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22 Cards in this Set
- Front
- Back
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How is hereditary nonpolyposis colorectal cancer (HNPCC aka LYNCH syndrome) inherited and what causes it?
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Auto dominant
d/t defective DNA mismatch repair genes |
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What type of cancer (besides colon) are pts suffering from Lynch syndrome at an especially high risk for developing?
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Endometrium and ovary
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From what do most colon cancers arise?
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Adenomas (adenomatous polyps)
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What are the 2 molecular pathways responsible for the development of colon cancer?
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1) loss of tumor suppressor APC genes
2) Mutation of oncogene k-RAS and inactivation of tumor suppressor p53 |
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Patients with right colonic cancers are more likely to have what symptoms?
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Iron-deficiency anemia
+hemoccult - stool changes |
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Patients with left colonic cancers are more likely to have what symptoms?
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+ hemoccult stool
Change in bowel habits Crampy LLQ discomfort/tenesmus (d/t stimulation of bowel by the tumor) Pencil stools |
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A 55 yo patient comes in with complaints of chronic fatigue. It is determined that he has iron deficiency anemia. What is your next thought?
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He's got colon cancer until it's ruled out with a further workup
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What area of the colon is most at risk for developing diverticula?
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Sigmoid colon at the areas where blood vessels penetrate the full thickness of the bowel - this is the weakest spot in the bowel
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What symptoms would diverticulosis cause?
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+ hemoccult
gross bleeding painless |
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What is diverticulitis?
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An inflammed (d/t infection) diverticula that has been blocked off by a particle of food allowing the bacteria to proliferate
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What are the symptoms of diverticulitis?
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LLQ pain
fever increased PMNs +/- diarrhea - hemoccult (b/c b.v. is tamponaded by impacted debris) |
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What is the major concern with diverticulitis?
How is it treated? |
Abscess formation, bowel perforation, and/or sepsis that is potentially life-threatening
Ciprofloxacin and Metronidazole |
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What causes irritable bowel syndrome?
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dysregulation of the enteric nervous system where it activates and inhibits itself w/o regard to the autonomic nervous system
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What type of lesions are seen in Crohn's dz?
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Skip lesions
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What are the complications of Crohn's dz?
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Fistula, fissures, strictures
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If you have a patient do a barium swallow and see a + string sign on x-ray, what type of bowel dz do they have?
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Crohn's dz d/t strictures
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Where do the lesions for ulcerative colitis begin?
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At the rectum and progresses proximally to the ileocecal jxn
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What can be seen in UC where an area of regenerating mucous membrane is encircled by ulcer?
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Pseudopolyps
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Which dz has the lead pipe colon?
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UC (d/t fibrosis from long standing dz resulting in loss of haustra)
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Risk for which dz is decreased by smoking (Crohn's or UC)?
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UC
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What are the major concerns for UC?
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Toxic megacolon and high risk of colon cancer (vs. mod risk of colon cancer in Crohn's)
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Describe Crohn's and UC in terms of pain and bleeding:
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Crohn's: less bleeding, more pain (d/t transmural lesions irritating nerves)
UC: more bleeding, less pain (lesions are superficial) |
