Exam 2 Flashcards
(220 cards)
1
Q
Patho of nausea/vomiting
A
Visceral afferent fibers
Vestibular system
High CNS (amygdala, like sights or smells)
Area postrema (CTZ)
2
Q
Acute vomiting
A
Less than 1 week, usually gastroenteritis, febrile illness or drugs
3
Q
Cyclic vomiting syndrome
A
Idiopathic disorder, recurrent, stereotypical bouts of vomiting with intervening periods of normal health
4
Q
Boerhaave syndrome
A
Rupture of the esophagus due to vomiting
5
Q
Non pharm nausea traetment
A
Ginger or acupressure at P6 on wrist
6
Q
Bout of hiccups
A
Less than 48 hours
7
Q
Intractable hiccups
A
Greater than 1 month of hiccups
8
Q
Common clinical setting for intractable hiccups
A
Chronic renal failure
9
Q
Singultus
A
Hiccups
10
Q
Organic versus psychogenic hiccups
A
Organic- hiccups do not go away when you sleep
Psychogenic- hiccups do go away when you sleep
11
Q
Belching is not a symptom of…
A
Organic disease
12
Q
Aeorophagia
A
Excessive swallowing of air (sucking air into the stomach)
Functional GI disorder caused by many things
13
Q
Volume problem in gas
A
Hydrogen nitrogen and methane
14
Q
Odor problem with gas
A
Sulfur gases and short chain fatty acids
15
Q
Gas production
A
Bacterial fermentation of unabsorbed foods
Malabsorption (lactose and fructose)
16
Q
FODMAPS
A
Foods that causes gas formation
Fermentable, oligosaccharides, disaccharides, monosaccharides, polyols
17
Q
Constipation definition
A
Disturbance in defecation that may include
Infrequent stools less than 3 times a week
Difficult stool passage
Abdominal discomfort/bloating
18
Q
Normal transit time
A
34-35 hours and up to 72 hours
19
Q
Normal transit constipation
A
Incomplete evacuation
Psychosocial distress
20
Q
Slow transit constipation
A
Infrequent stools, lack of urge, poor response to fiber and laxatives
Colonic motor dysfunction or inadequate caloric intake
21
Q
Diagnosis of chronic constipation
A
Symptoms for >3 months (with onset >6 months prior to diagnosis)
- 2 or more of the long list
- Loose stools are rarely present without the use of laxatives
- Insufficient criteria for IBS
22
Q
Alarm symptoms
A
Fever, anorexia, n/v, blood in stool, anemia, weight loss >10 lbs, colon cancer hx, constipation after age 50, acute constipation in an elderly patient
23
Q
Diagnostic tools for defecatory disorders
A
Anorectal manometry (pressure in the different sphincters)
24
Q
Acute diarrhea definition
A
Increased stool frequency (>3 BM/day) or liquidity of stool less than 2 weeks
25
Non inflammatory diarrhea symptoms
```
Watery
Cramping, bloating, N/V
Small bowel source
Vomiting (food poisoning)
Mild to voluminous
No fecal leukocytes
```
26
Inflammatory diarrhea symptoms
```
Blood or pus
Fever
LLQ cramps
Urgency, tenesmus
Distinguish from ulcerative colitis
Tissue damage from invasive organism or toxin
Smaller volume
Fecal leukocytes with invasive organisms
```
27
Antidiarrheal agents
Opioid agents
Bismuth subsalicylate
Anticholinergics
28
Chronic diarrhea
Decrease in fecal consistency lasting for >4 weeks
29
Secretory or osmotic?
Fecal osmotic gap < 50 is a secretory diarrhea caused by incomplete electrolyte absorption
30
Secretory diarrhea
Excessive stool water due to presence of Extra electrolytes resulting from reduction of electrolyte absorption or stimulation of electrolyte secretion in the intestine
31
Osmotic diarrhea
Due to ingestion of poorly absorbed cations, anions or carbohydrate malabsorption
Increased stool osmotic gap
32
Evaluating osmotic diarrhea
Stool pH, increased with malabsorbed carbs
33
Clues to malabsorptive diarrhea
Weight loss, steatorrhea, abnormal lab values, fecal fat >10 g in a day
34
Maldigestive diarrhea causes
Pancreatic enzyme insufficiency
Lipase inhibitor
Bile acid deficiency
35
Vibrio cholerae
Food and salt water
1-7 day course
Rice water stool, could be up to 1 L in an hour
Curved GNR!
36
Staph food borne dz
Toxin causes vomiting and diarrhea
Custards, canned foods/meat
1-2 day course, starts 2-6 hours after eating contaminated food
37
Bacillus cereus
Spores on grains, rice and veggies
It is identical to staph aureus disease
Diarrheal disease, 12 hours post ingestion, gets farther through the gut
38
Clostridium perfringens
Severe dz in soft tissue, toxin produced in gut after LARGE inoculum
Better within 24 hours
39
Shigella
Low infectious dose, high attack rate
Inflammatory, causes shiga toxin, bloody mucoid small volume stools
Usually self limited but can progress to dysentery
40
Shigella complications
Reiter's syndrome
Hemolytic uremic syndrome
41
Campylobacter jejuni
Raw milk, undercooked chicken
Only one with prodrome!! Fever, HA, myalgia, malaise
Can cause guillan barre
Usually self limited
42
Salmonella gastroenteritis
From animals
Can disseminate from gut into circulation
Abrupt onset of fever, chills, cramps, diarrhea, HA and vomiting
Symptomatic treatment
43
Enterotoxigenic E Coli
Traveler's diarrhea
Watery diarrhea that lasts 1-3 days
Pepto is an effective preventative measure
44
Shigatoxin producing E. coli aka 0157 H7
Food borne, warm months, kids and elderly
Bloody diarrhea, causes hemolytic uremic syndrome
Toxic effects that are made worse by antibiotics
45
Protozoan infections
Low infectious doses
46
Giardia
Trophozoites block absorption of fat and protein
Greasy, foul smelling stool
47
Cryptosporidiosis
Profuse, watery diarrhea
5-10 days
Bad in immunocompromised
48
Cyclospora
Dangerous in immunodeficient patients
Found on imported fruits
49
Entamoeba histolytica
Can cause liver abscesses
50
Viral gastroenteritis
Osmotic diarrheas, like rotavirus
51
Norovirus
Fecal/oral
2-3 day course
Sudden N/V/D
Self limited but careful disinfection needed
52
Taenia solium
In pork
Can migrate to eyes and brain, causes punched out lesions in the brain
Common in Latinos
53
Tapeworm treatment
Praziquantel
54
Enterobiasis
Pinworm
Females migrate to anus to lay eggs at night, causes intense pruritis
Scotch tape test, look under microscope
55
Ascaris lumbricodes
Eggs ingested and hatch in small intestine
Migrate to liver, heart and lungs and are free swimming and cause damage
Intense hypersensitivity reactions (eosinophilia)
56
Upper and lower esophageal spinchter pressures
UES is 60
| LES is 10-45
57
Unique property of esophagus
No serosa, doesn't protect the esophagus
58
Esophageal mucosal layers
Squamous epithelium for most, transitions to columnar epithelium at the Z line
59
Peristalsis of esophagus
Vagus nerve
Myenteric plexus- acetycholine is excitatory and NO is inhibitory
60
Afferent sensory input for the esophagus
Meissner's complex
61
Esophageal etiology of chest pain
>1 hour of pain
Postprandial, non radiating pain
Associated symptoms like heartburn or regurg
Relieved by antacid
62
Candida esophagitis
Usually C albicans, highest risk if HIV. Patients with CD4 less than 100
Barium swallow looks shaggy
63
CMV esophagitis
Serious complication of AIDS
Reactivation of latent disease
Large, flat and shallow ulcers with high risk of perforation
64
Herpetic esophagitis
HSV type 1, reactivation via vagus nerve or direct oral pharyngeal infection
Bone marrow and organ transplant recipient
Well circumscribed ulcers with volcano like appearance, multinulceated giant cells
65
Medication induced esophagitis
Usually at anatomical sites of esophageal narrowing, near aortic arch
Direct irritant effect causing caustic injury
66
Caustic esophageal injury
Accidental injury usually in children <5 years old
Usually strong alkali substance which is worse than acid
67
Eosinophilic esophagitis
Inflammatory response from food allergies, genetics, etc
Peripheral eosinophilia
Endoscopy with bx is key
Rule out GERD!
68
Achalasia
Global esophageal motor disorder causing slowly progressive dysphagia with episodic regurgitation and cheat pain
Loss of peristalsis and failure of LES relaxation
**bird beaked appearance on barium swallow
69
Achalasia patho
Degeneration of ganglion cells in myenteric plexus of esophageal wall
70
Achalasia diagnostics
Conventional manometry is required for diagnosis
Aperistalsis in distal 2/3 of esophagus, incomplete LES relaxation
Elevated resting LES pressure >45
71
Type 1 achalasia
Swallowing results in no significant change in esophageal pressurization
72
Type 2 achalasia
Swallowing results in simultaneous pressurization that spans the entire length of the esophagus
73
Type 3 achalasia
Swallowing results in abnormal lumen obliterating contractions or spasms
74
Achalasia management
Decrease resting LES pressure, mechanical disruption of muscles or biochemical reduction
75
Distal esophageal spasm
Rare
Dysphagia is most common symptom
Malfunction in nitrous oxide
Excess numbers of simultaneous contractions in the distal esophagus is the hallmark finding on manometry
76
DES on manometry
Simultaneous contractions in the distal esophagus with normal relaxation of the LES
Normal mean integrated relaxation pressure, >20% premature contractions
77
Barium radiography in DES
Can show rosary bead or corkscrew esophagus
78
Nutcracker esophagus
High amplitude peristaltic contractions in the distal 10 cm of esophagus
Average distal esophageal peristaltic pressures >220 after 10 or more 5 mL swallows
Vigorous contractions with normal relaxation of LES
79
Scleroderma esophagus
Smooth muscle atrophy and fibrosis
Replaced by scar tissue
Heartburn, regurgitation, dysphagia
80
Zenker's diverticulum
Posterior outpouching of esophageal mucosa through killian's triangle
Debilitating dysphagia and regurgitation of food
81
Schatzki ring
Circumferential at lower esophageal ring
Solid dysphagia
82
Esophageal webs
Non circumferential, thin membrane of squamous mucosa
Mid or upper esophagus
Congenital or acquired, usually asymptomatic
83
Plummer Vinson sydrome
Triad: severe iron deficiency, dysphagia, cervical esophageal web
White women 4th decade of life
84
Esophageal cancer etiologies
Squamous cell- proximal two thirds of esophagus
Adenocarcinoma- most common in US, distal third of esophagus
85
Risk factors of esophageal cancer
Male, >50 years old, smoking and alcohol (most common), etc
86
Common sites of mets for esophageal cancer
Liver, lungs, bones and adrenal glands
87
Esophageal cancer treatment
Palliative care, like adequate swallowing and nutritional status
Consider esophagectomy unless tumors, distant mets or invasion
Chemo if inoperable
88
Esophageal cancer prognosis
Less than 20% 5 year survival rate
2 most important predictors of poor outcomes - adjacent mediastinal spread, lymph node involvement
89
Dyspepsia
Upper abdominal pain/discomfort
ROME III criteria
No structural dz can explain symptoms
90
Rome III criteria
Epigastric pain/burning
Early satiety
Postprandial fullness
91
Diagnostics of dyspepsia patients >55 OR with alarm symptoms
Endoscopy
92
Gastropathy
Epithelial/endothelial damage without inflammation
93
Gastritis
Damage with inflammation
94
Diagnosis of gastritis
May see drop in Hgb/HCT, endoscopy if GI. Bleed expected
No correlation between symptoms and severity
95
Helicobacter pylori infection
Spiral gram negative rod
Inflammation and injury
Can be an acute illness or a chronic infection that is asymptomatic, gastritis, etc.
96
H pylori diagnostics
Fecal Ag immunoassay or urea breath test
97
NSAID gastritis
Chronic NSAIDs, be aware of alarm symptoms
Change to a Cox 2 because it decreases ulcer chances but try to discontinue NSAIDs
98
Stress gastritis
Gastric mucosa erosions present in 75% of critically ill patients
Stress is medical or physiological, like septic shock
99
Pernicious anemia gastritis
Autoimmune destruction
Decreased intrinsic factor secretion and b12 malabsorption
Decreased acid production, elevated gastrin production, can lead to tumor formation
100
Portal hypertensive gastropathy
Congestion of vessels of stomach from portal HTN
Rarely significant
BBs to reduce portal pressure and reduce risk of bleeding
101
Diagnosis of GERD
Clinical dx, heartburn that is relieved with antacids, worse at night and worst after 30-60 minutes after meals
102
Atypical clinical findings of GERD
Asthma/cough/sore throat
Noncardiac chest pain
Globus sensation
103
Barrett's esophagus
Complication of GERD
Squamous epithelium replaced by columnar epithelium
11-30x increased risk of esophageal cancer
Aggressive PPI therapy!
104
Peptic stricture
Complication of GERD
Progressive dysphagia to solids over months to years
105
Nissen fundoplication
Wrap fundus around lower 6 cm of esophagus, helps constrict the LES
90% resolution of GERD sx, but same as long term PPI
106
PUD
Break in gastric mucosa or duodenum extending through the muscle
Usually > 5 mm in size
107
Causes of PUD and most common site
H pylori
NSAIDs
Antrum is the most common site
108
PUD manifestations
Dyspepsia/epigastric pain
May wake patient up, gnawing dull and aching
Constant pain is at risk for perforation
Usually better with antacids
109
Zollinger ellison syndrome
Around 41 years old
Gastric secreting neuro endocrine tumor, MEN-1 25%
Usually in duodenum
"Gastrinoma triangle"
110
Gastrinoma aka zollinger Ellison syndrome
Over 2/3 of the tumors are malignant
Fasting serum gastrin level (will be incrased)
Check gastric pH
111
Zollinger Ellison diagnostics
Secretin stimulation test
Secretin inhibits gastic G cells, increases gastrin secretion in Gastrinoma
112
Zollinger Ellison syndrome diagnostics
Somatostatin receptor scintigraphy
Radiolabeled octreotide
Will be revealed what was not seen on CT scan
113
Gastric cancer types
Intestinal (most common), H pylori
Diffuse or signet cell, dismal prognosis
114
Gastric cancer diagnosis
Alarm sx
Gastric mass maybe
Signs of mets, like virchow node, sister mary Joseph nodule (umbilical node), rigid rectal shelf, ovarian mets
115
Gastric cancer treatment
Palliative care is key cause not usually curable
116
Ligament of treitz
Dividing line for upper and lower GI bleed
Suspensions ligament of the duodenum, marks the start of the jejunum
117
Upper GI bleed general
More common than lower
Ulcer disease is a common cause
118
Dieulafoy's lesion
Abnormal dilated submucosal artery that erodes overlying mucosa and bleeds
In stomach
119
Mallory Weiss tear
Non penetrating mucosal tear in the esophagus, usually at GE junction
Occurs with forceful vomiting or retching, causing painless hematemesis
120
Esophageal varices
Dilated submucosal veins, generally distal esophagus
Portal HTN
Asymptomatic until they bleed, more significant bleeding than Mallory Weiss
121
Upper GI bleed clinical findings
Hematemesis- frank blood or coffee grounds emesis
Melena 50-100 mL of blood in GI tract
122
Upper GI bleed lab findings
CMP- increased BUN without change in Cr from digestion of blood in small bowel
Hb levels usually normal in early bleed
123
Lower GI bleed findings
Hematochezia- brown stools with blood mixed or streaked
Large volume bright red blood- colon
Maroon stools- small bowel or ascending colon
124
Painless large volume bleed
Diverticular dz
125
Small bowel bleeding dx
Capsule endoscopy is the main stay
126
Pyloric stenosis general
Acquired (not congenital)
Hypertrophy and spasm of pyloric muscle causing gastric outlets obstruction
127
Pyloric stenosis symptoms
Vomiting that is forceful and projectile
Nonbilious vomit- undigested milk
Kids will be lethargic and dehydrated, and stomach becomes enlarged
Olive mass palpated
128
Pyloric stenosis diagnostics
Hypochlorite and hypokalemia
Metabolic alkalosis
KUB shows large stomach and no gas in intestines
String sign of barium GI series
129
Gastroparesis
Signs/symptoms of gastric or intestinal obstruction WITHOUT mechanical lesion to explain cause
Usually autonomic
130
Gastroparesis presentation
Early satiety
N/v 1-3 hours post meal, maybe distension
131
Gastroparesis diagnostics
Dilation (location variable)
Gastric scintigraphy very helpful because it measure gastric retention after a meal
132
Ileus
Loss of peristalsis in intestine without obstruction
Could be post surgery, medication
Mild, diffuse abdominal discomfort, N/V, bowel sounds diminished or absent
133
Ileus diagnostics
Distended gas filled loops of intestine
NPO then advance diet as bowel function returns
134
Ogilvie syndrome
"Pseudo obstruction"
Massive cecal/ascending colon dilation
High risk of perforation, most common in critically ill patients
More severe version of ileus
135
Intestinal atresia general
Developmental defect with partial or complete blockage of intestine
Hx of polyhydramnios, bilious vomiting
136
Intestinal atresia diagnostics
Double bubble sign- gas in stomach and proximal duodenum
Rule out CF
137
Meckel diverticulum
Outpouching o distal ileum
Usually asymptomatic, can gas massive painless GI bleed
Technetium scan to diagnose
138
Celiac disease
Immunological response to gluten that can cause diffuse damage to proximal small intestine
139
Celiac disease presentaiton
GI- diarrhea, malabsorption, nutrient deficiencies, dyspepsia and distension
Weight low, growth retardation, anemia
Dermatitis herpetiformis, psoriatic distribution of pruritic papulovesicles
140
Celiac disease diagnosis
Serology of IgA tissue transglutaminase
Biopsy of tissue
141
Whipple disease
Infection by tropheryma whippellii
Arthralgias, diarrhea, abdominal pain, fever, LAD, hyperpigmentation
FATAL IF UNTREATED
142
Bacterial overgrowth
Less bacteria in small intestine as opposed to large, overgrowth leads to malabsorption
Diagnosed by breath test
143
Short bowel syndrome
Post resection of large amounts of small intestine, decreased surface area for absorption
May need B12 supplements or low fat diet
144
Lactase deficiency
Lactase is at brush border, lack of it causes bloating, cramps, flatulence
Could cause an osmotic diarrhea
145
Lactase deficiency diagnostics
Hydrogen breath test (positive if more concentrated )
Try 2 weeks of lactose free diet
146
Mesenteric ischemia
Bowel or intestinal ischemia/angina
Could acutely be thrombotic or embolism occlusion, or chronic inadequate perfusion of intestines with increased pain with metabolic demand
147
Ischemic colitis
LLQ pain and tenderness, cramping, bloody diarrhea
Dz of inferior mesenteric artery
148
Mesenteric ischemia workup
CT of abdomen/pelvis with contrast
Need urgent evaluation for acute cases
149
Small bowel obstruction
Disruption of flow of intraluminal contents, commonly from post op adhesions
Leads to proximal dilation
Peristalsis increased above and below obstruction
150
SBO presentation
N/V, crampy pain, diarrhea (early), constipation (late), fever, sepsis, tachy, surgery recently
Distension, hyperactive BS like tinkling, blood, peritoneal signs
151
SBO on x ray
Coiled. Spring sign
Conniventes go across the bowel fully
152
LBO common causes
Neoplasms, volvulus, stricture etc
153
LBO diagnostics
X-rays are useful, CT scans are better
154
String of pearls sign
Small pearls for SBO
Large pearls for LBO
155
Perforated ulcer
Sudden onset of severe pain, sometimes epigastric
Chemical peritonitis, patient will look sick with a rigid abdomen and peritoneal signs
156
Wandering spleen
Risk of torsion
Splenomegaly
157
Splenic rupture
Dangerous because of how vascular it is
Need CT with LUQ pain
158
Appendicitis
Most common surgical emergency
10-30 years old
Obstruction of appendix, eventually gangrene and perforation
159
Appendicitis signs symptoms
Peritonitis
Periumbilical pain that migrates to RLQ over 12 hours
Low grade temp, anorexia, may draw knees up
McBurney's point
Will not want to move
160
Peritoneal signs
Rebound tenderness
Pain on percussion
Guarding
161
Obturator sign
Pain with flexion and internal rotation of right hip
Best with pelvic location of appendix
162
Psoas sign
Pain with extension of right hip
Best with retrocecal appendix
163
Abdominal abscess
Anything from stoool leaking causing body to wall it off
Treat aerobes and anaerobes
Drain it!!
164
Psoas abscess
Rare
Usually incidental finding
High grade bacteremia, diskitis
165
Peritonitis more often with...
Aerobes
166
Abscess more often with...
Anaerobes
167
Diastasis recti
Separation of rectus abdominis muscles with intact fascia
Buldges like a hernia, but not defect hole is present
168
Umbilical hernia
Often in kids, caused by increased intraabdominal pressure
Usually fat herniates
169
Spigelian hernia
Semilunar lines along lateral edge of rectus
Hard to find on exam, swelling in mid to lower abdomen with sharp pain or tenderness
Prone to incarceration
170
Indirect hernia
Through inguinal ring
More common on right side
Feel it at the tip of finger on exam
171
Direct hernia
Protrude within hesselbach's triangle
Side of finger touched on exam
172
Femoral hernia
More common in females
40% present with incarceration or strangulation
173
C diff risk factors
Antibiotic use (hepatically metabolized)
Advanced age
Immunocompromised
Increased gastric pH
174
C diff microbiology
Gram positive anaerobe
Spore forming
Toxin producing (must have for disease, causes pseudomembranous colitis)
175
C diff signs and symptoms
Moderate- watery diarrhea, crampy pain, anorexia, maybe fever
Severe- fever, pain, distension
Complicated- dehydration, pan colitis, perforation, sepsis, toxic megacolon
176
WBC 60-90 K
C diff!!
177
Diagnostics for c diff
PCR- expensive
EIA for toxins- quick and cheap, need high toxin burden
EIA for bacterial Ag- may have normal flora
Culture- good but takes time
178
Fecal microbiota transplant
Restores normal flora, helps decolonize c diff
Very little recurrence!
179
Diverticular disease
Diverticulosis- formation of outpouching of large intestine
Increased frequency with age
180
Diverticulitis
Inflammation of diverticulum, leading to LLQ pain, heme + stool, fever
Can lead to perforation
181
Diverticulitis surgery
One stage- resection of bowel, immediate re anastamosis
Two stage- resection of affected bowel, takedown to ostomy, delayed anastomoses
182
Intussiception
Telescoping of proximal bowel into downstream bowel
Small bowel into cecum is common
Most common in infants 1-2 years old
183
Intussiception findings
Sudden onset of crampy pain, crying, pallor, colic, refusal to feed
Currant jelly stools, sausage shaped mass
184
Intussiception treatment
Pneumatic enema dx and treat! Pressure reduces the invagination
185
Hirschprung disease
Aganglionic distal colon
Delayed meconium passage
186
Irritable bowel syndrome background
Chronic abdominal pain and altered bowel habits without organic cause
187
Clinical manifestations of IBS
Chronic abdominal pain- location varies, crampy, defecation gives relief
Altered bowel habits- diarrhea, constipation, maybe GERD, dyspepsia, CP
188
Ulcerative colitis basics
Bloody diarrhea is the hallmark
Starts in rectum, can ascend but only affects the colon
Colectomy can be curative
189
Crohn's basics
Terminal ileum most common site, but skip lesions can occur anywhere from mouth to anus
Transmural inflammation
Variable symptoms
190
IBD and colorectal cancer
Increased risk of cancer
Scope 8 years after IBD dx, follow up every 1-3 years after the first one
191
Apthous ulcers
More common in crohn's
Canker sores
192
Pyoderma gangrenosum
Neutrophilic dermatitis leading to inflammation and ulceration
Not infectious or gangrenous
Pathergy is common (worse after biopsy or tissue injury)
193
Erythema nodosum
Most common skin disorder with IBD
Red to violet sub Q pretibial nodules
194
Clubbing in IBD
From disordered inflammation/macrophage recruitment rather than hypoxia
Schamroth sign
195
Crohn's clinical manifestations
Fatigue, weight loss, fever, intestinal stricture/obstruction
Non bloody diarrhea, perianal disease, heme + stool
196
Crohn's diagnosis
Cobblestoning, granulomas, found in colonoscopy
Serologies of pANCA or ASCA
197
Ulcerative colitis
Inflammation of mucosal surface of colon, bleeding and friability
Rectal involvement (unlike crohn's)
Smoking is protective
198
Ulcerative colitis manifestations
Diarrhea that is bloody, small and frequent bowel movements
Weight loss, maybe fever, maybe anemias, all depending on extent of the disease
199
Polyps definition
Discrete protuberances projecting into the intestinal lumen
Can be adenomatous (progress to cancer) serrated also progresses
200
Advanced adenoma
Take 5 years to develop
>1 cm, villous features or high grade dysplasia
Greater liklihood of malignant transformation, which takes 10 years
of polyps effects overall risk
201
Polyps in proximal colon maybe be associated with...
More advanced neoplasia
202
Clinical findings of polyps
usually asymptomatic but can ulcerate or bleed
FIT- fecal immunochemical test, detects noncancerous polyps
203
CTC
Virtual colonoscopy, good sensitivity for polyps >1 cm
204
Follow up of polyps
30-40% will have adenoma as or serrated polyps 3-5 years after initial exam
If 1-2 small ones, follow up in 5 years
If 3-10 rescope in 3 years
>10, familial polyposis syndrome
205
% of colorectal cancers caused by genetic mutations
4%
206
Familial adenomatous polyposis
Gene testing used to diagnose
Autosomal dominant mutations
Hundreds to thousands of polyps
207
FAP presentation
Polyps by 15 years
Cancer by 40 years, inevitable by 40 years
Can also develop in stomach or duodenum
Tumors exist elsewhere in the body!
208
FAP diagnosis
>10 polyps
Gene testing or first degree relative with FAP
209
FAP treatment
Prophylactic complete proctocolectomy usually before age 20
```
Ileoanal anastamosis
Ileorectal anasatmosis (better bowel function but still risk of rectal cancer)
```
EGD every 1-3 yeras to watch for upper GI tumor
210
Hamartomatous polyposis syndromes
Rare!
Familial juvenile polyposis
Cowden disease
Peutz-jegher's syndrome- autosomal dominant
211
Lynch syndrome
Hereditary nonpolyposis colon cancer
Autosomal dominant- family hx is critical!
212
Lynch syndrome problem
Only a few adenomas develop, but progress to cancer in 1-2 years instead of 10
Consider genetic testing with Bethesda criteria
213
Screening with lynch syndrome
C scope at 25 for relatives
Subtotal colectomy if cancer is found
214
Colorectal cancer epidemiology
6% will develop if, 40% of those people will die from it
Majority are adenocarcinomas
P53 loss
215
Clinical manifestations of cancer
Asymptomatic early on
Obstruction is uncommon, but found in advanced disease
Rectal cancer- tenesmus, urgency, blood
Apple core lesion on barium enema
216
CEA in cancer
CEA >5 is bad prognostic factor
217
Mets in colon cancer
Peritoneum
Liver
Lung
218
Screening tests for colon cancer
Fecal occult blood test - guaiac or fecal immunochemical test
Cancer prevention (preferred)- colonoscopy
FIT- is a cancer detection test
219
Screening algorithm
Start at 50 years old, 45 in black patients
CRC is fatal in 50%!
<50% of population is appropriately screened
220
Colorectal cancer until proven otherwise:
```
Patient over 40:
Change in bowel habits
Hematochezia
Unexplained Fe deficiency
Unexplained occult bleeding
```
