GI Flashcards
(231 cards)
1
Q
Bristol stool char describe
A
1-separate hard lumps hard to pass 2-sausage with lumps 3-sausage with cracks 4-soft snake 5-soft blobs 6-fluffy blobs 7-entirely liquid
2
Q
Most common causes of constipation
A
Inadequate fiber
Poor bowel habits
3
Q
Fecal impaction
A
Impaction in rectal vault leading to bowel obstruction
- opoids, psych, bed rest, neurogenic disorders of colon,
- nauseas vomiting, decreased appetite, overflow incontinence (paradoxical diarrhea)
- stercoral ulcer
- do digital rectal
4
Q
Treat fecal impaction
A
Saline, mineral oil,
Digital disruption
Long term try to have soft stools and regular bowel movements
5
Q
Chronic use of laxatives
A
Melanesia coli
6
Q
Acute vs chronic diarrhea timing
A
Less than 2 weeks greater than 4
7
Q
Common causes chronic diarrhea
A
Medications, IBS, lactaste deficiency
8
Q
Chronic diarrhea
What does poop look like for malabsorptive
Inflammatory
Secretory
A
Greasy/malodorous
Plus blood
Watery
9
Q
What if have chronic diarrhea with abdominal pain
A
IBS IBD
10
Q
What are signs that warrant further examination with chronic diarrhea
A
Nocturnal diarrhea, weight loss, anemia, positive results on fecal occult blood test
11
Q
Routine lab test for chronic diarrhea
A
CBC, serum electrolytes, liver function test, calcium, phosphorus, albumin, thyroid stimulating hormone, vitamin a and d levels, INR, erythrocyte sedimentation rate, and c reactive protein
12
Q
Serologic test for celiac disease
A
IgA tissue transglutiminase
13
Q
Who with chronic diarrhea has anemia
A
Malabsorption (folate, iron defiency, b12)
Inflammatory convictions
14
Q
Who with chronic diarrhea has hypoalbuminemia
A
Malabsorption, protein losing enteropathy ex’s and inflammatory diseases
15
Q
Hyponatremia and non anion gap metabolic acidosis
A
Secretory diarrhea
16
Q
Increased erythrocyte sedimentation rate or c reactive protein
A
Suggests inflammatory bowel disease
17
Q
Osmotic gap over 50
A
Osmotic and malabsorptive diarrhea
18
Q
Sudan test
A
Stinking for fat
19
Q
Leukocytes, calprotectin and lactoferrin in poo
A
IBD
20
Q
Wet mounts
A
Giardia and e histolytica
21
Q
Fecal antigen for
A
Giardia and e histolytica are more sensitive and specific
22
Q
Acid strain
A
Cryptosporidium and cyclospora
23
Q
Colonoscopy with mucosal biopsy is done to exclude what
A
IBD
Microscopic colitis
Colonic neoplasia
24
Q
Upper endoscopy is preformed when
A
A small intestinal malabsorptive disorder is suspected (celiac or whipple)
AIDS to document cryptosporidium, microspordia, and M avium
25
What do is all poop studies/ endoscopy.colonoscopy inconclusive
24 hour stool collection for weight and fat
Fecal elastase less than 100mcg/g may be caused by pancreatic insuffiency
26
Calcification on plain abdominal radiograph
Chronic pancreatitis
27
SI intestinal imaging with barium, CT or MRI for diagnosis of what
Crohns, small bowel lymphoma, carcinoid, jejunum diverticula
28
How localize neuroendocrine tumors
Somatostatin receptor scinitgraphy
29
When consider secretory diarrhea due to neuroendocrine tumors
Chronic, high volume watery diarrhea with a normal osmotic gap that persists during fasting
30
Serum chromogranin A
Variety of neuroendocrine tumors
31
VIP
VIPoma
32
Calcitonin
Medullary thyroid carcinoma
33
Gastrin
Ze syndrome
34
Urinary 5-hydroxyindoleacetic acid 5-HIAA
Carcinoid
35
How conform small bowel bacterial overgrowth
Breath test for glucose or lactulose
Or get aspirate of SI for quantitative aerobic and anaerobic bacterial culture
36
How confirm carbohydrate malabsorption
Elimination trial 2-3 weeks
Hydrogen breath tests
Lactase drfiency0hydrogen breath test
37
Medications that cause diarrhea
Cholinesterase inhibitors, SSRI, angiotensin II receptor blockers, proton pump inhibitors, NSAIDS
Discontinue culprits
38
Two types of microscopic colitis
Lymphocytic and collagenous
39
Histology microscopic colitis
Chronic inflammation -lymphocytes and plasma cells
40
Who gets microscopic colitis
Women 5-6 decade
41
Collagenous colitis
Thickened band of subepithelial collagen
42
Meds implicated in microscopic colitis
NSAIDS
43
Treat microscopic colitis
Antidiarrheal therapy loperaminde
44
Osmotic diarrheas
Osmotic gap over 50
Indigestion or malabsorption of an osmotically active substance
Mainly carb malabsorption, laxative abuse, malabsorption
45
Factitious
Osmotic or secretory
46
Causes of osmotic diarrhea
```
Meds
Disaccharides defiency
Factitious diarrhea (magnesium laxative abuse)
```
47
Osmotic diarrhea resolved with fasting
Yup
48
What ask someone with osmotic diarrhea
Carbs, lactose, fruits and artificial sweeteners (fructose sorbitol) and alcohol
49
Ingestion of magnesium
Osmotic (laxative and antacids)
50
Fat substitute olestra
Causes diarrhea and cramps
51
Secretory diarrhea
High volume with normal osmotic gap
May get dehydration and electrolyte imbalance
Not fixed with fasting
52
Causes secretory diarrhea
Endocrine tumors (stimulating intestinal or pancreatic secretion, Ze, carcinoid, bile salt malabsorption (stimulating colonic secretion)
53
Causes of secretory diarrhea
Hormone (VIPOMA, carcinoid, medullary carcinoma of thyroid, Ze)
Factitious diarrhea (laxative abuse)
Villous adenoma
Bile salt malabsorption
Meds
54
Inflammatory diarrhea
IBD (UC, CD), microscopic colitis, malignancy, radiation enteritis)
55
Malabsorption diarrhea
Pancreatic insuffiency, small mucosal intestinal diseases, intestinal rejections, lymphatic obstruction, small intestinal bacterial overgrowth
-bile salt malabsorption, celiac, whipple, lactase defiency
Small bowel bacterial overgrowth-glucose or lactlose breath test)
56
Characteristics malabsorptive
Weight loss, osmotic diarrhea, steatorrhea, nutritional defiency
57
Pancreatic insuffiency malabsorptive
Chronic pancreatitis, CF< pancreatic cancer
Steatorrhea due to TG malabsorption
Weight loss, gaseous distention and flatulence large great foul smelling stools
Protein and carb not affected and nutrient defiencies rare
58
Causes of malabsorption syndromes
Small bowel disorders (sprue)
Lymphatic obstruction
Pancreatic disease
Bacterial overgrowth
59
Bile salt malabsorption cause
Biliary obstruction or cholesatic liver diseases
Terminal lien (cd, bacterial overgrowth, hypersecretion, meds bind bile salts)
60
Signs bile salt malabsorption
ADEK impaired
Watery secretory diarrhea
61
Microcytic anemia and microcytic anemia
Micro-iron
| Macro-b12, folic acid
62
Celiac disease
Destruction of mucosal enterocytes as a humoral immmune response that results in antibodies to gluten, tTG, and other autoantigens
63
Symptoms celiac disease
Weight loss, chronic diarrhea, dyspepsia, flatulence, abdominal distention, growth retardation (infants)
Older kids less likely to manifest signs of serious malabsorption
64
Atypical symptoms celiac
Dermatitis, herpetiformis, iron defiency anemia, osteoporosis
65
Extraintestinal celiac
Fatigue, depression, iron defiency anemia, osteoporosis , short, delayed puberty, amenorrhea, reduced fertility
66
Celiac dermatitis herpetiformis
Cutaneous celiac disease
Skin rash with pruritis papulovesicles over the extensor surfaces of the extremities and over the trunk, scalp and neck
67
Treat celiac
Gluten free
68
Who gets celiac
Whites 1/100 most undiagnosed
69
Genetics celiac
HLA DQ2
Mainly
DQ8
70
Lab celiac
```
Microcytic anemia
(CBC, iron defiency due to occult blood)
```
Megaloblastic anemia
(B12, folate)
Impaired calcium or vitamin d absorption with ostomalacia or osteoporosis(ALP up normal GGT)
Impaired fat soluble vitamin absorption (elevated prothrombin time, vitamin a or d down)
Small intestine protein loss or poor nutrition (albumin loss CMP)
71
Antibodies in celiac
IfA tissue transglutiminase IgA tTG antibody
IgG to deamindated gladin) anti-DGP)-low sensitivity though
IgA anti endomysial antibodies-not recommended lack of standardization
72
Velez of all antibodies become undetectable after _ months of dietary gluten withdrawal
3-12
73
Check antibodies on gluten free diet
No
74
Mucosal biopsy celiac
Condirm diagnosis
Atrophy or scalloping of the duodenal folds
Intraepithelial lymphocytosis alone->extensive infiltration of the LP with lymphocytes and plasma cells with hypertrophy of the intestinal crypts and blunting or complete loss of intestinal villi
75
What happens if have normal mucosal biopsy with celiac
Excludes diagnosis
76
Why dal energy x ray densitometry for all patients with sprue
Screen for osteoporosis
77
Most patients with celiac disease also have __ __
Lactose intolerance
78
Celiac disease association
Other autoimmune diseases
79
What supplements give celiac
Folate, iron zinc, calcium A B D E
80
Symptoms of whipple disease
Fever, LAD< arthralgias, weight loss, malabsorption, chronic diarrhea, arthralgias, diarrhea, abdominal pain and weight loss
81
Diagnose whipple
Duodenal biopsy PAS positive macrophages with characteristic bacillus, dilation of lacteals
82
Cause whipple
Gram positive bacillus tropheryma whipplei
83
Who gets whipple disease
White men in 4- decade
84
Whipple protein
Protein lowing enteropathy EDEMA
85
Physical exam whipple
Hypotension, low fever, malabsorption, LAD< heart murmurs , steatorrhea
86
What does whipple bacillus look like
Trilamellar wall
87
Treat whipple
Antibiotic
Ceftriaxone, meropenem, TMP SMX
Then duodenal biopsies every 6 months for at least a year and CSF PCR
88
Prognosis whipple
Fatal if untreated
| Prevent progression and neurological signs
89
Symptoms of bacterial overgrowth
Distention, flatulence, diarrhea, weight loss , increased fecal fat, vitamin defiency
90
Diagnose bacterial overgrowth
Breath tests glucose lactulose
Confirmed with jejunum aspiration with quantitative bacterial cultures
91
Bacterial overgrowth diarrhea
Osmotic and secretory
92
Causes of bacterial overgrowth
Gastric achlorhydia (PPI)
Anatomical abnormalities
Motility disorder
Fistula
93
Treat bacterial overgrowth
Oral broad spectrum antibiotics effective against enteric aerobes and anaerobes
Rifaximin 400 mg three times daily
94
Short bowel syndrome
Malabsorptive condition arises secondary to removal of significant segments of the small intestine
95
Causes of short bowel syndrome
Crohn’s disease, mesenteric infarction, radiation enteritis, volvulus, tumor resection, trauma
96
The type and degree of short bowel syndrome depend on what
Length and site of the resection and degree of adaption of the remaining bowel
97
Terminal ideal resection
Malabsorption of bile salts and B12
98
Over and under 100 cm of ileum removed short bowel syndrome
Less 100-watery diarrhea
Over 100-steatorrhea and malabsorption fat soluble
-need low fat diet and vitamin supplements
99
What happens when have unabsorpbed fatty acids with SBS
Bind calcium reducing its absorption and enhancing absorption of oxalate-oxalate kidney stones
Cholesterol gallstones
100
Ho prevent oxylate kidney stones
Calcium supplements to bind oxalate and increase serum calcium
101
Ileocolonic valve resection
Bacterial overgrowth may occcur in the small intestine usually is well tolerated
Remaking SI can adapt
102
Resection of 40-50% SI
Well tolerated
103
Massive small bowel resection
Weight loss, diarrhea, due to nutrient and electrolyte malabsorption
104
Colon and 100cm of proximal jejunum removed
Maintain adequate oral nutrition
Low fat, high carb diet
Fluid and electrolyte losses may still be significant
105
No colon and 200 cm of proximal jejunum
Required to maintain oral nutrition
106
No colon and less than 100-200 cm jejunum
Need parenteral nutrition
107
Duodenal resection
Folate, iron, calcium malabsorption
108
Lactase defiency symtomis
Diarrhea, bloating, flatulence, abdominal pain after ingestion of milky
109
Test lactase defiency
Hydrogen breath test
110
What kind of diarrhea with lactase defiency
Osmotic diarrhea
111
What is the most common cause of chronic diarrhea in young adults
IBS
112
Causes of motility disorders
Postsurgical -vagotomy, partial gastrectomy, blind loop with bacterial overgrowth,
Systemic disorders-scleroderma, DM, hyperthyroidism
IBS
113
IBS symptoms
Altered bowel habits, abdominal pain, absence fo detectable organic pathology
114
What are the 3 clinical presentations of IBS
Spastic colon, alternating constipation and diarrhea, chronic, painless diarrhea
115
Pathophysiology IBS
Altered colonic motility at rest and in response to stress, cholinergic drugs, cholecystokinin
Altered small intestinal motility
Enhanced visceral sensation
Increased frequency of physiological disturbances
116
Clinical IBS
Females young
Ab pain, cramps, irregular bowel habits,
```
Relief of pain with bowel movement
Increased frequency of stools with pain
Loose stools with pain
Mucus in stools
Sense of incomplete evacuation
```
117
Diagnose IBS
Over 6 months
118
What are alarm symptoms that make IBS not IBS and suggest another diagnosis
```
Acute onset
Nocturnal diarrhea
Severe constipation or diarrhea
Hematochezia
Weight loss
Fever-incompatible with IBS
```
Family history of cancer, IBD or celiac should have further evaluation
119
IBS is a diagnosis of ___
Exclusion
120
Rome criteria for IBS
Improvement with defecation
Onset associated with a change in frequency of stool
Onset associated with a change in form of stool
121
Treat IBS
Avoid stress and exercise -fiber doesn’t help
Diet-FODMAPS
Fermentable oligosaccharides, disaccharides, monosaccharides, and polyols
Low FODMAP diet
122
Acute paralytic ileus
Neurogenic failure or loss of peristalsis in the intestine in the absence of any mechanical obstruction
Commonly seen in hospitalized patients as a result of surgery, peritonitis, electrolyte abnormalities, meds, severe medical illness
123
Symptoms of acute paralytic ileus
NV, obstipation, distention, minimal abdominal tenderness, decreased or absent bowel sounds
124
Treat paralytic ileus
Restriction of oral intake with gradual liberization of diet as bowel functions eturns
Severe or prolonged needs nasogastric suction and parenteral administering of fluids and electrolytes
125
Acute colonic pseudo obstruction (ogilvie syndrome)
Spontaneous massive dilation of cecum or right colon without mechanical obstruction with severe abdominal distention, absent to mild abdominal pain, minimal tenderness
126
Symptoms acute colonic pseudo obstruction
NV
| Post operative state or with severe medical illness
127
Consequence acute colonic pseudo obstruction
Progressive cell dilation may lead to spontaneous perforation with dire consequences
Perforation risk correlated with cecal size and duration of colonis distention
128
Clinical findings acute colonic pseudo Obstructive
Abdominal distention 1st Disney
Plain film with colonic dilation
Bowel movements may be absent
Ab tenderness guarding or rebound tenderness
Bowel sounds may be normal or decreased
Significant fever or leukocytosis raises concern
129
Imaging acute colonic pseudo obstruction
X ray ct show colonic dilation , confined to the cecum and proximal colon over 9 cm
10-12 increased risk of colonic perforation
130
What causes toxic megacolon
IBD, C diff/ CMV,
Fever, dehydration, significant abdominal pain
131
Treat acutecolonic pseudo obstruction
Conservative-is less than 12
Oral laxatives not helpful
Watched for signs of worse
Cecal size radiographs every 12 hours
Intervention if no improvement in 48 hours
132
Chronic infections
Giardia, e histolytica , cyclospora
Stronglyloidasus
C diff
Immune-cryptosporidium, CMV< belli, cyclospora, mycobacterium
133
Antibiotic associated diarrhea most not c dif and are mild and self limited)
Diarrhea during period of antibiotic exposure, dose related and resolves spontaneously after discontinuation of the antibiotic
Mild self limited
134
Antibiotic associated colitis (C DIFF) an anaerobic
Colonized colon and released toxins:TcdA and TcdB
More than 3 days in hospital get
C diff all over hospitals
135
How minimization c diff
Hand washing
136
What antibiotics commons for c diff antibiotic related colitis
Ampicillin, clindamycin, third generation cephalosporins, fluoroquinolones
137
Prophylaxis antibiotic associated colitis
Probiotics
138
Who has a higher risk of getting c diff and developing c diff associated diarrhea
Old, immunocompromised, antibiotics, General feeding, PPI, chemo, IBD< higher risk
139
Clinical findings antibiotic diarrhea from C diff
Green, foul smelling watery diarrhea 5-15 times a day with lower abdominal cramps
No blood
White count up
140
What should be considered in all hospital causes of leukocytosis
C diff
141
What are lab values suggestive of severe diarrhea
White count greater 30000
Albumin less than 2.5
Elevated serum lactase or rising creatinine
142
Stool study for C diff
TcdA is an enterotoxin and TcdB is a cytotoxic
Do rapid enzyme assay for both
Nuclei acid PCR for TcdB gene
PCR assays superior to EIA high sensitivity
143
Flexible sigmoidoscopy c diff
Pseudomembranous colitis
Epithelial ulceration with a classic volcano exudate of fibrin and neutrophils
144
What get is severe fulminant symptoms with c diff
CT to detect perforation
145
Complications c diff
Severe colitis->fulminant_>megacolon
Weight loss and protein losing enteropathy
146
Treat c diff
Metronidazole, vancomycin or fidazomicin
147
What are systemic condition
Thyroid disease
Diabetes
Collagen cascular disorders
148
Diverticula disease
Herniation or sac like protrusions of the mucosa through the muscularis at points of nutrient artery penetration in the SIGMOID COLON
149
Diverticula disease increases with __
Age
150
Who is disposed for diverticula disease
Connective tissue disorders
151
Divertoculosis
90%
Asymptomatic
If pain recurrent left lower quad relieved by defecation alternating constipation and diarrhea
152
Diagnose diverticulosis
Barium enema
153
Hemorrhage diverticulitis
Yes
154
Diverticulitis
Acute abdominal pain LLQ fever, mass in LLQ, laukocytosis
Constipation first-> loose stools inflammation causing narrowing only liquid stool can pass
155
How get diverticulitis
Inflammation->microperfoation->macroperforation with abscess or generalizer peritonitis
156
Physical exam diverticulitis
Mild left lower quadrant tenderness with a thickened palpable sigmoid and descending colon
Pain, fever, NV< altered bowel hablite, leukocytosis
157
How see diverticulitis
CT with contrast
158
Endoscopy diverticulitis
No -risk of perforation
159
Complications uncomplicated diverticulitis
Pericolic abscess, perforation, fistula, liver abscess, stricture
160
Treat diverticulosis
High fiber, psyllium extract, anticholinergic
161
Treat diverticulitis
IV fluids, NPO at first
Antibiotics
Surgical resection
162
Acute mesenteric ischemia
Periumbilical pain out of proportion to tenderness
Nausea, vomiting, distention, GI bleeding, altered bowel habits
163
Acute mesenteric ischemia x ray
Bowel distention, air fluid levels, thumbprinting (eubmucosal edema), or normal
164
CT with contrast and angiography acute mesenteric ischemia
Early celiac and mesenteric
165
Peritoneal signs acute mesenteric ischemis
Laparotomy indicated to restore intestinal blood flow obstructed by embolus or thrombosis or to respect necrotic bowel
166
Chronic mesenteric insuffiency
Abdominal angina-dull cramps periumbilical pain after a meal and lasting several hours (patients have food fear), weight loss, occasionally diarrhea
Evaluate with mesenteric arteriography for possible bypass graft surgery
Superior mesenteric artery syndrome
167
Ischemic colitis
Due to non occlusive disease in patients with atherosclerosis-splenic flexure watershed area
168
Who gets ischemic colitis
Cocaine,
169
How does ischemic colitis present
Severe lower abdominal pain followed by rectal bleeding
170
Abdominal x ray with ischemic colitis
Colonic dilation, thumbpinting
171
Sigmoidoscopy ischemic colitis
Submucosal hemorrhage , friability, ulcerations, rectum often spread
172
Treat ischemic colitis
NPO IV fluids
Surgical resection for infarction or post ischemic stricture
173
Hemorrhoids cause
Increased hydrostatic pressure in hemorrhoidla venous plexus associated with straining at stool and pregnancy
174
Hemorrhoids anoscopic Adam
External anal inspection
175
Treat hemorrhoids
Bulk laxative and stool softeners, sits baths, witch hazel compress,
176
External hemorrhoid
Coughing, heavy lifting, straining
Acute onset painful, bluish perinatal nodule veered with skin
Resolve 2-3 days
Stir bath help
177
Anal fissure
Linear or rocket shaped ulcers that are usually small
Treatment o anal canal
Posterior midline
Hematochezia
Visual see
178
Treat anal fissure
Fiber , topical anesthetics, relaxation of anal canal with NO or Botox
179
Perinatal pruritus
Poor hygiene (fistula, fissures, prolapsed hemorrhoids, skin tad, incontinence)
or
too much hygiene (contact dermatitis)
Or
Infection, std, kin conditions
180
Treat perinatal pruritus
Education -spicy food, tomato, coffee, clean after poop, anal ointment
Topical glucocorticoid and antifungal agent
181
Nisseria gonorrhoeae: anorectal infection,
Rectal swab
Pharynx urethra men
Pharynx and cervix women
182
Treponema pallidus: anorectal infection
Dark field microscopy or fluorescent antibody testing of scraping from the chancre of condylomata
VDRL or RPR test
183
Chlamydia trachomatis: anorectal infection
May cause lymphogranuloma venereum
-proctocolitis with fever and bloody diarrhea, painful perianal ulcerations, anorectal strictures and fistulae and inguinal adenopathy
Increasing in MSM
Serology, culture, PCR, rectal ischarge
184
Herpes 2 anorectal infection
4-21 days after exposure
Viral pcr or antigen detection of fluid
Symptoms resolve in weeks but viral shedding may continue for several weeks
185
Condylomata acuminata anal condylomata (genial warts)
HPV
Treat with liquid nitrogen
186
Perianal or anal warts are seen in what % of MSM
25%
187
HIV with condylomata
Relapse higher
Higher progression to dysplasia or anal cancer
Detectable serum HIV RNA levels should have anoscopic surveillance every 2-6 months
188
How distinguish wart from condyloma lata or anal cancer
Biopsy suspicious lesion
189
Treat condylomata acuminata
Sex partners examined and treated
HPV vaccines 9-26
MSM get vaccinated
190
Colorectal cancer screening
Start at 45
76-85 depend
Over 85-no longer if don’t have history, family history, FAP, HNPAA, history of radiation
191
First degree relative with colorectal cancer or adenomas under 60
Screen colonoscopy every 5 years, beginning at 40 or ten years before the age of youngest affected relative
192
First degree relative diagnosed over 60
Screen at 40
193
Inherited syndromes of colorectal cancer
FAP-stats 10-12
HNPCC-every 1-2 years at 20-25 or ten years younger than youngest age of colorectal cancer diagnosis
194
Polyps of the colon
Discrete mass lesions that protrude into the intestinal lumen
Sporadic or FAP
195
Mucosal adenomatous polyps
70%
| Tubular , tubulovillous, villous
196
Mucosal serrated polyps
Hyperplastic, sessile serrated polyps, traditional serrated adenoma
197
Mucosal nonneoplastic polyps
Juvenile polyps, hamartoma, inflammatory polyps
198
Submucosal lesions
Lipomas lymphoid aggregates, carcinoid, pneumatosis cystoides intestinalis
199
What polyps have significant clinical implications
Adenomatous polyps and serrated polyps
200
Adenomas and serrated polyps
Non polyploid
Sessile
Pedunculated
201
Over 90% of adenocarcinoma of the colon are believed to arise from adenomas polyps. Majority?
Arise in adenomas after inactivation of APC gene->chromosomal instability and inactivation or loss of other tumor suppressor genes
202
Adenocarcinoma from serrated pathway
KRAS or BRAF with methylation of CpG rich promoter regions that lead to inactivation of tumor suppressor genes or mismatch repair genes MHL1
203
Clinical nonfamilial adenomatous and serrated polyps
Completely asymptomatic
Chronic occult blood loss may lead to iron defiency anemia
Large polyps may ulcerate, hematochezia
204
FOBT FIT
Fecal occult blood test and fecal DNA tests for CRC
205
What is fit
Fecal immunochemical test for hemoglobin that is more sensitive than others
206
Cool guard
Fecal DNA test with a fecal immunochemical test for stool hemoglobin
207
Barium enema CRC or CT colonography
Can see polyps
| But need bowel cleansing before
208
See polyps larger than 10 mm
Diagnostic but not therapeutic
209
CT radiation
Risk that may lead to cancer
210
Colonoscopy CRC
Requires colon prep
Diagnostic and therapeutic
Done for all patients with FOBT, FIT< fecal or DNA tests or iron defiency anemia due to neoplasms prevelance in these patients
Polyps detected on radiologic imaging studies adenomas detected on flexible sigmoid
REMAINS BEST TEST IN MOST PATIENTS TO DETECT AND TREAT COLORECTAL POLYPS)
211
TREAT POLYPS
Colonoscopy polypectomy-remove with biopsy forceps , but can get perforation or bleeding
Postpolypectomy surveillance-periodic colonoscopies surveillance to detect adematous and serrated polyps for 2-10 years
212
What recent of colorectal cancers are germline genetic mutations
4%
213
Who should be screened for hereditary CRC
Family history
Family history under 50
Family history of multiple polyps
Family history of multiple extracolinic malignancies
214
Bethesda criteria
For screening of hereditary colorectal cancer
215
FAP
Early development of hundreds to thousands of colonic adematous polyps and adenocarcinoma
.5% of colorectal cancer
216
Extracolonic manifestsations FAP
Duodenal adenomas, Desmond tumors, osteopath
217
Clinical FAP
Adenomatous polyps of the duodenum and periampullary area develop
Also soft tissue tumors of the skin, Desmond tumors, osteopath, and congenital hypertrophy of the retinal pigment
218
Genetics FAP
APC gene AD
8% MUTYH gene AR
De novo in 15%
219
Treat FAP
Prophylactic colectomy recommended to prevent otherwise inevitable colon cancer
Proctocolectomy with ileocecal anastomoses
Colectomy with ileocecal anastomoses is recommended usually before 20 years
220
Lynch syndrome HNPCC
CRC
Endometrial cancer
Ovarian, renal or bladder, hepatobiliary, gastric, SI cancer at young age
Polyps undergo RAPID transformation 1-2 years to adenoma to cancer
221
Calincial HNPCC lynch
Family cancer history genetic and colonscopic screening
Meet Bethesda screening
222
Genetics HNPCC
AD
| DNA base pair mismatches MLH1 MSH2
223
When suspect HNPCC
Tumor tissue histology staining for mismatch repair proteins or testing for microsatellite instability
Confirmed by genetic testing
224
Treat HNPCC
Subtotal colectomy with ileocecal anastomoses followed by anual surveillance
Screen for endometrial and ovarian cancer beginning at 30-55, pelvic exam, transvaginal US, endometrial sampling
*prophylactic hysterectomy and oophorectomy is recommended to women at 40 or once finished child bearin
Upper endoscopy for gastric cancer screen
Relatives screened
225
Gardners syndrome
Adenomatous colon polyps
95% develop colorectal polyps
Osteopath of mandible skull and long bones
Supernumerary teeth, epidermis and sebaceous teeth, thyroid and adrenal tumors
AD
226
Turncoats syndrome
Adenomatous colon polyps
Brain tumors
CRC 100% over 40
AD
227
Peutz jeghers
Hamartomatous polyps throughout GI lead to bleeding, intiussusception or obstruction
Mucocutaneous pigmented msucles on lips, buccal mucosa and skin
228
Familial juvenile polyposis
Several juvenile hamartomatous polyps located most commonly in colon
Increased risk of adenocarcinoma
229
PTEN multiple hamartoma syndrome (cowden disease)
Hamartomatous polyps and lipomas throughout GI tract trichilemommomas and cerebellar lesions
Increased rate of malignancy is demonstrated in the thyroid , breast, and urogenital tract
230
Genetics peutz jeghers
AD
| STK11
231
Familial juvenile polyposis genetics
AD
| Genetic defects 18q and 10q MADH2 and BMPR1A
