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Test Deca EQ Bodybuilding ForumBelow is a concise "test‑sheet" you can keep in your clinic notebook.
Each entry gives the name of the test (or a short description if you only have a few), why it’s useful, how to run it, and what the key interpretive clues are. Feel free to copy‑paste or write these out by hand.
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### Test Sheet
| # | Test / Procedure | Why It Matters | How to Perform | Key Interpretations |
|---|------------------|----------------|----------------|---------------------|
| 1 | **Rectal Palpation & Digital Rectal Exam** | Detects masses, strictures, or palpable disease in the distal colon and rectum. | Gently insert a gloved finger into the rectum; palpate for shape, thickness, tenderness, and any masses. | • Hard mass → neoplasm
• Soft/tender → inflammation/abscess
• No abnormalities → normal |
| 2 | **Colonoscopy** (with or without biopsy) | Gold‑standard for visualizing mucosa, obtaining biopsies, and ruling out polyps/cancer. | Insert colonoscope through the anus; advance to cecum while inspecting mucosa. Take biopsies of suspicious lesions. | • Normal mucosa → low suspicion
• Ulcerative or mass lesions → biopsy & staging |
| 3 | **Barium Enema** (optional, pre‑colonoscopy) | Helps delineate structural abnormalities when colonoscopy is not feasible. | Patient ingests barium; X‑ray taken to visualize colon lumen. | • Focal narrowing, diverticula, or masses can be identified |
| 4 | **Laboratory Tests** | Rule out inflammatory bowel disease (IBD) and infection. | CBC, ESR/CRP, stool studies (fecal calprotectin, ova & parasites). | Elevated inflammatory markers → suggests IBD; negative tests support malignancy suspicion |
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### **3. Differential Diagnosis**
| Condition | Supporting Features | How It Can Be Ruled Out |
|-----------|---------------------|------------------------|
| **Colorectal Cancer** | Age >50, iron‑deficiency anemia, rectal bleeding, weight loss, family history (e.g., BRCA1/2 carriers) | Colonoscopy with biopsy; imaging (CT/MRI) |
| **Inflammatory Bowel Disease (Crohn’s disease / Ulcerative colitis)** | Chronic diarrhea, abdominal pain, perianal disease, fever, anemia | Endoscopic appearance, histology showing granulomas or crypt abscesses |
| **Diverticulosis / Diverticulitis** | Left lower quadrant pain, hematochezia | CT abdomen/pelvis |
| **Hemorrhoids** | Anal itching, bright red blood on stool | Digital rectal exam, anoscopy |
| **Colonic Polyps (including sessile serrated adenomas)** | Asymptomatic bleeding or occult blood | Colonoscopy with polypectomy |
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## 2. Diagnostic Approach
### A. Initial Evaluation
| Step | Action | Rationale |
|------|--------|-----------|
| 1 | Comprehensive history (GI symptoms, weight loss, family history of colorectal cancer) and physical exam (including digital rectal exam). | Identify red‑flag symptoms; rule out hemorrhoids/anal fissures. |
| 2 | Baseline laboratory tests: CBC, CMP, CRP/ESR. | Detect anemia or inflammation that may influence endoscopic technique. |
### B. Primary Diagnostic Modality
**1. Colonoscopy (or flexible sigmoidoscopy if limited to left colon)**
- **Indications:** Age ≥ 45 yr, family history of CRC, symptomatic patients.
- **Preparation:** Standard bowel prep (polyethylene glycol solution) with split‑dose regimen; optional stool test for occult blood.
- **Procedure:** Visual inspection of mucosa; targeted biopsies or polypectomies as needed.
**Advantages:** Direct visualization, ability to remove adenomas, high sensitivity (~95 % for lesions ≥ 10 mm).
**Limitations:** Requires sedation, risk of perforation/bleeding, incomplete in severe diverticulosis.
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#### 2. Non‑invasive Imaging
| Modality | Indications | Sensitivity / Specificity | Pros | Cons |
|----------|-------------|---------------------------|------|------|
| **CT Colonography (Virtual Colonoscopy)** | Screening for polyps; diagnostic follow‑up when colonoscopy incomplete | ~90 % for ≥10 mm lesions | No sedation, quick | Requires bowel prep; radiation exposure; cannot remove lesions |
| **MRI Colonography** | Similar to CT but no ionizing radiation | Comparable to CT | No radiation | Expensive; limited availability |
| **Capsule Endoscopy (GI‑Cam)** | Small bowel evaluation when capsule passes through colon | ~95 % for small‑bowel pathology | Non‑invasive | Cannot control capsule movement; cannot perform biopsies |
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## 4. Practical Implementation Checklist
| Step | Action | Timing | Responsible |
|------|--------|--------|-------------|
| **1** | Confirm endoscopic findings (e.g., mucosal lesions, ulcers) | Immediately after scope withdrawal | Gastroenterologist |
| **2** | Evaluate patient for active bleeding signs (tachycardia, hypotension, melena, hematochezia) | Within 15 min of procedure | Nursing staff |
| **3** | Administer intravenous fluids and/or blood products as needed | As indicated by vitals/hemoglobin | Hematology team |
| **4** | Initiate proton pump inhibitor therapy (IV or PO) | Within 1 hour | Pharmacy |
| **5** | Arrange for repeat endoscopy if bleeding persists or is likely | Within 24–48 hours | Gastroenterology |
| **6** | Monitor hemoglobin/hematocrit daily and track stool output | Daily | Lab and nursing |
| **7** | Document all findings, interventions, and patient response | Throughout hospitalization | Attending physician |
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### 4. Follow‑Up Care
| Timing | Action | Responsible Party |
|-----------------|--------------------------------------------------------------------------------------------|-------------------|
| Day 1–3 | Assess clinical stability (vital signs, stool color, abdominal pain). | Nurse / RN |
| Day 5 | Repeat CBC and CMP. If stable, consider discharge planning if no ongoing bleeding. | Physician/Case Manager |
| Discharge | Provide written instructions: medication schedule, diet restrictions, warning signs (e.g., black tarry stools, dizziness). Arrange follow‑up with primary care in 7–10 days or sooner if symptoms recur. | Physician / RN |
| Follow‑up Appointments | Monitor hemoglobin trends, evaluate for iron deficiency; consider endoscopic evaluation if bleeding persists. | Physician |
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## Key Points & Rationale
- **Hemodynamic stabilization** is priority; early IV fluids and blood products restore perfusion and correct anemia.
- **Transfusion thresholds** (Hb <7 g/dL) are based on the latest AABB/ASH guidelines to balance benefits vs risks of transfusion.
- **Antifibrinolytics** (tranexamic acid) are safe in bleeding patients and help reduce blood loss when combined with fluid resuscitation.
- **Early ICU transfer** ensures continuous monitoring, rapid intervention if hemodynamics worsen, and facilitates further diagnostic workup (e.g., endoscopy, imaging).
- The plan is **dynamic**; interventions will be reassessed continuously, especially as new data on the patient’s vital signs, laboratory values, and response to treatment become available.
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**Prepared by:**
Your Name, MD
Title/Department
**Date & Time:**
Insert Date and Time
*This comprehensive emergency plan is intended for immediate use in the critical care setting and will be updated as new information becomes available.*