Villous Adenoma

VILLOUS ADENOMA 1.

CHIEF COMPLAINT •Villous adenoma

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HPI

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ROS

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SYMPTOMS • occult/overt bleeding (hematochezia) • diarrhea • constipation • flatulence • intermittent or progressive jaundice • abdominal pain • intestinal hemorrhage

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HISTORY

a. FAMILY HISTORY •Polyps •colon cancer b. SOCIAL HISTORY c. PAST MEDICAL HISTORY •Acromegaly •Inflammatory bowel disease d. SURGICAL HISTORY e. CHRONIC CONDITIONS •Acromegaly •Inflammatory bowel disease 6. 7.

ALLERGIES

PHYSICAL EXAMINATION • A palpable mass is present upon digital rectal examination. • Jaundice may be present with villous adenoma of the ampulla.

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SPECIFIC DATA LIKE GRADING • Mild dysplasia is characterized by uniform loss of mucin and hyperchromatic and elongated cells. Glands appear branched and budding. • Moderate dysplasia has more prominent nucleoli with increased crowding of cells. • In severe dysplasia, increased nuclear pleomorphism, prominent and numerous nucleoli, and increased nuclear-tocytoplasmic ratio occur. With continued cell proliferation, glands appear to form within glands, with a disordered cribriform appearance, and appear as carcinoma in situ.

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TESTS TO BE ORDERED •CBP •Serum iron levels •Transferrin saturation values •Fecal occult blood testing (FOBT) •Stool genetic studies •Double-contrast barium enema •CT colonography (virtual colonoscopy) •Video capsule endoscopy •Endoscopy •Sigmoidoscopy •Colonoscopy •Esophagogastroduodenoscopy •Enteroscopy •Endoscopic retrograde cholangiopancreatography

10. ASSESSMENT/PLAN •Surgical resection of a colorectal polyp •Pancreaticoduodenectomy for duodenal malignant villous adenomas and for villous tumors of the ampulla of Vater. 11. EDUCATION • Maintain normal body weight. • Exercise daily. Exercise helps decrease transit time and, therefore, the contact of harmful substances with the lumen. • Avoid smoking and excessive consumption of alcohol. • Dietary recommendations have been established to prevent colorectal cancer. Given the evidence for the adenoma-to-

carcinoma sequence, these recommendations likely also apply to adenomas. o Fat intake: Limit total fat to 25-30% of energy intake. A fatty diet may increase biliary sterols, which are damaging. o Fruit and fiber intake: Increase fruit and fiber intake to 5 servings daily. Increased fiber dilutes luminal contents and decreases the contact between carcinogenic substances and the lumen. Fruits and vegetables also contain minerals and vitamins that may impede carcinogenesis. o Fiber intake: Ingest 20-30 g of fiber daily. In addition to the benefits of increased fruit and fiber intake, fiber may inhibit some harmful bacteria and prevent damaging effects of bile acids

12. MEDICATION •Sulindac •Piroxicam •Aspirin 13. FOLLOW UP