Colorectal, in full.

After polyp removal, assign the next colonoscopy surveillance interval using USMSTF 2020 based on polyp number, size, and histology (e.g., 1-2 tubular adenomas <10 mm 7-10 years; 3-4 tubular adenomas <10 mm 3-5 years; 5-10 tubular adenomas <10 mm, any adenoma ≥10 mm, or adenoma with tubulovillous/villous histology or high-grade dysplasia 3 years; >10 adenomas 1 year with polyposis evaluation; and for serrated polyps, 1-2 sessile serrated lesions <10 mm 5-10 years, 3-4 sessile serrated lesions <10 mm or a hyperplastic polyp ≥10 mm 3-5 years, and a sessile serrated lesion ≥10 mm or with dysplasia or a traditional serrated adenoma 3 years), and apply the shortest interval indicated when findings are mixed. Confirm complete resection and adequate prep before applying an interval, and use site-check/tumor-board pathways for piecemeal resection and malignant (T1) polyps. Refer for genetic evaluation when Lynch, FAP/AFAP/MAP, or serrated polyposis syndrome criteria are met.

In a patient with proctitis symptoms and receptive anal sex history, test with rectal NAAT for gonorrhea and chlamydia (LGV testing if positive), syphilis serology, HSV PCR from ulcers, stool studies for enteric pathogens in proctocolitis, plus HIV and hepatitis testing. Give empiric ceftriaxone 500 mg IM once plus doxycycline 100 mg BID for 7 days presumptively while awaiting results, started whenever the presentation is consistent with acute proctitis (anorectal exudate on exam or polymorphonuclear leukocytes on a Gram-stained anorectal smear, or, if anoscopy/Gram stain is unavailable, in a patient reporting receptive anal exposure) rather than only once symptoms are "moderate-severe", then tailor therapy by pathogen (extend doxycycline to the full 21-day course presumptively for LGV when bloody discharge, perianal or mucosal ulcers, or tenesmus accompany a positive rectal chlamydia NAAT, rather than waiting for confirmed LGV; penicillin G benzathine for syphilis, antivirals for HSV). Include partner notification and treatment, sexual health counseling, and repeat STI testing at 3 months.

Triage suspected perforation with immediate IV access (2 large-bore IVs) and assessment of perfusion in parallel with diagnostics; obtain upright CXR and CT abdomen/pelvis (most sensitive/specific) plus labs and lactate, and start empiric broad-spectrum antibiotics. Fluid therapy is stratified by perfusion status, not given as a fixed protocol for all comers: in adults with sepsis-induced hypoperfusion or septic shock, give at least 30 mL/kg IV crystalloid within the first 3 hours (Surviving Sepsis Campaign 2026; conditional recommendation, low-certainty evidence), selecting the initial volume by individual patient characteristics and context (use adjusted or ideal body weight if BMI >30 kg/m²) with frequent, ongoing reassessment to avoid under- or over-resuscitation, alongside sepsis care: blood cultures as soon as possible and ideally before antimicrobials, lactate with serial measurement to guide resuscitation, and vasopressors if hypotension persists despite fluids. In patients without sepsis-induced hypoperfusion or shock, do not give protocolized volume resuscitation; use maintenance fluids or small individualized boluses guided by hemodynamic reassessment, and in fluid-sensitive patients (e.g., heart failure, end-stage renal disease) use smaller individualized boluses with close reassessment rather than a fixed weight-based volume. Obtain mandatory emergency surgical consultation for any confirmed perforation, hard peritoneal signs, free air, or hemodynamic instability, proceeding to exploratory laparotomy/laparoscopy or cause-specific surgery (Graham patch, Hartmann, colectomy). Selected contained post-procedural perforations that are small, clip-amenable, and hemodynamically stable may be managed conservatively with ICU monitoring, NPO, antibiotics, and serial imaging.