small intestine and Colon Disorders

Question 1

how common are colon polyps?

Answer 1

very common- either benign or malignant

Question 2

are polyps heritable?

Answer 2

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

Question 3

what is the link btw colon polyps and colon cancer?

Answer 3

• 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

Question 4

what are the sx of colon polyps?

Answer 4

• generally asx

- may see constipation, flatulence, and rectal bleeding

Question 5

what are secondary complications of colon polyps?

Answer 5

iron deficient anemia

Question 6

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

Answer 6

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

Question 7

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

Answer 7

dysplasia: hyperplastic polyps have the lowest risk of dysplasia

tubular polyps are at an increased risk

villous polyps carry the highest risk of malignancy

Question 8

what are the 3 classifications of polyps?

Answer 8

hyperplastic, tubular, and villous

Question 9

how are polyps tx?

Answer 9

depends on the size and histology

Question 10

what should tx be if large and dysplastic polyps?

Answer 10

removed w/ subsequent follow ups

Question 11

what about a single distal hyperplastic polyp?

Answer 11

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

Question 12

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

Answer 12

require a 5 year follow up

Question 13

what about villous polyps?

Answer 13

require follow up colonoscopy at 3 years

Question 14

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

Answer 14

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

-elective colectomy may be an option for high risk individuals

Question 15

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

Answer 15

pts over 50

Question 16

what are risk factors for colon cancer?

Answer 16

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)

Question 17

what is hereditary nonpolyposis colorectal cancer?

Answer 17

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

Question 18

what lifestyle features are related to colon cancer

Answer 18

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

Question 19

what is the prognosis for colon cancer?

Answer 19

good, in early dz

Question 20

what is Duke A or stage 1?

Answer 20

only mucosa involvement

5 yr survival rate is 90%

Question 21

what is duke B or stage II colon cancer?

Answer 21

penetration through the wall or involvment of regional lymph nodes

5 year: 70-80%

Question 22

what is Duke C or Stage III?

Answer 22

metastasis: lymph node postitive

5 year: 5%

Question 23

what is Duke D or Stage 4?

Answer 23

distant metastases

5 year: 5%

Question 24

what are clinical features of colon cancer?

Answer 24

-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

Question 25

what are features of right sided colon lesions?

Answer 25

chronic blood loss and iron deficiency anemia obstruction is uncommon

Question 26

what are left sided colon lesions features?

Answer 26

circumferential, causing change in bowel habits and obstructive symptoms

Question 27

what are secondary clincal features of colon cancer?

Answer 27

fatigue and weakness secondary to anemia

Question 28

are the diagnostic studies for colon cancer

Answer 28

- FOBT - CEA - LFTs - CBC (microcytic anemia) - colonoscopy

Question 29

what is the most common site of colon cancer metastses?

Answer 29

the liver, so check LFTs

Question 30

what is CEA?

Answer 30

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

Question 31

what is used to checkfor metastses?

Answer 31

CT of CXR

Question 32

what is the colonoscopy recommendations?

Answer 32

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.

Question 33

what is the treatment for colon cancer?

Answer 33

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

Question 34

celiac disease?

Answer 34

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

Question 35

clinical features of celiac dz?

Answer 35

- highly variable | - D, steatorrhea, flatulence, weight loss, wkns, abdominal distenstion

Question 36

what can older pts with celiac dz present with?

Answer 36

Fe deficiency, coagulopathy, hyopcalcemia

Question 37

what dx studies can be done for celiac dz?

Answer 37

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

Question 38

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

Answer 38

small bowel biopsy

Question 39

how is celiac dz treated?

Answer 39

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

Question 40

diverticular dz?

Answer 40

``` diverticulosis= large outpouching of the mucosa in the colon diverticulitis= inflammation of the diverticula caused by obstruction ```

Question 41

how can diverticulitis be prevented?

Answer 41

high-fiber diet and avoidance of obstructing or constipated foods

Question 42

what is the presentation of diverticulitis?

Answer 42

sudden-onset abdomnial pain, usually in LLQ or suprpubic region +/- fever +altered bowel movement like N, V

Question 43

how may diverticular bleeding present?

Answer 43

sudden-onset, large volume hematochezia that can resolve spontaneoulsy

Question 44

dx of diverticulitis?

Answer 44

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

Question 45

tx of diverticulites

Answer 45

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

Question 46

how does chronic ischemic bowel dz present?

Answer 46

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

Question 47

what part of the bowel is intestinal infarct more common?

Answer 47

small bowel- can lead to shock!

Question 48

what can cause acute mesenteric ishcmeia?

Answer 48

arterial embolus, arterial thrombosis,, venous thrombosis

Question 49

how is ischemic bowel dz diagnosis?

Answer 49

plain film radiograpy and CT to r/o toher causes duplex US that may be confriemd by angiography