3.07 Structural Disorders Colon

Question 1

Wha increases incidence of diverticulosis in Western societies?

Answer 1

Age
50% >80 yo

Question 2

Most diverticulosis found incidentally on endoscopy or barium enema are?

Answer 2

asymptomatic

Question 3

What is thought to contribute to diverticular disease?

Answer 3

high pressure and/or bad wall

Question 4

How can diverticula be best seen?

Answer 4

barian enema or CT imaging

Question 5

Treat meant for diverticula?

Answer 5

high fiber diet/supplements

Question 6

Complications of diverticula?

Answer 6

lower GI bleeding, diverticulitis

Question 7

What is the most common cause of lower GI bleeding in adults?

Answer 7

diverticulosis

Question 8

“left-sided appendicitis”

Answer 8

used to describe the symptoms and clinical features that sign with a diverticulitis

Question 9

What does macroscopic inflammation of the diverticulum seen in diverticulitis encompass?

Answer 9

inflammation, microperforation, macro perforation

Question 10

Diverticulitis differentials?

Answer 10

perforated colon cancer
infectious colitis
IBD
ischemic colitis
appendicitis
G/U Problems

Question 11

Diverticulitis tests?

Answer 11

leucocytosis, stool occult positive but frank bleeding unusual (hematochezia)

Question 12

If people do not improve after a couple of days of empiric therapy with diverticulitis diagnosis (or severe), what next step?

Answer 12

CT scan abdomen

Question 13

What will you see in a diverticulitis CT scan?

Answer 13

diverticulli, wall thickening, pericolic fat infiltrtation, abscess, extraluminal air, or contrast

Question 14

Why are endoscopy and colonography contraindicated during initial acute attack stages?

Answer 14

risk of free perforation

Question 15

Recommendation for mild diverticulitis with NO peritoneal signs?

Answer 15

unrestricted diet
safely without antibiotics
watchful and wait

Question 16

What are the next steps for severe diverticulitis? high fevers, leukocytosis, abscess, or peritoneal sign

Answer 16

nothing by mouth
Iv fluids + antibiotics

Question 17

Indications for surgery with diverticulitis?

Answer 17

generalized peritonitis
undrainable abscess large
clinical deterioration

Question 18

Complications of diverticulitis?

Answer 18

fistula formation,
stricturing of the colon

Question 19

If a high risk of recurrent diverticulitis?

Answer 19

surgical resection

Question 20

discrete mass lesions that are flat or protrude into intestinal lumens?

Answer 20

polyps

Question 21

What is the most common inheritance pattern of polyps?

Answer 21

sporadic
can be part of family syndorme

Question 22

Two common types of polyps?

Answer 22

hyperplastic polyp and adenoma

Question 23

What are polyp clinical findings?

Answer 23

mostly asymptomatic OR
chronic occult blood (iron deficiency anemia)

Question 24

Differential diagnosis of polyps

Answer 24

colorectal cancer or other GI bleeding problems

Question 25

What test has high specificity but low sensitive for GI bleeding since it test positive for all heme products?

Answer 25

gFOBT (guaiac)

Question 26

What test measures intact hemoglobin and could only be used to measure bleeding below ligament for triez?

Answer 26

FIT

Question 27

The test used to measure risk for colorectal cancer but does not measure blood presence in stool?

Answer 27

stool DNA test High Sn and Sp good screening

Question 28

Best way to detect and remove adenomatous polyps?

Answer 28

colonoscopy via polypectomy

Question 29

What is good for the detection of large polyps (>10mm) but less specific for smaller ones?

Answer 29

CT colonography

Question 30

Who should be considered for more frequent sometimes yearly routine colonoscopies?

Answer 30

multiple polyps that are high grade in nature (suspect familial condition)

Question 31

classic "apple core" lesion on barium enema?

Answer 31

colorectal cancer

Question 32

Almost all colon cancers are?

Answer 32

adenocarcinomas

Question 33

Most colortectal cnacers arise from malignant transfortaion of?

Answer 33

polyps

Question 34

5% of colorectal cancers are inherited with what pattern for polyposis syndromes or hereditary nonpolyposis colorectal cancer?

Answer 34

autosomal dominant

Question 35

Risk factors for colorectal cancer?

Answer 35

age, polyps history, family history, IBD, fats and red meats, race (black>white)

Question 36

Second leading cause of death due to malignancy in the US?

Answer 36

colorectal cancer

Question 37

What suggests the metastatic spread of colorectal cancer?

Answer 37

hepatomegaly

Question 38

What makes relatively early clinical findings of colorectal cancer very difficult?

Answer 38

asymptomatoc, PE is usually normal, weight loss uncommon

Question 39

Right-sided colon cancers cause?

Answer 39

weaknes form cornic blood loss

Question 40

left-sided colon cancer causes?

Answer 40

obstructive syndromes and stool streaked in blood

Question 41

rectal cancers cause?

Answer 41

rectal tenesmus

Question 42

Labs for colorectal cancers?

Answer 42

CBC, elevated liver enzymes, fecal occult test, etc.

Question 43

Persistently elevated levels of what may suggest persistent disease and need more investigating of colorectal cancer?

Answer 43

CEA (carcinoembryonic antigen)

Question 44

What can be used if colonoscopy is not available and can be preoperative staging?

Answer 44

CT chest, abdominal, pelvis

Question 45

Wha is the diagnostic of choice for colorectal cancer?

Answer 45

colonoscopy

Question 46

What is beneficial tratment for people with high risk for colorectal occurnac eor stage II disease?

Answer 46

adjuvant chemo

Question 47

What is used to treat stage III colorectal cancer?

Answer 47

postoperative adjuvant chemo GOLFOX and CapeOx

Question 48

Stage IV drug regimen colorectal cancer?

Answer 48

survival improvement 15 months

Question 49

What would indicate that the cancer has reoccurred?

Answer 49

rise in serum CEA level

Question 50

When should normal risk patient get a colonoscopy?

Answer 50

>45 years old and <75 years, old every 10 years