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Flashcards in GI health maintenance Deck (34):
1

RFs for colorectal cancer?

- age over 50
- hx of adenomatous polyps
- personal hx of IBD
- family hx
- african-american or Eastern European jews
- Type 2 DM (less favorable prognosis)

2

Why is it so impt to get colonoscopy at 50?

- 9/10 people dx with colorectal cancer are at least 50

3

Why are adenomatous polyps (adenomas) concerning?

- ***adenomas increase colon cancer risk
- large in size or mult polyps increase risk
- ***hyperplastic polyps don't increase risk

4

Why is personal hx of IBD impt?

- uclerative colitis
- crohn's
- chronic inflammation may lead to dysplasia and eventually cancer

5

What are lifestyle related factors related to increased risk of colon cancer?

diet:
high in red meat (beef, pork, lamb) and processed meats
- low fruit and veggie consumption
- physical inactivity
- obesity
- smoking
- heavy alcohol use

6

Importance of family hx of adenomatous polyps or colorectal cancer?

- 1/5 people with colorectal cancer have family members who were also affected
- first degree relative with colorectal cancer doubles risk
- even higher if that person is 45 or younger at dx
- family members with adenomatous polyps also increases risk

7

What are the inherited syndromes that put pts at higher risk for colorectal cancer?

- familial adenomatous polyposis (FAP) - 1% of all colorectal cancers
- hereditary non-polyposis colon cancer (HNPCC): 2-4% of all colorectal cancers
- Turcot syndrome
- peutz-jeghers syndrome: dramatically large polyps that are benign but pt at risk for other malignancies throughout the body

8

Previous tx for what other cancers put you at risk for colorectal cancer?

- testicular cancer
- prostrate cancer

9

What are the screening tests for colorectal cancer?

- flexible sigmoidoscopy
- colonoscopy
- double-contrast barium enema
- virtual colonoscopy
- FOBT, stool guaiac test: guaiac detects heme in stool
iFOBT or FIT:
-more accurate measurement
-less false positives
- no need to avoid meat and vitamin C
- uses abs to detect HB in stool

10

Flexible sigmoidoscopy use? How often? Cons? Risks?

- fairly quick and safe
- sedation usually not used
- doesn't reqr a specialist to perform
- done q 5 yrs
- views only about 1/3 of colon
- can miss polyps
- can't remove all polyps
- will need a colonoscopy if abnormal
- small risk of bleeding, infection or bowel tear

11

When is use of colonoscopy preferred? Risks, cons?

- preferred method for screening
- can usually view the entire colon
- can bx and remove polyps
- done q 10 yrs
- can miss small polyps
- full bowel prep needed
- sedation is needed
- small risk of bleeding, bowel tears or infection
- expensive

12

When is double contrast barium enema used? Pros, cons?

- can usually view the entire colon
- relatively safe
- done q 5 years
- no sedation needed
- 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
- test has largely been replaced by virtual colonoscopy
- contrast is with barium and air
- only detect 1/2 of large (over 1 cm) polyps
- use has declined with increasing use of endoscopic and CT procedures
- procedural expertise in double-contrast barium studies may be declining:
- no one really knows how to do these anymore

13

Virtual colonoscopy - pros and cons?

- fairly quick and safe
- can usually view entire colon
- done q 5 yrs
- no sedation needed
- full bowel prep needed
- cna miss small polyps
- some false positive test results
- colonoscopy will be needed if abnormal
- AKA CT colonography, air enema is given and CT scan of colon is done 2x (supin and one in prone position)

14

Pros and cons to FOBT?

- no direct risk to colon
- no bowel prep needed
- sampling done at home
- inexpensive
- may produce false positive test results
- may have pre-test dietary restrictions
- should be done yearly
- need 3 diff stool samples
- pt drops off or mails in (26% compliance rate)
- colonoscopy will be done if abnormal
- avoid NSAIDs for 7 days prior to testing: can cause false positives
- avoid vitamin C in excess of 250 mg daily (supplements and food) for 3 days prior to testing - false positives
- avoid red meats for 3 days prior to testing: false positives

15

Diff b/t FOBT and FIT (IFOBT) test?

- no pre-test dietary or med restrictions
- more accurate measurement
- less false positives
- no need to avoid meat and vitamin C
- use abs to detect HB in stool
- only need one day's sample
- automated vs manual system
- closed system, less risk of exposure
- better pt compliance: 96%

16

American Cancer Society guidelines for colon cancer screening?

- beginning at 50 (to 75-85) men and womn at avg risk should be screened with:
colonoscopy q 10 yrs

17

What should pt do if unable or unwilling to undergo colonoscopy?

if colonoscopy refused or CI then pick one of following:
- flexible sigmoidoscopy q 5 years
- double contrast barium enema q 5 yrs
- virtual colonoscopy q 5 yrs
- if all imaging tests refused or CI then:
FOBT yearly on 3 stool samples, or FITx 1 yearly

18

What are the exceptions to the screening guidelines of colorectal cancer?

- african americans should begin screening at age 45

if high risk for colon cancer guidelines are more aggressive:
-if 1st degree family member with colon cancer need colonoscopy 10 yrs prior to relative's age at dx
- IBD (UC and crohns): colonoscopy q 1-2 yrs
- personal hx of adenomatous polyps or colon cancer: colonoscopy 1 yr post resection then q 3-5 yrs
- Familial adenomatous polyposis (FAP): yearly flexible sigmoidoscopy beginning at age 10-12 years. If genetic testing is positive consider colectomy
- HNPCC: colonoscopy q 1-2 yrs beginning at age 20-25 yrs or 10 yrs before the youngest case in the immediate family

19

RFs for hepatocellular carcinoma?

- hepatitis B viral infection (highly assoc with development of HCC)
- chronic HCV infection
- hereditary hemochromatosis
- cirrhosis of almost any cause
- ***80% of cases are due to underlying chronic Hep B or C

20

Further RFs for HCC?

- nonalcoholic fatty liver disease
- DM
- chronic alcohol use
- chronic tobacco abuse
- alpha-1 antitrypsin deficiency

21

Screening for HCC indicated when?

- all pts with cirrhosis regardless of etiology
chronic HBV +
-Asian (men over 40, women over 50)
-African and African-Americans
-Family hx of HCC

Caucasians with HBV +
- active inflammation and high viral load for several years
- start men at 40 and women at 50

22

What test is recommended for screening of HCC?

- liver U/S: q 6 months (at least once a year)
- if abnormalities found on liver U/S pt will need further workup

23

RFs for esophageal cancer?

-older than 55
- men 3x more likely than women to develop
- ETOH abuse
- tobacco use
- obesity
- diet: high in processed meats, low in fruits and veggies

24

Medical conditions assoc with esophageal cancers?

- HPV infection
- GERD
- Barrett's esophagus: caused by GERD
- achalasia: narrowing of distal esophagus
- tylosis: esophageal papillomas
- plummer-vinson syndrome: esophageal webs

25

Screening for esophageal cancers?

- no universal screening test for general pop
- those with conditions that increase their risk need periodic endoscopies: Barrett's, achalasia, plummer-vinson syndrome

26

Increasing dietary fiber can be beneficial for tx of?

- hemorrhoids
- constipation
- diarrhea
- diverticulosis

27

2 diff types of fiber?

soluble: dissolves in water - oatmeal, oat cereal, lentils, apples, oranges, pears, oat bran, strawberries, nuts, flaxseeds, beans, dried peas, blueberries, psyllium, cucumbers, celery and carrots

insoluble: nondigestible
- whole wheat, whole grains, wheat brain, corn bran, seeds, nuts, barley, couscous, brown rice, bulgur, zucchini, celery, broccoli, cabbage, onions, tomatoes, carrots, cucumbers, green beans, dark leafy veggies, raisins, grapes, fruti, and root veggie skins

28

How does fiber tx both diarrhea and constipation?

- insoluble fiber: helps pull water from colon making stool softer and easier to pass and helps tx constipation
- soluble fiber: helps to absorb water in colon and can bulk up stool to tx chronic diarrhea

29

What can chronic constipation lead to?

- hemorrhoids
- anal fissures
- possibly the development of diverticulosis

30

What are the dietary fiber recommendations?

-women: 25 g/day
- men: 38 g/day

31

When does divericulosis usually occur?

- starting at 40, incidence increases about q 10 yrs
- about half of people b/t ages of 60-80 have divertucular disease
- almost everyone over 80 has it
- high fiber diet helps to prevent constipation which can lead to worsening divertiuclar disease and diverticulitis

32

GERD RFs?

- eating large meals or laying down right after a meal
- obesity
- foods: citrus, tomato, chocolate, mint, garlic, onions, spicy or fatty foods
- Drinks: ETOH, carbonated drinks, coffee, tea
- smoking
- pregnancy
- hiatal hernia

33

What meds can worsen GERD?

- NSAIDs
- BBlockers
- CCBs
- bronchodilators
- dopamine active drugs (tx of parkinson's)
- TCAs
- some muscle relaxants

34

What dietary and lifestyle counseling would you give pt to reduce GERD sxs?

- maintain healthy wt
- avoid tight fitting clothes
- avoid known trigger foods:
encourage a food and sx journal for 7-14 days
usual culprits are ETOH and coffee
- eat smaller meals
- wait 3 hrs after eating to lay down
- elevate head of bed 6-9 inches
- don't smoke or chew tobacco
- decrease stress and anxiety through exercise or other relaxation techniques