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Gastroenterology exam 2 > Diverticular disease, polyposis & AVM > Flashcards

Diverticular disease, polyposis & AVM Flashcards

1
Q

what is the difference between diverticulosis and diverticulitis

A

diverticulosis - presence of diverticula w/o inflammation

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2
Q

What is the difference between true and false diverticula?

A

false - mucosa and musculoaris mucosa only, herniated through serosa

true - all layers, usually congenital

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3
Q

What is the most common site of diverticular disease?

A

sigmoid colon

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4
Q

What kind of diet decreases incidence of diverticulosis

A

high-fiber

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5
Q

What is a complication that can occur in diverticulosis?

A

infection from:

  • perforation (macroscopic/microscopic)
  • contamination, inflammation, infection
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6
Q

What is the clinical presentation of diverticulosis? (Sx, radiograph, CT) What is contraindicated in the case of perforation?

A

Left-sided abd pain
radiographs detecting free abdominal air
CT = pericolic inflammation (phlegmon, abscess)

Contrast enema contraindicated in perforation

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7
Q

What are the CT findings of Uncomplicated diverticulitis?

A
  1. pericolic soft tissue stranding
  2. colonic wall thickening
  3. Phlegmon
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8
Q

What is the advised treatment of uncomplicated diverticulitis in immunosuppressed pts?

A

colectomy after a signel episode of document diverticulitis

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9
Q

What are different types of Complicated Diverticulitis?

A

Diverticulitis w:

  1. abscess
  2. obstruction
  3. diffuse peritonitis (free perforation)
  4. fistulas (colovesical, colovaginal, coloenteric, colocutaneous[rare])
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10
Q

What is the staging system of Complicated Diverticulitis? What are the 4 stages?

A

Hinchey staging system:
Stage 1: inflammation w pericolic abscess
Stage 2: inflammation w a retroperitoneal/pelvic abscess
Stage 3: purulent peritonitis
Stage 4: fecal peritonitis

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11
Q

What is Tx for incomplete obstructive Sx of Diverticulosis?

A
  1. respond to fluid resuscitation
  2. nasogastric suction
  3. low volume water or Gastrografin enemas
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12
Q

what is the most significant lower GI bleed? what is Tx?

A

erosion of peridiverticular arteriole

Tx: epinephrine injection or cautery

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13
Q

What are characteristics of Right-Sided Diverticula?

A
  1. cecum + ascending colon infrequently involved
  2. contains all layers of bowel wall
    3 congenital
  3. more common in younger/asian pts
  4. asymptomatic
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14
Q

What do a majority of colorectal carcinomas evolve from?

A

adenomatous polyps

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15
Q

What are the four types of colorectal polyps?

A
  1. neoplastic (tubular, villous, tubulovillous, serrated)
  2. Hyperplastic
  3. Hamartomatous (juvenile, Peutz-Jeghers, Cronkite-Canada)
  4. Inflammatory (pseudo, benign lymphoid)
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16
Q

What are the most to least cancerous types of neoplastic polyp?

A

villous > tubulovillous > tubular

17
Q

What are characteristics of hyperplastic polyps?

A

extremely common

shows histologic hyperplasia W/O dysplasia

18
Q

What are general characteristics of Hamartomatous polyps?

A
  1. NOT premalignant

2. bleeding = common symptom

19
Q

What are characteristics of juvenile polyposis? (inheritance, Sx, progression)

A
  1. autosomal dominant
  2. pts develop Hundreds of polyps
  3. Lesions may degenerate into adenomas - carcinoma
20
Q

What is Peutz-Jeghers syndrome? Sx, progression

A

polyposis of small intestine, colon, rectum
Melanin spots on buccal mucosa and lips
not significant risk for malignant degeneration

21
Q

What are Sx of Cronkite-Canada syndrome

A
  1. GI polyposis
  2. Alopecia
  3. cutaneous pigmentation
  4. atrophy of fingernails/toenails
  5. Primary Sx = Diarrhea
  6. vomiting, malabsorption, protein-losing enteropathy
22
Q

What is Cowden’s syndrome (inheritance, Sx) and what are associated diseases?

A
  1. Autosomal dominant
  2. Hamartomas of all 3 embryonal cell layers
  3. facial trichilemmomas
  4. a/w breast cancer + thyroid disease
23
Q

What context do inflammatory polyps usually present?

A

IBD,
amebic colitis,
ischemic colitis
schistosomal colitis

24
Q

What is the microscopic appearance of inflammatory polyps?

A

islands of normal, regenerating mucosa surrounded by areas of mucosal loss

25
Q

What are characteristics (inheritance, genetic mutation, Sx, progression) of Familial Adenomatous Polyposis (FAP)?

A
  1. Autosomal dominant condition
  2. Mutation of APC gene on Chromosome 5q
  3. Sx = hundred to thousands of adenomatous polyps after puberty
  4. risk of CRCancer approaches 100% by age 50
26
Q

What other diseases is FAP associated with?

A
  1. congenital hypertrophy retinal pigmented epithelium
  2. Desmoid tumors
  3. Epidermoid cysts
  4. Gardner’s syndrome (Mandibular osteomas)
  5. Turcot’s syndrome (CNS tumors)
27
Q

Where is the most common location of Angiodysplasia (aberrant blood vessels)

A

GI tract

Cecum - 37 percent of GI locations

Gastroenterology exam 2 (19 decks)

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