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GI > Disorders of the Colon & Rectum High Yield > Flashcards

Disorders of the Colon & Rectum High Yield Flashcards

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1
Q

MC demographics for UC and CD

A
  • UC: Males
  • CD: Females
  • Caucasians
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2
Q

Smoking is risk factor for which IBD?

A

CD

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3
Q

Characteristic description and location of CD

A

Terminal ileum with skip areas and transmural inflammation (cobblestoning)

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4
Q

Mass in RLQ in an IBD

A

CD

Crohn’s starts at the beginning of the colon

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5
Q

Skin findings seen in CD

A
  • Erythema nodosum
  • Pyoderma gangrenosum

CDE

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6
Q

Diagnosis of CD

A

Colonoscopy with biopsy showing skip areas and cobblestoning.

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7
Q

Goal of therapy in CD

A

Symptomatic relief and reduce flare ups.

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8
Q

Low risk CD treatment for ileum only

A

EC budesonide 9mg for 4 weeks, tapering down by 3mg every 2-4 weeks for 8-12 weeks of total therapy.

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9
Q

Tx for mild-mod CD with diffuse involvement

A

Oral prednisone 40mg 1 week, then 5-10mg taper every week.

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10
Q

Tx of relapse of mild-mod CD

A

Glucocorticoid + immunomodulator/biologic

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11
Q

High-risk criteria for CD

A
  1. Dxd younger than 30
  2. smoker
  3. Elevated CRP
  4. Deep ulcers
  5. Long segments of involvement
  6. Perianal disease
  7. Extra-intestinal manifestations
  8. Hx of bowel resection
  9. Failure to achieve remission
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12
Q

Tx for high-risk CD

A

TNF blocker + Immunomodulator

Infliximab + azathioprine C for combo

Alt is prednisone then maintenance with a biologic/TNF

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13
Q

MC location for UC

A

Rectum + sigmoid

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14
Q

Hallmark sign of UC

A

Bloody diarrhea

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15
Q

Extra-intestinal manifestations of UC

A
  • Arthritis
  • Ankylosing spondylitis
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16
Q

Severity grading for UC

A
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17
Q

MC Demographic for UC

A

Non-smokers

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18
Q

Gold standard for Dx of UC

A

Sigmoidoscopy showing continuous friable mucosa

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19
Q

Diagnosis of UC

A
  1. 4 weeks of chronic diarrhea
  2. Active inflammation of sigmoidoscopy
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20
Q

Who does NOT get a colonoscopy with suspected UC?

A

Severe disease or severe colitis dt/t risk of perf.

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21
Q

Main complications of UC

A
  • Toxic megacolon
  • Cancer
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22
Q

Recommended diet change for UC

A

Cessation of caffeine

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23
Q

Tx of mild-mod UC confined to rectosigmoid

A

Topical mesalamine (via enema or suppository)

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24
Q

Tx of mild-mod UC w/ spread past sigmoid

A

Oral mesalamine + topical mesalamine

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25
Tx of mod-severe UC
Prednisone
26
Curative tx of UC
Total proctocolectomy w/ ileostomy
27
Maintenance tx of UC
Mesalamine
28
CI of mesalamine/5-asa
ASA or sulfa allergy
29
BBW of immunomodulators
* Mutagenic potential * Rapidly growing malignancies or lymphoma | Azathioprine
30
Methotrexate role in IBD
Only for CD if azathioprine failed. | Don't use meth at UC
31
BBW of TNF-blockers
Risk of serious infection | mabs
32
ABX for IBD
Metronidazole or Ciprofloxacin if risk of abscess
33
Live vaccine timeline if being treated for IBD
4 weeks before tx
34
MC type of polyp
Mucosal adenomatous
35
MC type of adenomatous polyp to be cancerous
Villous | villain = evil
36
Risk factors that make adenomatous polyp more likely to be malignant
1. Polyps > 1 cm 2. Villous histology 3. # of polyps 4. Flat
37
Characteristic of submucosal lesions
Made up of multiple tissue types
38
Risk factors for colon cancer
1. > 50 2. FMHx 3. High fat 4. Smoking 5. Obesity
39
Average age of screening for colon cancer
45
40
Presentation of proximal colon cancer
* Anemia * Weakness/fatigue * Melena, positive FOBT * Wt loss
41
Presentation of distal colon cancer
* Change in bowel habits * Obstruction * Hematochezia * Tenesmus
42
Diagnosis and staging of colon cancer
* Diagnosis: Colonoscopy * Staging: CT/MRI | CEA is for prognosis
43
Tumor marker to monitor established colon cancer
CEA
44
How often is colonoscopy post resection of cancer?
1 year after, then 3 years if no more polyps.
45
Classic FAP ages for development and cancer
* Age 15 is polyp development * Age 40 will have cancer unless prophylactic colectomy done.
46
Recommendations for suspected FAP
Complete proctocolectomy w/ anastomosis by age 20 and EGD every 1-3 years.
47
Characteristics of Lynch syndrome
* Risk inc for multiple cancers * Few polyps, but they are likely to be malignant
48
3 tool screening for Lynch
1. 1st degree relative with CRC before age 50 2. Pt with CRC before age 50 3. 3+ relatives with CRC | CRC = colorectal cancer ## Footnote Genetic testing if positive
49
Tx for Lynch
* Subtotal colectomy w/ anastomosis * Prophylactic hysterectomy + oophorectomy at 40 or after done with having kids * EGD every 2-3 yrs at 30. * Colonoscopy every 1-2 yrs at 25.
50
Separates internal and external hemorrhoids
Dentate line
51
3 main locations for Hemorrhoids
* Right anterior * Right posterior * Left Lateral | RAP LL
52
What vein makes external hemorrhoids?
Inferior hemorrhoidal veins
53
Presentation of symptomatic internal hemorrhoids
* Bleeding * Prolapse * Mucoid discharge | Not really painful unless stage 4
54
Conservative tx of hemorrhoids
Stage 1-2 is proper toileting and high fiber
55
Tx of recurrent stage 1-2 or 3-4 hemorrhoids
* Rubber band ligation (PREFERRED) * Injection sclerotherapy
56
Tx of severe stage 3 or 4 hemorrhoids
Hemorrhoidectomy
57
Tx of external hemorrhoids
* Warm sitz * Ointment * Evacuate clot
58
Main diff in presentation of external vs internal hemorrhoids
External hurts (and its external)
59
MC location for anal fissures
Posterior midline | Anywhere else suggests disease
60
What causes anal fissures usually?
Hard stools
61
Tx of anal fissures
Eat fiber like a healthy person | Chronic = surgery
62
MCC of perianal abscesses
Perianal fistulas
63
Tx of perianal abscess
* I&D * Maybe abx * Surgical excision
64
Tx of perianal fistula
Surgical fistulotomy under anesthesia
65
Tx of complete rectal prolapse
Surgery | Emergent if complete
66
Pilondial disease
Like an extra anus

GI (17 decks)

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