Large Group 3 - Lower GI

Question 1

Diverticulosis is found on which side of colon?

Answer 1

Antimesenteric

Question 2

Most diverticula are localized where?

Answer 2

Distal colon

*but can occur anywhere in colon, just not the rectum

Question 3

How are uncomplicated diverticulosis usually found?

Answer 3

Incidental findings

Question 4

Diverticulosis can present as what other bowel syndrome?

Answer 4

Irritable bowel syndrome

Question 5

2 common complications of Diverticular Disease

Answer 5

Diverticulitis and Bleeding

Question 6

What is complicated diverticulitis?

Answer 6

Presence of an abscess, fistula, obstruction, or perforation

Question 7

What is simple or uncomplicated diverticulitis?

Answer 7

Inflammation in the absence of complications

Question 8

Most common complaint of diverticulitis?

Answer 8

LLQ pain

Question 9

Right sided- diverticulitis is common in which ethnic region?

Answer 9

Asia

Question 10

Name the syndrome: LLQ pain, low grade fever, mild leukocytosis, urinary sx

Answer 10

Diverticulitis

*Urinary sx due to bladder irritation from the inflamed sigmoid

Question 11

Tx for uncomplicated diverticulitis

Answer 11

ciprofloxacin with metronidazole

Question 12

Tx for uncomplicated diverticulitis

Answer 12

amoxicillin-clavulanate

Question 13

Tx for uncomplicated diverticulitis

Answer 13

SMX-TMP and metronidazole

Question 14

Tx for complicated diverticulitis

Answer 14

ampicillin, gentamicin, metronidazole

Question 15

Tx for complicated diverticulitis

Answer 15

pipercillin-tazobactam

Question 16

When is surgery implicated for diverticular Dz?

Answer 16

after first attack of complicated diverticulitis or after two or more episodes of UNcomplicated within 12 mos

Question 17

Most common intestinal ischemia?

Answer 17

Colonic - 70%

Question 18

What is Griffith’s point also known as?

Answer 18

Splenic flexure

Question 19

Sudek’s point is also known as?

Answer 19

Rectosigmoid junction

Question 20

Why is right colon a watershed area?

Answer 20

Sometimes Marginal a. of Drummond is poorly developed in that area, causing low perfusion states

Question 21

Most common locations for colonic ischemia *watershed areas

Answer 21

splenic flexure and sigmoid colon

Question 22

LLQ pain can be two diseases. Name them.

Answer 22

Colonic ischemia or diverticulitis

Question 23

How do you diagnose and Tx colonic ischemia?

Answer 23

CT at watershed areas, colonoscopy, biopsy

Question 24

Colonoscope demarcation zone

Answer 24

colonic ischemia

Question 25

Complication from surgery

Answer 25

Strictures (Scar)

Question 26

Third most common US cancer?

Answer 26

Colon cancer

Question 27

Risk of colorectal cancer if two 1st degree relatives have it?

Answer 27

3-4

Question 28

Risk of colorectal cancer if one 1st degree relative under 50yo has it?

Answer 28

3-4

Question 29

Risk of colorectal cancer if one 1st degree relative has it?

Answer 29

2-3

Question 30

Risk of colorectal cancer if 2nd or 3rd degree relative has it?

Answer 30

1.5

Question 31

Risk of colorectal cancer is no family Hx?

Answer 31

1

Question 32

Mutation for Familial Adenomatous Polyposis

Answer 32

APC mutation on chromosome 5

Question 33

What is the heredity mode for FAP? (how is it carried?)

Answer 33

autosomal dominant

Question 34

What age is colorectal cancer seen in FAP?

Answer 34

45yo

Question 35

What is Tx for unaffected FAP carrier?

Answer 35

prophylactic colonectomy

Question 36

Does ampulla of Vater see FAP cancers?

Answer 36

yes

Question 37

HNPCC is also called?

Answer 37

Lynch syndrome

Question 38

How is HNPCC carried?

Answer 38

autosomal dominant

Question 39

Are the lesions proximal or distal with HNPCC?

Answer 39

proximal bowel

Question 40

Mismatch repair genes are mutated in which Dz?

Answer 40

HNPCC | MSH2, MLH1, MSH6

Question 41

Most common hereditary colon cancer Dz

Answer 41

Hereditary nonpolyposis colorectal cancer | HNPCC - 5%

Question 42

Which polyp type is most commonly cancerous? hyperplastic or adenomatous?

Answer 42

Adenomatous. (give rise to 90% colorectal cancers)

Question 43

This mutation leads directly to adenoma polyp formation

Answer 43

K-ras

Question 44

Name the gene disturbances leading to adenoma

Answer 44

K-ras-->DCC deletion-->p53 deletion

Question 45

What leads to hyperproliferative epithelium?

Answer 45

Methylation abnormalities

Question 46

If a pt with colon cancer is jaundice, what is the most simple explanation?

Answer 46

liver metastasis

Question 47

Which stage of colorectal cancer is curative?

Answer 47

Stage 1

Question 48

Test of choice for Colorectal Cancer?

Answer 48

colonoscopy

Question 49

Screening age for colorectal cancer?

Answer 49

50 with no FamHx. 45 if AA

Question 50

If you have a FamHx with someone having colon ca under age 60, when should you be screened?

Answer 50

40yo every 5 years

Question 51

Surg Tx for Chronic UC

Answer 51

Total colectomy and ilieoanal pullthrough to create a rectum