1. Colon Mass SGD

2. Case A 45‐year old female comes to the hospital with moderately severe colicky abdominal pain, abdominal distention, and nausea of two days duration.

3. History of the Present Illness: Just before admission, she vomited previously‐taken food twice. She has not passed any stool or gas in the last 24 hours. She is previously well except for frequent episodes of watery stools alternating with hard,

4. Family History: She reveals that her father died of colon cancer at age 50 and so did his father’s sister at age 52. She is unaware of her grandparents’ medical history. She is unsure but is aware that two of her cousins had been diagnosed with some form of abdominal cancer. They are still alive and receiving chemotherapy. She is the eldest of 4 siblings (40, 36, and 33 years old) and all of them are apparently well.

5. Physical examination: Normosthenic female not in any form of distress Her vital signs are top normal. Chest and lungs are normal. Abdomen is globularly distended, with normal to hyperactive bowel sounds, soft, and nontender. Digital rectal examination is normal.

6. Salient Features 45 y.o. Female Has moderately severe colicky abdominal pain Abdominal distention Nausea Lost 15 pounds in the last month Constipated Obstipated Strong family history of cancer

7. DISCUSS: What is your clinical working impression? – Intestinal obstruction secondary to probable malignancy Basis? – Patient’s inability to pass stool or gas – Moderately sever colicky abdominal pain – Abdominal distention – History of vomiting previously-taken food – Significant weight loss in one month – Patient’s strong family history of cancer

8. What are your immediate diagnostic and therapeutic plans? Justify the need for each one. Diagnostic plans: Digital Rectal Exam Scout Film Therapeutic plans: Decompression by discontinuation of all oral intake Nasogastric suction Cecostomy Transverse colonostomy Definitive: resection

9. Digital Rectal Exam – Done as part of routine physical exam, or before a sigmoidoscopy or colonoscopy – To detect presence of bleeding Scout Film – Confirmatory of small-bowel obstruction – Specific findings: Dilated small-bowel loops (>3cm in diameter) Air-fluid levels on upright films Paucity of air in the colon