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Clin Med I- GI > Colon > Flashcards

Colon Flashcards

1
Q

Mg vs. Calcium antacids

A

Mg antacids- cause movements (diarrhea). Calcium antacids- cause constipation

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2
Q

What if patient is hemoccult + and complains of rectal bleeding-

A

refer to colonoscopy

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3
Q

What if patient is 45 or older with positive hemoccult test but denies rectal bleeding-

A

refer for colonscopy, and give trial of fiber supplementation

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4
Q

What are studies of pelvic floor function

A

balloon expulsion test, defacography, anorectal manometry

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5
Q

Diagnostic studies for constipation

A

Colon transit study and studies of pelvic floor function

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6
Q

Tx for constipation- general

A

minimize constipation causing meds, lifestyle changes, treat hypothyroidism, treat diabetes, increase fluid and fiber intake, regular exercise

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7
Q

pharmacologic therapy for constipation

A

ONSES- osmotic laxatives (mag citrate), non-absorbable sugars, saline laxatives (MOM), emollient laxatives, stimulant laxatives

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8
Q

What is a consequence of excessive stimulant laxative use in tx of constipation?

A

melanosis coli- inner lining of colon turning brown

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9
Q

Rescue meds for acute constipation tx

A

stimulant and osmotic laxatives, and enemas (avoid soap studs)

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10
Q

tx of fecal impaction

A

manual disimpaction

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11
Q

Colonic pseudoobstruction and dilation of colon seen in..

A

Ogilve’s syndrome

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12
Q

Cause of ogilve’s syndrome related to..

A

electrolyte abnormalities

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13
Q

Tx of ogilve’s syndrome

A

bowel rest, IVF, electrolyte replacement

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14
Q

cause of diverticulosis

A

pulsion, d/t increased colonic pressure

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15
Q

What part of colon is spared in diverticulosis?

A

Rectum spared

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16
Q

pathogenesis of diverticulosis

A
  1. Hypermotility- high colonic pressure, affects mostly sigmoid colon. 2. Simple massed diverticulosis- occurs throughout colon, d/t weak muscular wall from CT disorder like Marfan’s or Ehlers-Danlos
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17
Q

complications from diverticulosis

A

bleeding and infection(diverticulitis)

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18
Q

tx of uncomplicated diverticulosis

A

high fiber diet

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19
Q

Which diagnostic imaging tests are contraindicated in acute diverticulitis?

A

Barium enema and colonoscopy

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20
Q

Patient presents with colicky abdominal pain, severe pain in LLQ, constipation, diarrhea, pain relieved by defecation, N/V, abdominal distension. Also see colovesical fistula. Dx?

A

Probably diverticulitis

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21
Q

What is colovesical fistula?

A

most common type of fistula from colon to bladder in diverticulitis

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22
Q

Tx of diverticulitis

A

outpatient abx or IV hospitalize if necessary

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23
Q

Should you perform colonoscopy in diverticulitis?

A

NO. Wait 6-8 weeks after resolution to perform to r/o cancer

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24
Q

After 3-4 episodes of diverticulitis…consider

A

elective colectomy

25
Q

When would you need to emergently perform surgery in diverticulitis

A

If free perforation, causing pneumoperitoneium and fecal peritonitis. Surgery involves removal of colon and formation of an ostomy (Hartman procedure). Takedown ostomy in 2-3 months and bowel is reconnected

26
Q

Hartman procedure

A

removal of rectosigmoid colon and formation of ostomy- surgery used in colon cancer and complicated diverticulitis

27
Q

Ischemic colitis cause

A

mesenteric vascular occlusion (inferior mesenteric artery often)

28
Q

Patient presents with LUQ abdominal pain, bloody diarrhea. Is hypotensive and dehydrated. You suspect..

A

Ischemic colitis

29
Q

Watershed area

A

areas perfused by 2 arteries- splenix flexure in colon - this is why ischemic colitis usually presents with LUQ pain

30
Q

ischemic colitis- how do diagnose?

A

colonscopy

31
Q

Patient presents with RUQ pain, fever, watery or bloody diarrhea, distenstion, nausea. Areas most affected are right colon, including cecum. You suspect..

A

Neutropenic colitis or typhlitis

32
Q

Diarrhea in toxic megacolon can either by bloody or no movement- why?

A

if bloody diarrhea- early toxic megacolon. if no movement- late due to lack of contractility.

33
Q

Most common causes of toxic megacolon

A

C. Diff colitis, or U. Colitis

34
Q

C. Difficile infection often follows…

A

antibiotic use

35
Q

What does C. difficile cause

A

pseudomembraneous colitis (accordion sign). also a cause of gastritis and peptic ulcers

36
Q

“Accordion sign” -

A

Pseudomembranous colitis (caused by C. diff)

37
Q

Tx of c diff infection

A

oral and IV abs

38
Q

tx for toxic megacolon

A

surgery

39
Q

Xray finding characteristic of colon cancer

A

apple core lesion

40
Q

95% of colon cancers are…

A

adenocarcinomas

41
Q

3-4% of patients with colorectal cancer have a genetic susceptibility syndrome, like…

A

HNPCC or FAP (autosomal dominant, highly penetrated)

42
Q

hereditary polyposis diseases

A

Juvenile polyposis, Peutz-Jegher’s syndrome, HNPCC, FAP

43
Q

4 types of juvenile polyposis

A

Juvenile polyposis syndrome, Cronkhite-Canada syndrome, Bannayan-Riley-Ruvalcaba syndrome, and Cowden disease

44
Q

Extracolinic manifestations in juvenile polyposis syndrome

A

None

45
Q

manifestations besides polyps in colon in cronkhite-canada syndrome

A

ectodermal lesions

46
Q

manifestations besides polyps in colon in bannayan RR syndrome

A

macrocephaly and genital hyperpigmentation

47
Q

manifestations besides polyps in Cowden disease

A

facial trichilemmomas, thyroid goiter, and cancer, breast cancer

48
Q

mode of inheritance in Peutz-Jeher’s syndrome

A

autosomal dominant

49
Q

Peutz Jegher’s syndrome characterized by…

A

multiple hamartomatous polyps and melanotic pigmentation of the skin, lips, and gums. Lifetime risk of colorectal cancer

50
Q

Difference in R vs. L sided tumors in colon cancers in Stools

A

R sided tumors present with bleeding- stool on R is liquid. L sided tumor stools are solid and cause obstruction (alternating constipation and diarrhea)

51
Q

How fast does colon cancer spread?

A

Doubling time is 130 days. Takes 5 years to produce tumor large enough to produce any symptoms. Slow growing!

52
Q

Persistent rectal bleeding in patient

A

workup for colon cancer!

53
Q

Steps in diagnosis of colon cancer

A

Hx of unrelenting rectal bleeding or abdominal pain in patient, Hemoccult positive- order colonoscopy. One diagnosis is made, CT scans of chest, abdomen, and pelvis to stage disease

54
Q

CEA

A

Carcinoembryonic angigen- useful in detecting recurrences of colon cancer after resection, but not specific

55
Q

complications of colon cancer

A

obstruction, perforation, and direct extension

56
Q

tx of colon cancer

A

partial colectomy usually with anastomosis- laparoscopic or open

57
Q

Primary vs. metastatic colon cancer tx

A

primary- chemo agents, antimetabolites. Metastatic- (MAb to VEGF)- Bevacizumab, Topoisomerase I inhibition (irinotecan), MAb to EGFR- cetuximab

58
Q

adjuvant vs. neoadjuvant

A

adjuvant- meds given AFTER sx. neoadjuvant- meds given BEFORE sx - to make tumor smaller for surgery

59
Q

F/U with colon cancer colonoscopy

A

colonoscopy 3 months after emergency resection. And then every 1-3 years for screening.

Clin Med I- GI (10 decks)

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