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Spring Round II Exams > clin med- first two lectures > Flashcards

clin med- first two lectures Flashcards

1
Q

DiverticulOSIS

A

the presence of diverticula (sac like protrusion of colon wall)

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2
Q

Diverticulosis

A

prev increases w age
usually SIGMOID colon

often No sx, discovered incidentally

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3
Q

Worsening factors of Diverticulosis

A

Weak points in wall, vasa recta penetrate

Low fiber diet –> constipation –> increase pressure –> herniation

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4
Q

Diverticulosis sx (if present, usually not)

A

Abd cramp, constipation, diarrhea, bloating

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5
Q

DiverticulOSIS
Labs/imaging
Tx

A

Labs/image: none

Tx: High FIBER (and water)

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6
Q

Diverticulitis

A

ACUTE, symptomatic episode d/t inflammation of diverticula

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7
Q

Pathophys of DiverticulITIS

A

impaction obstructs the neck of diverticulum OR increased pressure —> erosion of wall –> inflammation and necrosis –> Perforation

(Micro vs Macro perforation)

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8
Q

Free air/peritonitis

A

result of Diverticulitis

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9
Q

Subtypes of Diverticulitis

A

Uncomplicated

Complicated: abscess, fistula, obstruction, perforation

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10
Q

ACUTE diverticulitis sx

A

Progressive, steady, ACHING pain (LLQ)
Fever/chills

maybe the following: n/v, change bowel habits, urinary sx,

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11
Q

Rectal/ Pelvic exam in Diverticulitis

A

Rectal may reveal mass or tender (GET STOOL GUIAIC)

Perform pelvic on women

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12
Q

Acute Diverticulitis labs

A

CBC: might show Leukocytosis

Also order: CMP, amylase, lipase, UA/culture, preg test, stool study (if diarrhea), stool occult

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13
Q

Imaging Test of choice for Diverticulitis

A

CT WITH contrast

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14
Q

CT (with contrast) of Diverticulitis will show

A

Wall thickening/fat stranding

Colonic diverticula

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15
Q

If worried about obstruction or perforation, can also order

A

X Ray (abd or CXR)

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16
Q

CONTRA tests in Diverticulitis

do NOT order these

A

Colonoscopy/flex sigmoid (could cause Perf)

Barium Enema (could worsen inflammation if Perf present)

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17
Q

Acute UNCOMPLICATED Diverticulitis tx

A

Gram neg/Anaerobic coverage x7-10d

Close F/u in 2 days

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18
Q

Acceptable regimens for Acute UNCOMPLICATED diverticulitis

A

Metronidazole + Cipro
Metronidazole + Bactrim
Augmentin, OR
Moxifloxacin

Gram neg/ Anaerobic

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19
Q

Acute Diverticulitis INPATIENT tx

A 
NPO
IVF
Analgesics
IV abx (transition to PO to complete total of 10-14d)
GI, surgery, consult

Repeat imaging IF not improving in 2-3 d of abx

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20
Q

When to refer Acute diverticulitis to surgery

A
  • Perforation with peritonitis
  • Worsen or fail to improve within 3d of meds
  • Complicated case
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21
Q

Acute diverticulitis Long term tx

A

High fiber (once acute episode resolved)

Colonoscopy 6-8 wks later (r/o CA or IBD)

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22
Q

Diverticular bleeding is common cause of

A

OVERT lower GI bleeding

Usually resolved spont

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23
Q

Which side of colon is usually involved with Diverticular bleeding?

A

RIGHT side

diverticulum are wider and vasa recta more exposed here

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24
Q

Clinical sx of diverticular bleeding

A 
PAINLESS hematochezia (fresh blood in stool)
Blood on rectal exam

May have bloating, cramping, TTP

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25
Imp thing to do with diverticular bleeding
Once resuscitation complete, LOCATE source of bleeding w/ flex sig/ colonoscopy
26
Tx for diverticular bleeding
USUALLY resolves on its own Main goal: maintain blood volume (transfuse prn) Tx of bleeding site prn: Endoscopic, Angiographic, +/- surgery
27
Flat polyp
Sessile
28
Hyperplastic polyp
Non-CA completely benign Usually distal colon
29
Pseudopolyp
Non-CA Inflammatory usually d/t IBD
30
Adenoma
Neoplastic, "Pre-CA"
31
Adenoma subtypes
Tubular adenoma- most common Tubulovillous adenoma Villous adenoma
32
Sessile serrated polyps
emerging type of Pre-CA Usually R side colon Flat, few surface blood vess difficult to see
33
70% of Colorectal CA arise from adenoma
Progression from Adenoma --> CA takes about 10 years
34
High Risk Adenoma (#, size, histoloty)
>1 cm Villous or tubulovillous High grade dysplasia
35
Most common side of Colon CA
LEFT side
36
Risk factors CRC | not modifiable
IBD >8-10 yrs >50 YO African American Personal or family hx: - Adenoma or Colon CA - Familial ademomatous polyposis - HNPCC
37
Risk factors CRC | modifiable
``` TOBACCO alc diet (high fat, low fiber) red meat obesity DM ```
38
CRC usually A-sx, but RED FLAGS are:
``` Change bowel habit Hematochezia or occult blood in stool Iron def anemia Anorexia/weight loss Abd pain (refer to GI for Colonoscopy) ```
39
CRC sx (if present)
``` Cachectic Pallor Lymphadenopathy Abd distention, ascites, mass, organomegaly DRE: hemoccult + stool, rectal mass ```
40
CRC diagnostic
CBC: look for anemia | Liver test: ALP may be elevated w Liver METs
41
What is CEA (carcinoembryonic antigen) used for?
Prognostic indicator | Monitor recurrence
42
"apple core lesions"
Colon CA
43
Colonoscopy and CT
Colonoscopy: biopsy for pathologic confirmation CT chest/abd/pelvis: show tumor extension/complication, METs
44
CRC staging "TNM" system
Tumor- depth Node- regional lymph node involvement METs- yes or no stage 0-4
45
CRC tx options
Partial colectomy w wide margins and adjacent lymph node removal Chemo (if METs) Radiation (Rectal adenocarcinoma)
46
CRC surveillance
Serial CEA levels Annual CT (depend on stage) Colonoscopy periodically
47
Visualization tests
Colonscopy Flex sig CT colonography
48
Stool based tests
gFOBT (hemoccult SENSA) FIT (fecal immuno test) FIT-DNA (cologuard)
49
CRC screening Gold standard
Colonoscopy (diagnostic and therapeutic) can remove polyps, take biopsy
50
Do you need bowel prep for Colonoscopy
Yes
51
CT Colonography
"Virtual colonscopy" dont have to sedate, but CAN MISS FLAT OR SMALL POLYPS still need bowl prep cannot remove polyps
52
gFOBT stool test | "Hemoccult SENSA"
requires 3 consecutive stools Annual use recommended (one time screening doesn't tell us much)
53
FIT stool test* | test for human hgb
PREFERRED CRC detection test! single specimen, non invasive BUT annual use still recommended
54
FIT-DNA stool test (Cologuard) like the FIT but also test for DNA mutation biomarkers in cells shed by CRC
MAIN CONCERN: false positives if +, get colonscopy ASAP rocky requires entire bowel movement
55
Overall, stool tests
have lower sensitivity sometimes miss polyps that don't bleed need to be annual (pt compliance)
56
If you have IBD, when should you have first Colonoscopy
8-10 yrs after sx onset
57
If 1st deg family hx of CRC or Advanced adenoma, when to get YOUR first colonscopy?
If relative <60 YO (or two 1st deg relatives any age) -every 5 yrs starting at 40YO or 10 yrs younger than dx of relative If relative >60 YO -start at 40, if normal continue on as normal indiv
58
FAP (familial adenomatous polyposis)
tons of polyps! >100 adenomatous poyps Starts ~16 YO nearly ALL polyps will become CA by age 39 if untreated
59
Tx for FAP
Prophylactic colectomy Risk of extracolonic CA (stomach, duod, ampullary CA is common)
60
Screening for FAP who are gene carriers or have family hx (even without genetic confirmation)
Sigmoid/Colonoscopy start at 10-12 YO and repeat every 1-2 years +Routine EGD
61
HNPCC | "lynch syndrome"
Inc risk for RIGHT sided CRC | age 45-60
62
HNPCC | "lynch synd"
multiple family members usually affected Increased risk of other CA: Endometrial being most common
63
3-2-1 rule diagnosis | Amsterdam criteria for HNPCC
At least 3 relatives w Lynch syndrome assoc CA At least 2 generations in a row At least 1 before age 50
64
HNPCC screening
Annual Colonoscopy starting at age 20-25 OR 2-5 yrs before onset of earliest dx age in family whichever comes first
65
Other screening to consider with HNPCC
``` Pelvic exam (endometrial CA) EGD (start 30-35 YO and every 2-3 yrs) ```
66
Consider familial Colon CA condition if
>1 fam member hx CRC Persona/ fmx CRC at age earlier than 50 YO Personal/fmx of MULTIPLE adenomas (>10-20) Personal/fmx of multiple Extracolonic CA

Spring Round II Exams (10 decks)

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