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Flashcards in GI Health Maintenance Deck (45):
1

Risk factors for colorectal cancer?
6

1. Age > 50
2. History of adenomatous polyps
3. Personal history of inflammatory bowel disease
4. Family history
5. African-American or Eastern European Jews
6. Type 2 DM

2

Adenomatous polyps (adenomas) increase colon cancer risk
1. What characteristics of these make the risk greater? 2
2. What kind of polyps do not increase risk?

1. Large in size or multiple polyps increase risk
2. Hyperplastic polyps do not increase risk

3

Lifestyle related factors:
1. What kind of diet would put you at risk for colon cancer? 2

2. What other lifestyle factors would contribute to this? 4

1. High in
-red meat (beef, pork, lamb) and processed meats
-Low fruit and vegetable consumption

2.
-Physical inactivity
-Obesity
-Smoking
-Heavy alcohol use


Sounds like typical American diet and lifestyle

4

How does having a first degree relative with colorectal cancer increase your risk of cancer?

First degree relative with colorectal cancer doubles risk

-Even higher risk if that person was 45 years or younger at diagnosis
-Family members with adenomatous polyps also increases risk

5

What are inherited syndromes that would increase your risk of colon cancer?
4

1. Familial Adenomatous Polyposis (FAP)
-1% of all colorectal cancers
2. Hereditary non-polyposis colon cancer (HNPCC)
-2-4% of all colorectal cancers
3. Turcot syndrome
4. Peutz-Jeghers syndrome

6

Even after adjusting for obesity what disease increases risk of colon cancer and also has a less favorable outcome if they are diagnosed?

Type 2 Diabetes

7

Previous treatments for other cancers also increase risk. Specially what two?

Testicular cancer
Prostate cancer

8

Colorectal Cancer Screening Tests
6

1. Flexible sigmoidoscopy
2. Colonoscopy
3. Double-contrast barium enema
4. Virtual colonoscopy
5. Fecal Occult Blood Test (FOBT)…stool guaiac test
6. Fecal Immunochemical Test (iFOBT or FIT)

9

What does guaiac detect in the stool?

Guaiac detects heme in stool

10

Advantages of Fecal Immunochemical Test (iFOBT or FIT)?
4

1. More accurate measurement
2. Less false positives
3. No need to avoid meat and vitamin C
4. Uses antibodies to detect HB in stool

11

Flexible Sigmoidoscopy
1. Advatnages? 3
2. Done every how many years?
3. Views how much of the colon?
4. Disadvantages? 3
5. Small risk of what? 3

1.
-Fairly quick and safe
-Sedation usually not used
-Does not require a specialist to perform

2. Done every 5 years

3. Views only about a third of the colon

4.
-Can miss small polyps
-Can’t remove all polyps
-Will need a colonoscopy if abnormal

5. Small risk of
-bleeding,
-infection or
-bowel tear

12

What is the preferred method of colon cancer screening?

colonoscopy

13

Colonoscopy
1. Advantages? 2
2. Done every how many years?
3. Disadvantages? 3
4. Small risk of what? 3

1.
-Can usually view the entire colon
-Can biopsy and remove polyps
2. Done every 10 years

3.
-Can miss small polyps
-Full bowel prep needed
-Sedation is needed

4. Small risk of
-bleeding,
-bowel tears or infection
-Expensive

14

Double Contrast Barium Enema
1. Advantages? 3
2. Done every how many years?
3. Disadvantges? 5

1.
-Can usually view the entire colon
-Relatively safe
-No sedation needed

2. Done every 5 years

3.
-Can miss small polyps
-Full bowel prep needed
-Some false positive test results
-Can’t remove polyps during testing
-Colonoscopy will be needed if abnormal

15

Double Contrast Barium Enema
1. Test has largely been replaced by what?
2. Use has also declined with the increasing use of what? 2

1. colonscopy
2. endoscopic and CT procedures

16

Virtual Colonoscopy
1. Advanatges? 3
2. Done every how many years?
3. Disadvantages? 4

1.
-Fairly quick and safe
-Can usually view the entire colon
-No sedation needed

2. Done every 5 years

3.
-Full bowel prep needed
-Can miss small polyps
-Some false positive test results
-Colonoscopy will be needed if abnormal

17

Virtual Colonoscopy
1. aka?
2. What is given first in the process?
3. What kind of imaging is done and how?

1. Also known as CT colonography
2. Air enema is given
3. CT scan of the colon done X 2 (supine and prone positions)

18

Fecal Occult Blood Test (FOBT)
1. Advantages? 4
2. Disadvantages? 3
3. Should be done how often?
4. Process? 2

1.
-No direct risk to the colon
-No bowel prep needed
-Sampling done at home
-Inexpensive

2.
-May produce false positive test results
-May have pre-test dietary restrictions
-Colonoscopy will be done if abnormal

3. Should be done yearly

4.
-Need 3 different stool samples
-Patient drops off or mails in cards

19

FOBT
1. Avoid _______ for 7 days prior to testing
2. why?
3. Avoid WHAT for 3 days prior to testing?
4. why?
5. Avoid _________ for 3 days prior to testing
6. WHy?

1. NSAIDs
2. Can cause false positives
3. vitamin C in excess of 250mg daily (supplements or foods)
4. False positives
5. red meats
6. False positives

20

Fecal Immunochemical Test (FIT) or iFOBT: Difference between this and the FOBT?
9

1. No pre-test dietary or medication restrictions
2. More accurate measurement
3. Less false positives
4. No need to avoid meat and vitamin C
5. Uses antibodies to detect HB in stool
6. Only need one day’s sample
7. Automated vs manual system
8. Closed system, less risk of exposure
9. Better patient compliance

21

American Cancer Society Guidelines for Colon Cancer Screening

Beginning at age 50 (to age 75-85) men and women at average risk should be screened with:
Colonoscopy every 10 years

22

If colonoscopy refused or contraindicated pick one of the following:
3


If all imaging tests refused or contraindicated then what? 2

1. Flexible sigmoidoscopy every 5 years
2. Double contrast barium enema every 5 years
3. Virtual colonoscopy every 5 years

1. FOBT yearly on 3 stool samples
2. Or FIT x 1 yearly

23

Exceptions to the guidelines
4

1. African-Americans
2. If at high risk for colon cancer the guidelines are more aggressive
3. Familial adenomatous polyposis (FAP) –
4. Hereditary nonpolyposis colon cancer (HNPCC)

24

1. African american should begin screening when?

2. Familial adenomatous polyposis (FAP) – yearly flexible sigmoidoscopy beginning at age _____ years. If genetic testing is positive consider ________.

3. Hereditary nonpolyposis colon cancer (HNPCC) – colonoscopy every _____ years beginning at age _____ years or ____ years before the youngest case in the immediate family

1. should begin screening at age 45
2. 10-12, colectomy
3. 1-2, 20-25, 10

25

If at high risk for colon cancer the guidelines are more aggressive
such as?
3

1. If 1st degree family member with colon cancer need colonoscopy 10 years prior to the relative’s age at diagnosis

2. Inflammatory bowel disease (UC and Crohn’s) – colonoscopy every 1-2 years

3. Personal history of adenomatous polyps or colon cancer – colonoscopy 1 yr post resection then every 3-5 yrs

26

Risk factors for HCC
(Hepatocellular carcinoma)


4

1. Hepatitis B viral (HBV) infection
2. Chronic hepatitis C virus (HCV) infection
3. Hereditary hemochromatosis
4. Cirrhosis of almost any cause


80% of cases are due to underlying Chronic Hepatitis B or C

27

Further risk factors for HCC
5

1. Nonalcoholic fatty liver disease
2. Diabetes mellitus
3. Chronic alcohol abuse
4. Chronic tobacco abuse
5. Alpha-1 antitrypsin deficiency

28

HCC Screening needed for….
8

1. All patients with cirrhosis regardless of etiology

2. Chronic Hepatitis B infection +
3. Asian (men > 40, women > 50)
4. African and African-Americans
5. Family history of HCC

6. Caucasians with Chronic Hepatitis B +
7. Active inflammation and high viral load for several years
8. Start men > 40, women > 50

29

What Screening tests are recommended for HCC?
2

1. Liver ultrasound
-Every 6 months
2. If abnormalities found on liver ultrasound patient will need further workup

30

Hepatitis __ infection highly associated with development of hepatocellular carcinoma

B

31

Esophageal cancer risk factors
6

1. Age > 55
2. Men are 3x more likely than women to develop
3. ETOH abuse
4. Tobacco use
5. Obesity
6. Diet

32

What kind of diet would increase risk for esophageal cancer?
2

1. High in processed meats
2. Low in fruits and vegetables

33

Medical conditions associated with esophageal cancers
6

1. HPV infection
2. GERD
3. Barrett’s esophagus (Caused by GERD)
4. Achalasia (Narrowing of distal esophagus)
5. Tylosis (Esophageal papillomas)
6. Plummer-Vinson syndrome (Esophageal webs)

34

Those with conditions that increase their risk need periodic endoscopies. Such as? 3

1. Barrett’s,
2. achalasia,
3. Plummer-Vinson syndrome

35

Increasing dietary fiber can be beneficial for treatment of:
4

1. Hemorrhoids
2. Constipation
3. Diarrhea
4. Diverticulosis

36

What are the two types of fiber?

1. Soluable
2. Insoluable

37

Describe soluable fiber?

Which foods?

1. Dissolves in water

2. oatmeal, oat cereal, lentils, apples, oranges, pears, oat bran, strawberries, nuts, flaxseeds, beans, dried peas, blueberries, psyllium, cucumbers, celery, and carrots.

38

Describe insoluable fiber?

Which foods?

1. Nondigestible

2. whole wheat, whole grains, wheat bran, corn bran, seeds, nuts, barley, couscous, brown rice, bulgur, zucchini, celery, broccoli, cabbage, onions, tomatoes, carrots, cucumbers, green beans, dark leafy vegetables, raisins, grapes, fruit, and root vegetable skins

39

Fiber treats both diarrhea and constipation
1. Insoluable fiber helps with what?
2. Soluable fiber helps with what?

1. Insoluble fiber helps pull water from the colon** making the stool softer and easier to pass and helps treat constipation

2. Soluble fiber helps to absorb water in the colon and can bulk up the stool** to treat chronic diarrhea

40

Chronic constipation can lead to:
3

1. Hemorrhoids
2. Anal fissures
3. Possibly the development of diverticulosis

41

Dietary fiber recommendations
1. women?
2. men?

1. Women - 25 grams per day
2. Men - 38 grams per day

42

Diverticulosis
1. Starting at age 40, incidence increases about every ___ years
2. About half of people between the ages of ________ have diverticular disease
3. Almost everyone over ___ has it

High fiber diet helps to prevent constipation which can lead to worsening diverticular disease and diverticulitis

1. 10
2. 60 and 80
3. 80

43

GERD risk factors
7

1. Eating large meals or laying down right after a meal
2. Obesity
3. Foods: citrus, tomato, chocolate, mint, garlic, onions, spicy or fatty foods
4. Drinks: ETOH, carbonated drinks, coffee, tea
5. Smoking
6. Pregnancy
7. Hiatal hernia

44

Meds that can worsen GERD
7

1. NSAIDs
2. Beta-blockers
3. Calcium channel blockers
4. Bronchodilators
5. Dopamine active drugs (treatment of Parkinson’s)
6. TCAs
7. Some muscle relaxants

45

Dietary and lifestyle counseling to reduce GERD symptoms

8

1. Maintain a healthy weight
2. Avoid tight fitting clothes
3. Avoid known trigger foods
-Encourage a food and symptom journal for 7-14 days
-Usual culprits are ETOH and coffee
4. Eat smaller meals
5. Wait 3 hours after eating to lay down
6. Elevate the head of the bed 6-9 inches
7. Don’t smoke or chew tobacco
8. Decrease stress and anxiety through exercise or other relaxation techniques