
What are the signs/symptoms of anal fissure?
Pain in the anus, painful (can be excruciating) bowel movement, rectal bleeding, blood
on toilet tissue after bowel movement, sentinel tag, tear in the anal skin, extremely
painful rectal exam, sentinel pile, hypertrophic papilla
What is a sentinel pile?

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

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