1. 65歲男性主訴暗紅色血便達三週之久，而且偶而有腹部絞痛或覺得解不乾淨的感覺：A. 除了必要的理學檢查，應排那些檢查以利 確定診斷？B. 若此時，病人已有合併腸阻塞的情形，則手術的選擇方式有那些？ D/D Lower GI bleeding Diverticular disease IBD Colonrectal carcinoma and polyos Ischemic bowel disease hemorrhoids Tenesmus Inflammatory bowel disease (IBD) Anorectal abcess Infectious colitis (infection of the colon) Colorectal cancer or tumors GI bleeding Upper GI bleeding- NG tube , EGD Lower GI bleeding- angiography , technetium 99m-labeled RBC scanning , colonscopy Lab Studies: complete blood count; serum chemistries- may fine anemia ; liver and kidney function tests – preoperative workup carcinoembryonic antigen (CEA) test Rigid proctosigmoidoscopy Direct visualization of the lesion, and provides an estimation of the size of the lesion and degree of obstruction. Obtain biopsies of the lesion, assess ulceration, and determine the degree of fixation . An accurate measurement of the distance of the lesion from the dentate line Endorectal ultrasound Assessing depth of invasion of rectal cancers The accuracy of detection of lymph node involvement ranges from 73-86% Overestimation of staging and nodal involvement occurs more often than understaging Endorectal surface-coil MRI An alternative to ERUS, this technique is touted as equally or more accurate than ERUS in lymph node staging. Metastatic workup Chest radiograph CT scan MRI - liver metastases PET CEA scan Surgery Transanal excision Transanal endoscopic microsurgery Sphincter-sparing procedures Low anterior resection Abdominal perineal resection Surgery Anterior resection "no touch" isolation technique - resection is performed segmentally (eg, right or left hemicolectomy) with end-to-end anastomosis Partial hepatectomy for colorectal cancer metastases --

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