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GI / Nutritional Part 2 (Colorectal cancer - Gastric carcinoma) Flashcards

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1
Q

What is the MCC of LBO in adults?

A

Colorectal cancer (CRC)

also the MCC of occult bleed

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2
Q

MCC of CRC?

colorectal cancer

A

adenomatous polyps

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3
Q

What are the 4 different stages of polyps concerning malignancy likelihood/development?

A
  1. Hyperplastic
  2. Tubular
  3. Tubulovillous
  4. Villous

From least likely to most likely to be cancerous (HTTV)

Villous are villains

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4
Q

What size of a colorectal polyp is concerning?

A

1 cm or greater

less than this = unlikely to be malignant

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5
Q

RF of CRC (non-genetic)

A

age > 50 yo
IBD
Obesity, smoking, ETOH

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6
Q

What type of IBD is MC for CRC?

A

UC

> Crohn’s

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7
Q

What are the genetic predospitions to CRC? (4)

A

1) Familial Adenomatous Polyposis (FAP)
2) Turcot Syndrome
3) Lynch Syndrome (Hereditary Nonpolyposis CRC)
4) Puetz-Jebher’s Syndrome

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8
Q

Familial Adenomatous Polyposis (FAP) is a genetic mutation of the _ gene

A

APC

adenomatous polyposis coli (APC) gene

tumor supressor gene

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9
Q

What are the characteristics of Familial Adenomatous Polyposis (FAP) and the resulting treatment?

A

adenomas of colon at childhood

almost all will develop colon cancer by age 45yrs; prophylactic colectomy best for survival

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10
Q

What are the characteristics of Turcot syndrome and how does it differ from FAP?

A

FAP-like syndrome + CNS tumors (medulloblastoma, glial tumors)

FAP on steroids

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11
Q

Inheritance pattern of Lynch Syndrome and genes affected?

Hereditary Nonpolyposis CRC

A

Autosomal dominant

LADS (lynch autosomal dominant syndrome)

loss of function in DNA mismatch repair genes (MLH1, MSH2/6, PMS3)

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12
Q

What are the age differences of Lynch Syndrome vs FAP?

A

1) Lynch occurs at a mean age of late 40s
2) FAP = childhood adenomas

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13
Q

Difference between type I and type II Lynch syndrome

A

1)type I: esp. seen on right side
2)type II: ↑ risk of extra-colonic cancers (esp. endometrial)

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14
Q

Inheritance pattern of Puetz-Jegher’s Syndrome and associated characteristics

A

Autosomal dominant (like lynch syndrome)

hamartomatous polyps, mucocutaneous hyperpigmentation (lips, oral mucosa, hands) – risk of breast/pancreatic cance

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15
Q

In general what are the common clinical manifestations of the 4 CRCs?

A
  1. Iron deficiency anemia
  2. rectal bleeding
  3. abd pain
  4. change in bowel movements

advanced disease: ascites, abdominal masses, hepatomegaly

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16
Q

Clinical manifestations of right sided (proximal) CRC

A

Just general CRC symptoms

chronic occult bleeding

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17
Q

Clinical manifestations of left sided (distal) CRC

A

bowel obstruction; present later & cause changes in stool diameter – may develop Streptococcus bovis endocarditis

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18
Q

What are the characteristics of LOW risk CRC? (3)

hint, one is the size

A

*pedunculated
*tubular
*<1cm

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19
Q

What are the characteristics of HIGH risk CRC? (3)

A

*sessile (flat)
*villous (finger-like projections)
*>1cm

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20
Q

1st line diagnosis of CRC

A

Colonscopy + bx

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21
Q

If you were to do a barium enema for CRC, what is classic finding?

A

apple core lesion

constriction of lumen

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22
Q

Tumor marker for monitoring CRC

A

CEA

Carcinoembryonic antigen

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23
Q

Screening age for CRC and 3 screening options

assuming no RF

A

45 yo

1) q 10 years for colonoscopy
2) q 1 year fecal occult blood testing alone
3) flexible sigmoidoscopy q5yrs + fecal occult blood testing q3yrs

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24
Q

Screening frequency for CRC with the following level of RF
1) low
2) high
3) mega

A

1) low risk: q5-10yrs
1-2 polyps, <1cm, tubular, low grade
2) high risk: q1-3yrs
≥3 polyps, ≥1cm, sessile/villous, high grade
3) mega risk: q2-6mo
≥10 polyps

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25
You have Lynch Syndrome (or a FH?), what is the screening protocol?
colonoscopy q1-2yrs beginning at **20-25yrs** ## Footnote remember, cancer typically appears in 40s
26
You have FAP (or a FH?), what is the screening protocol?
flexible sigmoidoscopy annually beginning **10-12yrs** ## Footnote appears in childhood
27
Overall management of non-metastatic CRC
surgical resection followed by post-op chemo ## Footnote radical vs endoscopic chemo to destroy residual cells and prevent METS
28
Mangement of METS CRC?
Palliative chemo :(
29
What chemo is used for CRC?
FOLFOX FOLFIRI VGEF inhibitor (bevacizumab) ## Footnote folinic acid and leucovorin Ca2+ is used in FOLFOX and FOLFIRI (along with other chemo agents)
30
MCC of gastroenteritis?
Viruses ## Footnote rotavirus and **norovirus**
31
Length of subacute diarrhea
2-4 weeks ## Footnote above this = chronic (4+ weeks) below this = acute (< 2 weeks)
32
MCC of foodborne disease outbreak
Norovirus
33
Common locations to get norovirus?
Cruise ships and daycare
34
Overall, if you want to use diagnostics for viral gastroenteritis, what might you use?
PCR | also antigen tests and stool analysis ## Footnote it seems
35
All viral gastroenteritis have supportive treatment as management, but this virus has a prevention
Rotavirus ## Footnote VACCINATE YOUR KIDDOS
36
Which causitive organism for gastroenteritis holds a risk of Guillain-Barre? hemolytic uremic syndrome (HUS)?
GB = Campylobacter jejuni HUS = E. coli, Shiga-toxin-producing (STEC) ## Footnote only sometimes!
37
How might you get Campylobacter jejuni infection? ## Footnote for bacterial gastroenteritis
Think dairy/ animal exposure | at camp drinking milk ## Footnote poultry, unpasteurized milk, untreated water, new pets, dairy farms
38
Treatment of Campylobacter jejuni
Supportive typically ## Footnote **azithromycin** x3d or **erythromycin** x5d can shorten duration when given early in illness
39
Symptoms of E. coli, Shiga-toxin-producing (STEC) and what should be monitored
**hemorrhagic colitis** w/ bloody diarrhea ## Footnote monitor: CBC/BUN/Cr for **HUS**
40
Treatment of E. coli, Shiga-toxin-producing (STEC)
Supportive ## Footnote abx not recommended d/t HUS risk!!!
41
Dx and treatment of C diff
DX: two-step: 1) enzyme immunoassay for glutamine 2) dehydrogenase w/ confirmatory toxin testing by NAAT or toxin immunoassay ## Footnote Metro for mild Vanc for severe Fidaxomicin for continuous relapse
42
What is the causitive agent for traveler's diarrhea? Symptoms?
E coli | s/s = watery diarrhea + abd cramps
43
Treatment of E coli induced gastroenteritis ## Footnote Traveler’s diarrhea
**azithromycin** or **cipro** x3d may ↓ duration
44
Complications of non-typhoid salmonella?
Spread of infection systemically | **s**almonella = **s**ystemic ## Footnote bacteremia, osteomyelitis, brain abscess, meningitis
45
Tx of non-typhoid salmonella
Rocephin + azithromycin OR amoxicillin OR bactrim ## Footnote ONLY in patients with high risk of systemic disease: 3mo, chronic GI dz, HIV/immunocompromised
46
What are the hosts for salmonella typhi and the presentation?
Humans | sys symptoms + bloody diarrhea, then **HSM** & **rose spots** by wk2 ## Footnote humans are the only natural hosts!
47
Treatment of salmonella typhi
Rocephin OR Azithromycin | +/- steroids in kiddos with enteric fever ## Footnote monotherapy unlike non-typhoid salmonella?
48
Common outbreak location of shigella and s/s
Daycare ## Footnote s/s vary - watery or bloody diarrhea w/ systemic symptoms
49
Treatment of shigella
rocephin OR azithromycin OR FQ
50
What is the causative agent of gastroenteritis that leads to this characteristic finding - "rice water diarrhea"?
Vibrio cholerae
51
Apart from rice water diarrhea, what are the symptoms of Vibrio cholerae and why does this make sense?
LOTS of watery diarrhea with no pain, but electrolyte abnormalities ## Footnote from losing soooo much liquid
52
Treatment of Vibrio cholerae
Rocephin OR Azithromycin OR Cipro OR Tetracycline ## Footnote very similar to shigella
53
What bacterial enteritis is often cause by exposure to any of the following: SWINE; pork, milk, well water, chitterlings, tofu
Yersinia enterocolitica ## Footnote uncommon in US
54
What is Yersinia enterocolitica often mistaken for?
Appendicitis ## Footnote very similar s/s - but bloody diarrhea is seen!
55
Treatment of Yersinia enterocolitica
parenteral 3rd gen ceph, Bactrim, aminoglycosides, FQs, tetracycline, doxy, chloramphenicol – only for neonates/IC
56
What are the two common causes of parasitic gastroenteritis?
Giardia lamblia Entamoeba histolytica
57
What is Giardia lamblia aka and what exposures often lead to it?
backpacker’s diarrhea ## Footnote daycare, camping trips, **contaminated water**
58
s/s of Giardia lamblia
acute – **watery diarrhea**, **foul-smell**, flatulence, anorexia; can lead to **FTT**
59
treatment of Giardia lamblia
**tinidazole** x1, **metronidazole** x5-10d, **nitazoxanide** x3d ## Footnote remember, parasitic
60
What are the s/s of Entamoeba histolytica caused by? How does this present?
intestinal amebiasis ## Footnote gradual onset bloody diarrhea, lower abd. pain, tenesmus, wt loss; complications: toxic megacolon, fulm. colitis
61
Dx and treatment of Entamoeba histolytica and why this makes sense
Stool O&P metronidazole then paramomycin ## Footnote remember, fungal
62
What antidiarrheal is indicated in patients with inflammatory diarrhea?
Bismuths ## Footnote antimicrobial properties; salicylate: anti-secretory & anti-inflammatory properties
63
Apart from pepto, what is another bismuth?
Kaopectate ## Footnote pectate kinda sounds like pepto
64
SE of bismuths and CI
dark colored stools, darkening of tongue ## Footnote CI in kiddos d/t Reye's syndrome (because salicylate)
65
What two antidiarrheals bind to gut opioid receptors, thereby decreasing peristalsis? Which one increases anal sphincter tone as well?
Diphenoxylate and loperamide | loperamide also increases anal tone ## Footnote should not be used in inflammatory diarrhea as a result!
66
Indications for Diphenoxylate and loperamide
non-invasive diarrhea ## Footnote watery/non-bacterial?
67
Why use anticholinergics for diarrhea and what are they?
Decreases gut secretions (can't poop) | inhibits Ach-related GI motility ## Footnote Phenobarbital, Hyoscyamine, Atropine, Scopolamine
68
MOA of zofran and suffix of generic names?
blocks serotonin receptors ## Footnote -setron meds (sim to serotonin)
69
SE of -setron (anti-emetic anti-cholinergic) meds
**neuro**: HA, fatigue, sedation **cardiac**: QT prolongation, arrhythmias **GI**: bloating, diarrhea, constipation
70
What are the dopamine blockers used as anti-emetics? (3)
Prochlorperazine Promethazine Metoclopramide ## Footnote blocks CNS dopamine receptors; mild antihistaminic/antimuscarinic
71
SE of dopamine blockers used as anti-emetics?
QT prolongation, anticholinergic, drowsiness **also EPS**: rigidity, bradykinesia, tremor, akathisia, parkinsonism: rigidity, tremor
72
Treatment of dystonic reactions (dyskenesia) from EPS 2ndary to dopamine blockers
IV diphenhydramine | Benadryl
73
MCC of ACUTE lower GI bleed
diverticulosis ## Footnote chronic = CRC, remember :)
74
Diverticulosis is outpouchings due to herniation of the mucosa into the wall of the colon along natural openings at the () of the colon
vasa recta
75
Most common location vs site of bleeding for diverticulosis
Location = Left colon Bleeding site = Right colon
76
MC location of diverticulitis
sigmoid colon ## Footnote remember, this is at the LLQ, which is why you feel pain there!
77
Dx of diverticulosis vs diverticulitis
**diverticulosis** = incidental **colonscopy** **diverticulitis** = **CT** **w/ IV contrast** after characteristic symptoms
78
Treatment of diverticulitis
**Metro** + **cipro** OR **levaquin** for uncomplicated | with a clear liquid diet ## Footnote Surgery: refractory to medical therapy, frequent recurrences, perforation, strictures
79
MCC of Esophageal Neoplasms in US vs worldwide
US = adenocarcinoma WW = squamous cell
80
MC location of esophageal adenocarcinoma VS squamous cell
**adenocarcinoma** = distal esophagus, esophagogastric junction **squamous cell**= mid to upper third of the esophagus
81
which esophageal neoplasm can be a complication of barret's esophagus?
adenocarcinoma
82
What are the characteristic findings of an esophageal neoplasm?
*progressive dysphagia – solid food dysphagia progressing to include fluids *odynophagia *weight loss ## Footnote think esophageal problems
83
Dx of esophageal neoplasms
Upper endoscopy w/ bx
84
Management of esophageal neoplasms
**Resection + chemo** OR radiation + chemo (5-FU) ## Footnote palliative stenting (advanced)
85
Management of Barrett's
endoscopic eval q3-5yrs ## Footnote watchful waiting and observing the esopahgus
86
What esophageal disease can lead to Plummer-Vinson Syndrome and what is it? Why is it a concern?
**Esophageal Strictures** *dysphagia + webs + iron deficiency anemia *may be associated w/ atrophic glossitis | ***increased risk for esophageal SCC**
87
MC location of esophageal webs vs Shatzki Rings? ## Footnote Esophageal Strictures
Esophageal Web = mid-upper esophagus Shatzki Ring = lower esophagus (at the squamocolumnar junction) Rings fall down d/t gravity | Webs can attach high in the sky
88
Risks of Esophageal Strictures
hiatal hernia ## Footnote d/t compromised anatomy?
89
MC symptom of Esophageal Strictures | be specific
**Dysphagia** (esp. to solids)
90
Diagnosis and treatment of Esophageal Strictures
Barium esophagram (swallow) ## Footnote Symptomatic: dilation
91
MC gastric carcinoma and biggest RF
Adenocarcinoma ## Footnote H. pylori biggest risk factor
92
MC symptoms associated with gastric carcinoma
weight loss & persistent abdominal pain | early satiety also seen ## Footnote think what would happen if your stomach was having issues
93
What are the palpable LNs sometimes associated with gastric carcinoma
*supraclavicular lymph nodes (**Virchow’s node**) *umbilical LN (**Sister Mary Joseph’s node**) *left axillary LN (**Irish sign**) *palpable nodule on rectal exam (**Blumer’s shelf**)
94
Diagnostic of choice for gastric carcinoma and what imaging is used for METS
**Upper endoscopy w/ bx** standard ## Footnote **Abdominal/pelvic CT** (METS) CXR sometimes
95
What are the lab findings characteristic of gastric carcinoma? (2)
1) microcytic/hypochromic anemia 2) + guaiac ## Footnote iron deficiency anemia?
96
Treatment of early local disease gastric carcinoma
endoscopic resection ## Footnote other therapies depending on location and course of disease (gastrectomy, chemo, radiation)

Surgery EOR (17 decks)

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