Colon cancer

BMI

Body mass index (BMI)

The body mass index is a simple measure for classifying body weight. It is calculated as body weight in kilograms divided by the square of height in meters (kg/m²). The BMI serves as a rough estimate of underweight or overweight but does not take body composition (muscle vs. fat mass) or fat distribution into account.

paradoxical

With a colonic stenosis stool accumulates before the narrowing. Through bacterial decomposition it becomes partially liquefied and can pass the stenosis as thin stool. In addition, mucosal irritation promotes fluid secretion. Because diarrhea occurs despite the outflow obstruction, this is referred to as paradoxical diarrhoea.

Tenesmus

Tenesmus

Tenesmus are tormenting, often painful and usually unsuccessful urges to defecate. Typical is the feeling of incomplete evacuation and repeated unsuccessful attempts. Inflammatory or rectal diseases that can lead to this symptomatology are often underlying causes.

Constipation

Constipation

Constipation refers to difficult or too infrequent bowel movements with hard or only incompletely evacuated stool. Accompanying symptoms can include straining, the feeling of incomplete evacuation and mechanical problems during defecation. Causes are varied and range from dietary and lifestyle factors through medications to functional or structural bowel disorders.

Diarrhoea

Diarrhoea

Diarrhoea describes an increase in stool frequency and/or stool liquidity (looser stool) compared with the individual’s normal state. Acute and chronic diarrhoea are distinguished; potential consequences are fluid and electrolyte losses. Causes can be infectious, inflammatory, secretory or malabsorptive processes.

Pallor

Pallor

Pallor describes an unusual lightening of the skin or mucous membranes. It can result from a reduced hemoglobin content in the blood (e.g., in anaemia) or from reduced perfusion and is not a specific sign, so further evaluation is necessary.

Dizziness

Dizziness

Dizziness refers to the subjective experience of balance disturbances or the sensation of spinning, swaying or lightheadedness. Vestibular rotational dizziness phenomena, unsteadiness when walking and presyncopal lightheadedness are distinguished.

Causes are varied and range from inner ear disorders through neurological diseases to circulatory problems; a drop in blood pressure when standing up (orthostatic hypotension) is a possible and common cause of dizziness on changing position.

Dyspnoea

Dyspnoea

Dyspnoea is the subjective perception of shortness of breath or difficult breathing. It can occur with physical exertion or at rest and vary in intensity and character.

Fatigue

Fatigue

Fatigue denotes persistent, often functionally limiting exhaustion or tiredness that cannot be remedied by rest alone. It differs from normal sleepiness or transient tiredness.

Common associations are chronic diseases, psychological stress and systemic causes such as anaemia, which can contribute to generalized tiredness.

Hematochezia

Hematochezia

Hematochezia denotes visible, fresh blood in the stool. It usually indicates a bleeding source in the lower gastrointestinal tract, for example in the colon or rectum.

In exceptional cases very heavy bleeding from the upper gastrointestinal tract can also cause fresh red blood in the stool, but hematochezia usually points to a distal bleeding source.

Pyrexia

Pyrexia

Pyrexia is the medical term for fever, i.e. an increase in the body’s temperature due to a reset of the set point by pyrogenic influences. Fever is a common sign in infections, inflammations, certain tumors or as a reaction to medications.

nocturnal hyperhidrosis

Nocturnal hyperhidrosis

Nocturnal hyperhidrosis denotes excessive sweating during sleep that leads to soaked clothing or bedding. It must be distinguished from normal night sweating, which can be caused by ambient temperature or sleep rhythms.

Nausea

Nausea (nausea)

Nausea denotes the subjective feeling of discomfort in the upper abdomen or throat with a marked urge to vomit. It is a symptom, not a finding, and can have many causes, such as gastrointestinal diseases, vestibular disorders, drug effects, metabolic disturbances or pregnancy. Nausea often precedes actual emesis and can lead to appetite reduction and, with persistent symptoms, secondary problems such as fluid loss.

Haematemesis

Haematemesis (bloody vomiting)

Haematemesis denotes the vomiting of blood or blood-containing material and indicates a bleeding source in the upper gastrointestinal tract. The vomit may appear freshly bloody or dark/”coffee-ground” depending on the dwell time and decomposition of the blood in the stomach. Haematemesis usually requires prompt diagnostic evaluation as it can be a sign of a clinically significant gastrointestinal bleed.

pathological findings or coatings

Pathological mucosal changes or coatings can indicate an inflammatory bowel disease (IBD) such as Crohn’s disease or ulcerative colitis, but they are not specific for these conditions.

Melena

Melena (tarry stool)

Melena denotes black, tar-like stool material that is produced by the breakdown and oxidation of blood in the upper gastrointestinal tract. The dark color results from chemical changes to the blood during passage through the stomach and small intestine. Melena often indicates a bleeding source proximal to the colon and is a clinically relevant sign that requires further evaluation.

Haemorrhoids or anal fissures

Haemorrhoids and anal fissures

Haemorrhoids are enlarged vascular cushions in the anal area that can cause bleeding, itching or a slight foreign-body sensation. Anal fissures are painful tears in the anal mucosa, typically with bright red blood on the stool or during defecation. Common causes include mechanical strain from severe straining with constipation or recurrent diarrhoea; other triggers can be pregnancy, increased venous pressure or inflammatory diseases.

Jaundice or pruritus

Jaundice and pruritus

Jaundice refers to the yellowing of the skin and sclera due to elevated bilirubin levels. Pruritus is generalized or localized itching. Both symptoms are nonspecific but important clinical signs that can indicate liver dysfunction, impaired bile flow (cholestatic processes), biliary obstruction or, more rarely, increased bilirubin production states (e.g., hemolytic). The occurrence of jaundice or pronounced pruritus justifies further diagnostic evaluation to differentiate hepatocellular, cholestatic or extrahepatic causes.

Antibiotic use

Antibiotic use

Antibiotic use refers to the administration of antimicrobial drugs. Recent or repeated use can alter the gut flora and thereby increase the risk of antibiotic-associated complications. Clinically relevant is in particular the increased risk of Clostridioides-difficile-associated diarrhoeal disease or pseudomembranous colitis after systemic antibiotic therapy.

Insomnia

Insomnia

Insomnia denotes persistent difficulties falling asleep, staying asleep or unrefreshing sleep quality with resulting daytime impairment. Common triggers are psychological stress, burdensome life circumstances, psychiatric disorders, medical problems or disturbances of the sleep–wake rhythm. Chronic sleep disorders often have negative effects on mood, performance and somatic health and should be diagnostically and therapeutically evaluated.

Frontal sinusitis

Frontal sinusitis

Frontal sinusitis is an inflammation of the frontal sinuses, one of the paranasal sinuses. Causes can be viral or bacterial infections, allergic reactions or anatomical obstacles. Typical complaints are pressure or pain in the forehead area, increased nasal discharge or nasal obstruction and occasionally fever. With bacterial involvement purulent secretions may occur; complications with spread to adjacent regions are rare. Therapeutic principles include measures to promote drainage and decongestion as well as symptomatic treatment; if bacterial infection is proven, antibiotic therapy may be required.

Coxarthrosis

Coxarthrosis

Coxarthrosis refers to the degenerative change of the hip joint with progressive cartilage loss and joint functional impairment. Risk factors are older age, overweight, malalignment, repetitive overloading and prior injuries. Clinical signs are load-dependent pain in the groin, buttock or thigh, morning stiffness and restricted mobility. Treatment in early stages aims at conservative measures such as physiotherapy, weight reduction, aids and analgesic medication oriented to symptoms; with advanced joint destruction, endoprosthetic replacement may become necessary.

Claustrophobia

Claustrophobia

Claustrophobia is the specific fear of narrow or enclosed spaces that can lead to avoidance behavior and subsequently to marked distress or panic attacks. Triggers are situations with restricted freedom of movement or anticipated difficulty leaving the space. Effective treatment approaches include psychotherapeutic methods with exposure and cognitive restructuring; additionally, behavioral techniques for anxiety management can be used, and if needed short-term pharmacological support for symptom relief.

Panic attacks

Definition:
A panic attack is a sudden episode of very intense fear or great agitation, accompanied by physical symptoms such as palpitations, breathing difficulties, dizziness, trembling or the feeling of losing control or dying.
Panic disorder:
Panic disorder is defined by recurrent, unexpected panic attacks; further diagnostic assessment typically includes persistent concern about additional attacks or marked behavioral changes (e.g., avoidance). A rigid requirement of six months as a prerequisite is not correct.
Causes:
The origin is usually multifactorial with genetic predisposition, stressful life events or traumatic experiences as well as neurobiological factors.
Treatment:
Psychotherapeutic methods, especially cognitive behavioral therapy with exposure components, are considered first-line. For pharmacological long-term treatment selective serotonin reuptake inhibitors (SSRIs) are used. Short-term benzodiazepines can be used for acute symptom relief but are not recommended for long-term therapy because of dependence and sedation risks. Beta blockers can reduce certain physical symptoms but are not a primary long-term treatment for panic disorders. Complementary relaxation and breathing techniques can be helpful.

Lyme borreliosis

Pathogen and transmission:
Lyme borreliosis is caused by Borrelia bacteria transmitted to humans by the bite of certain tick species.
Clinical presentation:
Typical in the early stage is a lateral, expanding redness at the bite site (erythema migrans). Accompanying flu-like symptoms such as fever, fatigue and joint pain may occur. In later stages neurological findings, cardiac involvement, or recurrent joint inflammations are possible.
Diagnostics:
With a typical erythema migrans presentation the diagnosis is often clinical; serological tests (for example ELISA as screening with confirmatory tests) are used for further evaluation but can be negative in very early stages.
Therapy:
Treatment is with appropriate antibiotics; the choice depends on the stage and manifestation of the disease.

Ski accident

Definition:
A ski accident denotes an injury sustained while skiing or snowboarding caused by a fall or collision.
Typical injuries and consequences:
Commonly affected are the knee (e.g., cruciate ligament injuries), shoulder and clavicle, head injuries and fractures of the upper and lower extremities.
Acute measures and care:
Emergency care includes securing the scene, pain relief, immobilization and, if indicated, imaging diagnostics. Further treatment can be conservative with immobilization and physiotherapy or surgical depending on the type and severity of the injury.

Acromioclavicular joint

Anatomy and function:
The acromioclavicular joint is the connection between the lateral end of the clavicle and the acromion of the scapula. It contributes to the movement and stability of the shoulder girdle.
Clinical relevance:
The joint can be injured by direct falls onto the shoulder or by traumatic forces; typical findings are pain over the joint and a visible deformity in severe ligament injuries.
Treatment:
Minor injuries are usually treated conservatively with immobilization, analgesia and physiotherapy; in pronounced ligament ruptures or persistent complaints surgical measures may be indicated.

Strabismus

Definition:
Strabismus denotes a misalignment of the visual axes in which the gaze directions of the two eyes are not parallel.
Causes and significance:
Causes can include congenital muscle imbalances, differing refractive errors, neurological disorders or acquired diseases. In children untreated strabismus can lead to the visual impairment amblyopia; in adults double vision is possible.
Diagnostics and therapy:
Evaluation includes orthoptic examination and, if necessary, refraction testing. Treatment options are corrective glasses, occlusion therapy (patching the dominant eye), prismatic lenses and, if indicated, surgical interventions to correct the extraocular muscles. Early treatment is important to avoid permanent visual impairment.

Valsartan

Group: Angiotensin II receptor blockers (ARB).

Mechanism of action: Blocks AT1 receptors for angiotensin II and thereby inhibits the vasoconstrictive and aldosterone-mediated effects of this hormone, leading to blood pressure reduction and cardiac unloading. Angiotensin II is formed in the RAAS by conversion of angiotensinogen (liver) involving renin (kidney) and ACE; it is not primarily “produced” in the kidney.

Indications: Mainly arterial hypertension and heart failure; also after myocardial infarction and in certain kidney diseases depending on clinical assessment.

Important risks and side effects: Blood pressure drop with dizziness, worsening renal function, increased potassium (hyperkalaemia), rare angioedema. Cough is much less common with ARBs than with ACE inhibitors. Caution is advised with concurrent use of potassium-sparing substances or in impaired renal function.

Valerian

Name and use: Valerian (Valeriana officinalis) is a herbal preparation traditionally used to treat mild sleep disorders and nervous restlessness.

Effects and evidence: Clinical studies show heterogeneous results; some investigations report slight effects on time to fall asleep or sleep quality, but the data are not consistently clear and efficacy is considered limited.

Safety and interactions: Common side effects are gastrointestinal complaints, headache or daytime drowsiness. Combination with other central nervous depressants (e.g., benzodiazepines, alcohol) can increase sedation. Valerian preparations are over-the-counter in many countries.

Pack-years

Definition and calculation: Pack-years describe cumulative tobacco exposure. Formula: (Number of cigarettes smoked daily ÷ 20) × Number of smoking years.

Calculation example for context: For the given consumption pattern the cumulative exposure is 16.25 pack-years.

Testicular torsion

Definition: Acute rotation of the testis around the spermatic cord with resulting disturbance of venous and possibly arterial blood flow.
Clinical presentation: Typical is a sudden onset of very severe unilateral scrotal pain, often accompanied by swelling and a high-riding testis; nausea and vomiting may occur. Occurrence is common in adolescence.
Diagnostics: The suspected diagnosis is primarily clinical. Color Doppler sonography can assess perfusion and support the diagnosis.
Therapy: In suspicion a rapid surgical intervention is required; the goal is detorsion of the testis and fixation of both testes (orchidopexy). If tissue changes are no longer reversible, removal of the affected testis is necessary.

Multiple sclerosis

Definition: Inflammatory demyelinating disease of the central nervous system with variable relapsing and/or progressive course.
Clinical features: Common symptoms are visual disturbances (e.g., optic neuritis), sensory deficits, pareses, coordination disorders and bladder or sexual dysfunctions.
Diagnostics: Key findings come from MRI of the brain and spinal cord as well as cerebrospinal fluid; clinical course observation and established diagnostic criteria are used to secure the diagnosis.
Therapy: Acute relapse therapies are used in the short term; long-term disease-modifying immunotherapies are an option; symptomatic and rehabilitative measures are applied additionally.

Colonic polyps

Definition: Colonic polyps are localized protrusions of the mucosa in the large intestine that can have various histological types.
Clinical aspects: Many polyps cause no symptoms; possible complaints are rectal bleeding, altered bowel habits or nonspecific abdominal discomfort.
Risk and course: Some polyps can undergo malignant transformation over time; the risk depends on histological type, size and number.
Therapy and prevention: The usual measure is endoscopic removal during colonoscopy with histological processing for risk assessment; early removal reduces the risk of malignant transformation.

Colorectal carcinoma

Definition: Colorectal carcinoma denotes malignant tumors of the colon and rectum that are predominantly of glandular origin.
Histology: The majority of colorectal tumors are adenocarcinomas arising from the glandular epithelium of the mucosa.
Clinical and prognostic subtypes: There are various histological subtypes with different behavior; some, such as medullary carcinoma with dense lymphocytic infiltration, may show a comparatively more favorable prognosis, whereas signet-ring cell carcinomas often run more aggressively.
Risk factors: Known risk factors include older age, certain dietary habits, genetic predispositions including familial polyposis syndromes, and other acquired influences.
Prevention/management: Early detection by screening and endoscopic evaluation as well as histological assessment of polyps are central measures to reduce disease risk and mortality.

Adhesions

Definition: Adhesions are fibrous scar tissue connections that abnormally join different internal surfaces and organs.
Causes and significance: They often arise after surgical procedures but also as a result of inflammation or trauma. Adhesions can contribute to chronic pain, mechanical bowel obstruction, or infertility in women.
Clinical relevance: In the diagnostic workup of abdominal symptoms, prior abdominal surgery is an important clue to possible adhesions as a differential diagnosis.

Irritable bowel syndrome

Definition and classification
Irritable bowel syndrome is a functional disorder of the gut in which no structural or inflammatory cause is found. Clinically, recurrent abdominal pain predominates and may be associated with changes in bowel habit (predominantly diarrhea, constipation, or alternating stool consistency).
Key feature and differentiation
Typical is the absence of “alarm” findings such as persistent weight loss, bloody stools (hematochezia), or a progressive course; the occurrence of such signs increases the likelihood of an organic disease and justifies further diagnostics.
Treatment focus
Therapeutically, lifestyle measures are paramount, including targeted dietary adjustments and stress management techniques. Pharmacologic or other interventional measures are directed by the predominant symptoms and the clinical course.

Heart rate

Term and significance
Heart rate denotes the number of heartbeats per minute and is a fundamental vital parameter.
Measurement and influencing factors
It is recorded at rest or during exertion; age, physical activity, medications, temperature, and stress influence the rate. Deviations from the expected resting heart rate can indicate cardiovascular or systemic disorders and may require further evaluation.

Blood pressure

Term and measurement principle
Blood pressure indicates the pressure that circulating blood exerts on the vessel walls and is described by systolic and diastolic values.
Procedure of measurement
For measurement, an inflatable cuff and a measuring device are usually used; the cuff generates a pressure with which the arterial pressure values are determined. Correct cuff application technique and selection of cuff size are important for meaningful results.

Respiratory rate

Term and clinical significance
Respiratory rate is the number of breaths per minute and a basic vital parameter for assessing respiratory function.
Measurement and influencing factors
It is counted at rest and can be altered by pain, fever, pulmonary or metabolic disorders, as well as emotional stress. Deviations from the expected respiratory rate indicate respiratory or systemic problems and should be assessed in the clinical context.

Oxygen saturation

Term and measurement methods
Oxygen saturation describes the proportion of hemoglobin bound to oxygen relative to total hemoglobin in the blood and is often measured noninvasively by pulse oximetry.
Importance and clinical relevance
The measurement provides a quick assessment of the body’s oxygenation; reduced values can indicate impaired pulmonary gas exchange or circulatory problems and may require further investigations.

Temperature

Term and measurement sites
Body temperature is a vital parameter that reflects the body’s heat balance. It can be measured at various sites such as rectally, orally, or in the axilla, with the measurement site affecting the measured values.

digital rectal examination

Digital rectal examination

Purpose: Clinical palpation of the distal rectum and anal canal to assess palpable findings, bleeding, or locally limited changes.

Procedure: A gloved and lubricated finger is gently introduced into the rectum. The examination is brief and serves to palpate mucosa, rectal wall and, in men additionally, the prostate.

Findings and indications: Detected findings can include tumors, indurations, bleeding sources or palpable sphincter changes. The examination can be uncomfortable and may provoke pain with inflammatory or painful lesions; minimal bleeding is occasionally possible.

Peutz-Jeghers

Peutz-Jeghers syndrome

Definition: Hereditary syndrome characterized by multiple hamartomatous polyps in the gastrointestinal tract and characteristic pigmented macules on the lips and face.

Clinical presentation: Typical are pigmented spots on perioral skin and mucosal areas as well as gastrointestinal polyps that can lead to bleeding or intussusception.

Genetics and risk: Usually inherited in an autosomal dominant manner (common cause: STK11/LKB1 mutation). Affected individuals have an increased risk for various tumors in the gastrointestinal tract and other organs.

Gardner syndrome

Gardner syndrome

Definition: A form of familial adenomatous polyposis that, in addition to numerous colorectal adenomas, shows pronounced extraintestinal manifestations.

Clinical features: Multiple colorectal polyps with high carcinogenic potential, bony osteomas (commonly skull, jaw), epidermal cysts and soft tissue tumors such as desmoids.

Genetics and prognosis: Usually autosomal dominant due to mutations in the APC gene. Without preventive interventions there is a very high risk of developing colorectal carcinoma.

complete blood count

To rule out anemia a blood count is determined. For a hemoglobin value below 7 g/dl a transfusion of packed red blood cells should be considered. The decision also depends on symptoms, hemodynamic status and comorbidities. Prior to transfusion the ABO blood group and the rhesus factor (Rh) are determined as well as an antibody screen and a crossmatch. Immediately before the transfusion a bedside test is performed on the patient.

Renal function parameters

Renal function parameters

Definition and purpose: Laboratory chemical measurements to assess renal performance and renal excretory function.

Typical parameters: Common measurements are serum creatinine and blood urea (urea); the estimated glomerular filtration rate (eGFR) is usually calculated from the creatinine value. Complementary tests can include electrolyte values and urine analyses.

Significance: Changes in these values provide clues to acute or chronic renal dysfunction and serve for monitoring the course.

Electrolytes

Electrolytes

Significance: Electrolytes are central ions (e.g., sodium, potassium, chloride) important for water balance, acid-base balance and cellular functions.

Typical disturbances with fluid losses:
– Vomiting: can lead to potassium losses and a hypochloremic metabolic alkalosis with accompanying hypokalemia.
– Diarrhea: can lead to volume loss, hyponatremia and hypokalemia as well as frequently to a metabolic acidosis.

Clinical relevance note: With significant gastrointestinal losses of fluid or gastric contents, electrolyte measurements are indicated for assessment and monitoring.

ALT

Alanine aminotransferase (ALT)

Definition and function: ALT is an enzyme involved in amino acid metabolism and catalyzes transfer of an amino group.

Occurrence and clinical significance: It is mainly present in liver cells and is detectable in increased amounts in the blood after release from damaged hepatocytes. Measurements are used to assess hepatocellular injury but are not sufficient alone for differential diagnosis.

AST

Aspartate aminotransferase (AST)

Definition and function: AST is an enzyme of amino acid conversion involved in transamination reactions.

Occurrence and clinical significance: It is present in the liver but also in heart muscle, skeletal muscle and other tissues. Elevated serum values indicate cell death or tissue damage, with AST not being liver-specific and rising in injuries of other organs.

GGT

Gamma-glutamyltransferase (GGT)

Definition and function: GGT is an enzyme involved in glutathione metabolism and contributes to the amino acid transport function of the cell membrane.

Occurrence and clinical significance: It is found in liver cells and in the epithelial cells of the bile ducts. Laboratory elevations commonly occur in cholestatic liver diseases or with enzyme induction (e.g., by alcohol or certain medications) and support the assessment of liver and biliary diseases.

Pancreatic enzymes

Pancreatic enzymes

Overview and functions: The exocrine enzymes of the pancreas include amylase, lipase, and proteolytic enzymes such as trypsin and chymotrypsin.

Action: Amylase catalyzes the breakdown of starch and related carbohydrates; lipase promotes the cleavage of dietary fats; trypsin and chymotrypsin are proteases that cleave peptide bonds in protein molecules.

C-reactive protein

C-reactive protein (CRP)

Definition and function: CRP is an acute-phase protein produced in the liver in response to inflammatory stimuli and tissue damage.

Clinical significance: Serum measurement is used to monitor the presence and course of inflammatory processes. CRP provides information about the activity and dynamics of an inflammation but is not a specific indicator of the cause.

CEA

CEA (carcinoembryonic antigen)

Definition: CEA is a tumor marker that plays a role in fetal development and can reappear at increased levels in adulthood with certain tumors.

Clinical significance: Elevated blood levels are found in some solid tumors (particularly colorectal neoplasms) but are not sufficiently sensitive or specific for screening purposes. The marker is mainly used for monitoring and follow-up, not as a sole diagnostic test.

CA 19-9

Definition
CA 19-9 is a carbohydrate antigen measurable in blood and can be associated with certain epithelial tumors.

Clinical use
The marker is mainly used for monitoring disease course and therapy of tumors, particularly pancreatic and biliary diseases. It is not suitable as a stand-alone screening test.

Limitations
Sensitivity and specificity are limited. Elevated CA 19-9 levels can also occur in other solid tumors as well as in various benign conditions (e.g., cholestatic states, pancreatitis, liver diseases). Therefore, laboratory values must always be interpreted in the clinical context and together with imaging findings.