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GI (inpt) > small intestine and Colon Disorders > Flashcards

small intestine and Colon Disorders Flashcards

1
Q

how common are colon polyps?

A

very common- either benign or malignant

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2
Q

are polyps heritable?

A

yes! familiar adenomatous polyposis, hamartomatous polyposis (Peutz-Jeghers syndrome, familial juvenile polyposis, PTEN multiple hamartoma syndrome)

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3
Q

what is the link btw colon polyps and colon cancer?

A
  • removal of polyps reduces the risk of colon cancer
  • if one of the inherited polyp syndromes: almost 100% risk of developing colon cancer, up to 5% of colon ca comes from one of these syndromes
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4
Q

what are the sx of colon polyps?

A
  • generally asx

- may see constipation, flatulence, and rectal bleeding

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5
Q

what are secondary complications of colon polyps?

A

iron deficient anemia

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6
Q

what are dx studies that can be done if suspicious of polyps?

A
  • stool guiac
  • barium enema, flexible sigmoidoscopy, and colonoscopy
  • histological evaluation
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7
Q

what does histological evaluation help you determine if pt has polyps?

A

dysplasia: hyperplastic polyps have the lowest risk of dysplasia

tubular polyps are at an increased risk

villous polyps carry the highest risk of malignancy

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8
Q

what are the 3 classifications of polyps?

A

hyperplastic, tubular, and villous

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9
Q

how are polyps tx?

A

depends on the size and histology

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10
Q

what should tx be if large and dysplastic polyps?

A

removed w/ subsequent follow ups

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11
Q

what about a single distal hyperplastic polyp?

A

same recommendation of every 10 years as someone w/o polyps

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12
Q

what about multiple hyperplastic polyps, hyperplastic polyps at sites rather than distal, or tubular polyps?

A

require a 5 year follow up

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13
Q

what about villous polyps?

A

require follow up colonoscopy at 3 years

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14
Q

what if a pt has family members wi/ familial polyposis syndrome?

A

evaluated every 1-2 years beginning at age 10-12 yo

-elective colectomy may be an option for high risk individuals

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15
Q

what age group is mostly likely to be diagnosed with colon cancer?

A

pts over 50

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16
Q

what are risk factors for colon cancer?

A

IBD (more UC than Crohn’s)

family history of colon cancer or polyps

personal hx of polyps

hereditary polyposis syndromes:Familial polyposis, Gardner’s Syndrome, Turcot’s Syndrome (bascially 100% risk of developing this dz)

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17
Q

what is hereditary nonpolyposis colorectal cancer?

A

aka lynch syndrome: leads to an extremely high risk of colon cancer: autosomal dominant that accounts for 3% of colon cancer

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18
Q

what lifestyle features are related to colon cancer

A 
Low fiber diet
High fat diet
Alcohol (beer) intake
Obesity
Prolonged/high consumption of red meat or processed meat
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19
Q

what is the prognosis for colon cancer?

A

good, in early dz

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20
Q

what is Duke A or stage 1?

A

only mucosa involvement

5 yr survival rate is 90%

21
Q

what is duke B or stage II colon cancer?

A

penetration through the wall or involvment of regional lymph nodes

5 year: 70-80%

22
Q

what is Duke C or Stage III?

A

metastasis: lymph node postitive

5 year: 5%

23
Q

what is Duke D or Stage 4?

A

distant metastases

5 year: 5%

24
Q

what are clinical features of colon cancer?

A

-slow growing, and sx often appear late int he dz:
abdominal pain, change in bowel habits, occult bleeding (stool size and shape, blood), intestinal obstruction

*pencil thin stools

25
Q

what are features of right sided colon lesions?

A

chronic blood loss and iron deficiency anemia

obstruction is uncommon

26
Q

what are left sided colon lesions features?

A

circumferential, causing change in bowel habits and obstructive symptoms

27
Q

what are secondary clincal features of colon cancer?

A

fatigue and weakness secondary to anemia

28
Q

are the diagnostic studies for colon cancer

A
  • FOBT
  • CEA
  • LFTs
  • CBC (microcytic anemia)
  • colonoscopy
29
Q

what is the most common site of colon cancer metastses?

A

the liver, so check LFTs

30
Q

what is CEA?

A

(Carcinoembryonic Antigen): Colon cancer tumor marker. Can be high in other circumstances: tobacco use, IBD, alcoholic liver disease. Therefore, not used for screening.

31
Q

what is used to checkfor metastses?

A

CT of CXR

32
Q

what is the colonoscopy recommendations?

A

Beginning at age 50 and repeated every 10 years in average-risk patients
Screening in African Americans should begin at age 45
If personal history of colon polyps, every 5 years
If a first-degree family member has had CRC, screening should start at age 50, or 10 years before age of diagnosis, which ever is younger; and this should be repeated every 5 years.

33
Q

what is the treatment for colon cancer?

A

surgical resection that is accompanies by chemo in stages III or higher

34
Q

celiac disease?

A

inflammation of small bowel secondary ot he ingestion of gluten-containing foods such as wheat, rye, anc barley leading to malabsorption

35
Q

clinical features of celiac dz?

A
  • highly variable

- D, steatorrhea, flatulence, weight loss, wkns, abdominal distenstion

36
Q

what can older pts with celiac dz present with?

A

Fe deficiency, coagulopathy, hyopcalcemia

37
Q

what dx studies can be done for celiac dz?

A

IgA antiendomysial (EMA) and atnitissue transglutaminase (anti tTG) are serologic screening test

38
Q

what needs to be done to confimr dx of celiac dz?

A

small bowel biopsy

39
Q

how is celiac dz treated?

A

involes gluten free diet, may also need lactose free diet

  • vitamin supplementation: iron, vit B 12, folic acid, ca, vit d
  • prednisone in refractory cases
40
Q

diverticular dz?

A 
diverticulosis= large outpouching of the mucosa in the colon
diverticulitis= inflammation of the diverticula caused by obstruction
41
Q

how can diverticulitis be prevented?

A

high-fiber diet and avoidance of obstructing or constipated foods

42
Q

what is the presentation of diverticulitis?

A

sudden-onset abdomnial pain, usually in LLQ or suprpubic region +/- fever

+altered bowel movement like N, V

43
Q

how may diverticular bleeding present?

A

sudden-onset, large volume hematochezia that can resolve spontaneoulsy

44
Q

dx of diverticulitis?

A

occult stool: WBC
plain film xray to rule out free air
avoid barium enema

45
Q

tx of diverticulites

A

broad spectum abx: cipro, metronidazole, bactrim , augment, moxifloxacin

46
Q

how does chronic ischemic bowel dz present?

A

abdominal angina, w/ pain occuring 10-30 mins after eating, relieved by squatting or lying down

PE normal

47
Q

what part of the bowel is intestinal infarct more common?

A

small bowel- can lead to shock!

48
Q

what can cause acute mesenteric ishcmeia?

A

arterial embolus, arterial thrombosis,, venous thrombosis

49
Q

how is ischemic bowel dz diagnosis?

A

plain film radiograpy and CT to r/o toher causes

duplex US that may be confriemd by angiography

GI (inpt) (16 decks)

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