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Flashcards in Step up to Med Deck (23):
1

Colorectal cancer

most all arise from adenomas
liver is most common site of distant spread
most common cause of large bowel obstruction in adults

2

Colorectal staging

Duke's staging
A- muscularis mucosa only (90% 5 yr)
B- past muscularis mucosa, no nodes (70%)
C- positive regional nodes (40%)
D- distant mets (5%)

3

Colorectal cancer risk factors

age (>50)
Adenomatous polyps (villous)
Prior CRC
Inflammatory bowel disease (UC > Chron's)
Family hx
Dietary
Polyposis syndromes

4

Familial adenomatous polyposis

autosomal dominant
colon always involved, duodenum (90%)
CRC risk 100% by 20's-30's
prophylactic colectomy

5

Gardner's syndrome

Polyps + osteomas, dental abnormalities, benign soft tissue tumors, desmoid tumors, sebaceous cysts
CRC risk 100% by 40

6

Turcot's syndrome

autosomal recessive
polyps + neuro tumor (medulloblastoma, glioblastoma multiforme)

7

Peutz-Jaghers

single or multiple hamartomas throughout GI tract
pigmented spots around lips, oral mucusa, face
intussusception or GI bleeding may occur

8

Familial juvenile polyposis coli

presents in childhood, small risk CRC

9

Hereditary non-polyposis CRC

Lynch syndrome I- early onset CRC, absent multiple polyposis
Lynch synd II- as above + other cancers

10

Diverticulosis

caused by increased intraluminal pressure
most commonly in sigmoid colon
LLQ discomfort, bloating, constipation/diarrhea

Dx: barium enema
Complications: painless rectal bleeding (40%)

11

Diverticulitis

impacted feces in diverticulum
fever, LLQ pain, leukocytosis

Dx: CT scan with contrast
Tx: initial- IV abx, bowel rest, iV fluids
Multiple episodes- surgery

12

Abx with frequent association to pseudomembranous colitis

clindamycin
ampicillin
cephalosporins

13

Child's classification

A- no ascites, bili < 2, no enceph, good nutrition, albu > 3.5
B- controlled ascites, bili 2-2.5, minimal enecph, good nutrition, albu 3-3.5
C- uncontrolled ascites, billi >3, sever enceph, poor nutrition, albu < 3

14

Wilson's disease

deficiency of ceruloplasmin, can't excrete copper

Tx: D-penicillamine, chelating agent

15

asymptomatic elevation of LFTs

Autoimmune hepatitis
hep B
hep C
Drugs or toxins
Ethanol
Fatty liver (triglyceridemia)
Growths (tumors)
Hemodynamic disorders (CHF)
Iron (hemochromatosis), copper (wilsons), AAT deficiency

16

Boa's sign

referred right subscapular pain of biliary colic

17

Charcot's triad

RUQ pain
jaundice
fever

cholangitis- only in 50-70% pts

18

Reynolds' pentad

Charcot's triad + septic shock and altered mental status

19

antimitochondrial antibodies (AMAs)

positive in 90-95% of primary biliary cirrhosis
98% specificity

20

Ranson's criteria

Assess acute pancreatitis

Glucose > 200
Age > 55
LDH > 350
AST > 250
WBC > 16,000

21

Small bowel obstruction

Dehydration is key
Intestinal distention causes reflex vomiting, increased secretions proximal to obs, decreased absorption -> hypochloremia, hypokalemia, metabolic alkalosis

22

Extraintestinal manifestations of IBD

Eye- Episcleritis, Anterior uveitis
Skin- Erythema nodosum (CD), Pyoderma gangrenosum (UC)
Arthritis- Migratory monoarticular arthritis, Ankylosing spondylitis, Sacroiliitis
Thromboembolic-hypercoagulable
Idiopathic thrombocytopenic purpura
Osteoporosis
Gallstones (CD, ileal involvement)
Sclerosing cholangitis (UC)

23

Sulfasalazine

main treatment for IBD (UC, CD)
Mesalamine (5-ASA) is active component (metabolite from intestinal bacteria breakdown)