GI #3 Flashcards by Tyler Cichowski

What is the pathophysiology of chronic mesenteric ischemia?

Ischemic bowel disease due to mesenteric atherosclerosis: hypo perfusion related to eating (increased demand during eating + decreased blood supply)

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Symptoms of chronic mesenteric ischemia

Chronic, dull abdominal pain worse after meals (intestinal angina)
Anorexia (aversion to eating) leading to weight loss

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What is the definitive diagnostic test for chronic mesenteric ischemia?

-Angiography

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Definitive management for chronic mesenteric ischemia

-Revascularization (angioplasty with stenting or bypass

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What is the MC cause of acute mesenteric ischemia?

-Acute arterial occlusion (embolism from A-fib)

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What artery is MC occluded in an acute mesenteric ischemia?

-Superior mesenteric artery

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Symptoms of acute mesenteric ischemia

Severe abdominal pain out of proportion to physical findings
Pain poorly localized
Nausea, vomiting, diarrhea

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What is the initial test to assess ischemia for acute mesenteric ischemia?

-CT angiography

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However, to get a definitive diagnosis for acute mesenteric ischemia, what should be done?

-Conventional arteriography

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Treatment for acute mesenteric ischemia

Surgical revascularization

- Anticoagulation in patients with A-fib

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Ischemic colitis is

decreased colonic perfusion, leading to inflammation

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What is the MC etiology of ischemic colitis

-Transient systemic hypotension or atherosclerosis involving the superior and inferior mesenteric arteries

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Ischemic colitis occurs MC at watershed areas (between 2 arteries with decreased collaterals) such as the _____ and _______

splenic flexure and rectosigmoid junction

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Symptoms of ischemic colitis

LLQ crampy abdominal pain
Bloody diarrhea
Hematochezia
Tenderness (not as severe and more lateral than acute mesenteric ischemia)

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What is the first imaging study that is done for ischemic colitis and what does it show?

CT of the abdomen: thumb printing (segmental bowel wall thickening)

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What is the treatment for ischemic colitis?

Supportive care: restore perfusion, bowel rest, IVF

- May need empiric broad spectrum ABX, but most resolves without therapy

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What type of colon polyp is the MC non-neoplastic polyp?

Hyperplastic

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Pseudopolyps/Inflammatory polyps are due to

Inflammatory bowel disease (UC, Crohn’s)

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What type of colon polyp is the MC neoplastic polyp?

Adenomatous polyps

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How long does it take an adenomatous polyp to become cancerous?

10-20 years

Which type of adenomatous polyp is associated with the least risk?

Tubular Adenoma (MC type and least risk)

Which type of adenomatous polyp has the highest risk of becoming cancerous?

Villous adenoma

Risk factors for colorectal cancer

Age > 50
African Americans
Family history of colorectal cancer
IBD: UC > Crohn’s
Diet (low fiber, high in red or processed meat)
Obesity
Smoking
EtOH

Familial Adenomatous Polyposis is a genetic mutation of the _____ gene. Explain what happens with this condition

APC gene

Adenomas begin in childhood. Almost all develop cancer by 45 years old. Prophylactic colectomy is best for survival.

What is Peutz-Jehgers Syndrome?

Autosomal dominant condition associated with hamartomatous polyps, mucocutaneous hyperpigmentation (lips, oral mucosa, and hands), and risk of breast and pancreatic cancer

What are some protective factors for colorectal cancer?

Physical activity Regular use of Aspirin NSAIDs

What is the diagnostic of choice for colorectal cancer?

Colonoscopy with biopsy

Right sided (proximal) lesions for colorectal cancer tend to cause _________

Chronic occult bleeding (iron deficiency anemia, positive Guiac) and diarrhea

Left sided (distal) lesions in colorectal cancer tend to cause

Bowel obstruction, present later, and cause changes in stool diameter

Furthermore, those with a left sided (distal) lesion, may develop ______ endocarditis

Strep bovis

With a barium enema, in colorectal cancer, what is seen?

Apple core lesion -Need a follow up colonoscopy or CT colonography

What lab abnormality is expected with colorectal cancer and why?

Iron deficiency anemia -Colorectal cancer is the MCC of occult GI bleeding in adults

Most commonly monitored tumor marker in colorectal cancer

CEA

Management of localized colorectal cancer

-Surgical resection followed by postoperative chemotherapy

Colon Cancer Screening Guidelines

- Colonoscopy begins at age 50-75 every 10 years (average risk) - Colonoscopy begins at 40, every 10 years (1st degree relative > 60) - Colonoscopy begins at 40, every 5 years (1st degree relative < 60)

If a patient has familiar adenomatous polyposis, what is the screening recommendation for colonoscopies?

Initiate screen at 10-12 years with flexible sigmoidoscopy yearly

MCC of esophagitis

GERD

Pill-induced esophagitis occurs frequently with what types of pills?

Bisphosphonates, BB, CCB, NSAIDs

Infectious esophagitis is most commonly associated with _____, and some causes are ______

Immunocompromised states Candida, CMV, HSV

Three classic symptoms of esophagitis are

Odynophagia, dysphagia, and retrosternal chest pain

What is the diagnostic of choice for esophagitis?

Upper endoscopy (allows for direct visualization)

What are the three components of pathophysiology of IBS?

- Abnormal motility: chemical imbalance in intestine (of serotonin and acetylcholine) causing abnormal motility and spasm - Visceral hypersensitivity: lowered pain thresholds to intestinal distention - Psychosocial interactions: altered CNS processing

Symptoms of IBS

- Abnormal pain associated with altered defecation/bowel habits - Pain often relieved with defecation

Name three alarm symptoms of IBS

- Evidence of GI bleeding - Anorexia or weight loss, family history of GI cancer, IBD, celiac sprue - Persistent diarrhea causing dehydration, onset > 45 years old

What is the Rome IV Criteria in regards to IBS?

- Recurrent abdominal pain on average at least 1 day/week in the last 3 months associated with at least 2 of the following: - -related to defecation - -change in stool frequency - -change in stool appearance

What is the first-line management of IBS?

Lifestyle and dietary changes (low fait, high fiber, unprocessed food diet) - Sleep hygiene - Smoking cessation - Exercise

If the patient is experiencing constipation symptoms, what are some medications that can be given?

- Fiber, Psyllium | - Polyethylene Glycol

If the patient is experiencing diarrhea symptoms, what are some medications that can be given?

- Loperamide | - Dicyclomine, Hyoscyamine