Internal Medicine

0521779407-18 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 8:1

Radiation Enteritis and Colitis Raynaud’s Syndrome 1265

➣Cholestyramine reduces bile salt malabsorption and diarrhea

➣Trial of TPN for failed medical therapies or poor surgical candi-

dates

■Chronic radiation colitis or proctitis

➣Patients with anemia or persistent bleeding treated with endo-

scopic laser or electrocoagulation of bleeding ectasias

➣Formalin irrigation of the rectum and hyperbaric oxygen therapy

also effective for control of bleeding

➣Mild obstruction from rectal or sigmoid strictures treated with

stool softeners or mineral oil enemas

➣More severe strictures treated with endoscopic balloon dilation

or Savary-Gilliard dilators

➣Long or tortuous strictures best managed with surgical resection

and immediate reanastomosis

➣Abdominoperineal resection reserved for severe cases

➣Rectovaginal, rectovesical, enterocolic fistulas treated surgically

➣Presacral sympathectomy for severe uncontrolled pelvic pain

follow-up

■After diagnosis and treatment established, at least a half of patients

continue to have symptoms, develop new complications, or both

■Close monitoring indicated for the potential risk of secondary malig-

nancy development

complications and prognosis

■Complications – see above; manage on an individual basis

■Mortality of surgery for complications of radiation enteritis up to

17%

■About 50% of patients will continue to experience symptoms and/or

develop complications (1/3 of these require further surgery)

■5-yr survival rates 40%, increasing to 70% for those surviving surgery

RAYNAUD’S SYNDROME

RAJABRATA SARKAR, MD

history & physical

HISTORY

■No associated connective tissue diseases=Primary Raynaud’s

■Collagen Vascular Disease (mainly scleroderma)=Secondary Ray-

naud’s