Gi Tumors; Gi D/os In Elderly

Front 1

What is the ras family?

Back 1

GTP binding proteins that are signal transducing oncogenes. If they get mutated, there can be a gain of function.

Front 2

Germline mutations in these underlie all known inherited cancer syndromes

Back 2

Tumor suppressor genes (p53)

Front 3

What is the function of the Adenomatous Polyposis Coli (APC) gene product?

Back 3

Causes degradation of beta-catenin, which normally enters the nucleus and activates transcription of growth-promoting genes.

Front 4

What is microsatellite instability?

Back 4

The appearance of abnormally long or short microsatellites in an individual's DNA is referred to as microsatellite instability. Microsatellite instability (MSI) is a condition manifested by damaged DNA due to defects in the normal DNA repair process.

Front 5

T/F Microsatellites have an intrinsic tendency to be copied inaccurately and therefore require the DNA mismatch repair system to work.

Back 5

T

Front 6

What is a DNA chance that occurs in the smallest adenomas and may represent first step?

Back 6

hypomethylation (leading to overactivity)

Front 7

Mutations in APC gene are linked to what?

Back 7

Found in small adenomas, linked to dysregulated proliferation.

Front 8

Kras oncogene mutations linked to what?

Back 8

Arise during the adenomatous stage and inactivate the portions of the protein involved in halting signal transduction

Front 9

Mutations in p53: how does it relate to colon cancer?

Back 9

Interferes with ability of p53 protein to modify gene expression in nucleus. Coincides with transition to malignancy.

Front 10

________ arises from germline mutations of the APC gene and is inherited in an autosomal dominant manner. When present, it virtually guarantees development of colon cancer.

Back 10

Familial Adenomatous Polyposis (FAP)

Front 11

Clinical characteristics of FAP

Back 11

hundreds to thousands of colonic adenomatous polyps at an early age. Will develop colon cancer unless colon is removed.

Front 12

What is Gardner syndrome?

Back 12

Variant of FAP. Has typical GI involvement, but also extraintestinal lesions including osteoma, odontomas, epidermoid cysts, fibromas, desmoid tumors.

Front 13

What is Turcot syndrome?

Back 13

Another variant of FAP where patients also develop CNS malignancies, especially medulloblastoma.

Front 14

What is Attenuated Polyposis Coli (AAPC)?

Back 14

Variant of FAP where development of colon cancer isn't inevitable.

Front 15

_____ arises from inherited mutations in any one of six mismatch repair genes, although mutations in only two of them (hMLH1 and 2) account for >95% of them.

Back 15

Hereditary Nonpolyposis Colorectal Cancer (HNPCC)

Front 16

hMLH1 and hMLH2 are associated with what disease?

Back 16

Hereditary Nonpolyposis Colorectal Cancer (HNPCC)

Front 17

How is HNPCC inherited?

Back 17

autosomal dominant

Front 18

___% of colon cancer cancers are hereditary (HNPCC, FAP)

Back 18

5

Front 19

HNPCC is aka

Back 19

Lynch Syndrome

Front 20

polyp dwell time: defn

Back 20

time it takes for a single adenoma to gross invasive cancer.

About 10 years.

Front 21

Most colorectal cancers arise from _____ polyps

Back 21

adenomatous

Front 22

Characteristics of tumors with microsatellite instability:
Where located?

Back 22

Generally in proximal colon

Front 23

metachronous: defn

Back 23

a time interval between detection of the first lesion and detection of a subsequent primary lesion

Front 24

hamartoma: defn

Back 24

normal tissue elements growing in a disorganized fashion

Front 25

What is MYH-associated polyposis (MAP?)

Back 25

Resembles FAP in absence of family history. It's inherited in autosomal recessive fashion.

Front 26

Lynch syndrome: Amsterdam Criteria (3:2:1 rule)

Back 26

At least 3 family members must have it.

2 or more generations

1 case a first-degree relative (no skipping generations)

One case before age 50.

Front 27

name 4 colon cancer screening tests

Back 27

Fecal Occult Blood Test (FOBT)

Sigmoidoscopy

Double Contrast Barium Enema

Colonoscopy

Front 28

name 4 factors that put someone into a high risk group

Back 28

Positive Family History
Inherited polyp syndromes
Inflammatory Bowel Disease
Previous adenoma/ Cancer

Front 29

What is a lower risk family history?

Back 29

Single first degree relative diagnosed age >60 with cancer or adenomas.
Two second degree relatives with CRC

Front 30

For someone whose father had CRC at age 65, when should screening begin?

Back 30

Age 40 (lower risk family history)

Front 31

What is a high risk family history?

Back 31

Single first degree relative diagnosed with cancer or adenomas at age < 60.
2 first degree relatives with colon cancer at any age.

Front 32

For someone whose mother and sister both had CRC at age 50 and 34, respectively, when should colonoscopy screening begin?

Back 32

Begin screening at age 40 or 10 years younger than the earliest diagnosis in the family.
Colonoscopy every 5 years.

Front 33

What are risk factors for CRC development in a person with IBD?

Back 33

extent of colonic involvement

duration of disease

Front 34

Colonoscopic Surveillance every ___ years is recommended for individuals with IBD

Back 34

1-3

Front 35

For individuals with a personal history of CRC, Clearance of the remainder of the colon at or around the time of resection, followed by colonoscopy at ___ years after curative resection, then at ___ year intervals to detect metachronous neoplasia.

Back 35

3; 3-6

Front 36

Virtual colonoscopy: pros and cons

Back 36

Pros: Non-invasive, no sedation, better safety profile than colonoscopy

Cons: Still requires prep and is uncomfortable

Front 37

2 most common risk factors for colon cancer

Back 37

1) Age
2) family history

Front 38

The screening of at-risk individuals usually involves colonoscopy initiated ____ years before the index case was diagnosed with colon cancer

Back 38

10

Front 39

What is the next step for a + FOBT?

Back 39

colonoscopy

Front 40

What is the problem with sigmoidoscopy?

Back 40

only detects 1/2 of CRC or polyps

only goes to splenic flexus

Front 41

T/F the only option recommended for high-risk groups is colonoscopy

Back 41

T

Front 42

T/F Drug reactions are extremely important to consider in elderly patients' GI complaints

Back 42

T

Front 43

hyposmia: defn and important

Back 43

decrease in olfaction, occurs in up to 40% of people. may affect appetite

Front 44

Xerostomia: defn and importance

Back 44

dry mouth. very common medication side effect.

adversely effects swallowing.

Anticholinergic agents of all types notorious for this.

Front 45

What is the difference between oropharyngeal dysphagia and esophageal dysphagia?

Back 45

oropharyngeal : difficulty initiating the act of swallowing, patient (especially if demented) may "forget" how to swallow.

Esophageal: difficulty in esophageal passage of food bolus due to mechanical obstruction, problems swallowing solids manifest first.

Front 46

Common causes of esophageal dysphagia

Back 46

1) extrinsic compression (thyroid, spine, other masses)

2) Dysmotility (often intermittent symptoms)

Front 47

What type of dysphagia is the kind caused by stroke?

Back 47

Oropharnygeal.

Front 48

How to assess swallowing function?

Back 48

1) History: ask about symptoms of coughing, sensation of food stuck in throat, respiratory sx, nutritional and cognitive state

2) PE:watch them swallow, speech coordination

Generally SLP evaluates these patients.

Front 49

Where is NG tube feeding a problem?

Back 49

LTC facilities
Patients’ homes

Front 50

When are PEG tubes placed?

Back 50

When the patient is in a nursing home and can't otherwise eat (nursing homes won't accept NG tube patients)

Front 51

Pill esophagitis: defn

Back 51

pills getting stuck and burning the esophagus

Can present with sudden pain with swallowing (odynophagia)

NSAIDs especially

Front 52

Pill esophagitis: prevention

Back 52

swallow pills while upright with >150 mL of liquid

Front 53

T/F There is an increased risk of GERD in elderly

Back 53

T, even though there's no increase in acid or pepsin production

Front 54

What is the cause and implication of Diminished mucosal capacity to resist damage in elderly?

Back 54

Cause:
Decreased barrier function

Implication:
Increased risk of peptic ulcer disease (PUD)

Front 55

When is occult cholecystitis a concern in elderly?

Back 55

Hospitalized and dehydrated which results from changes in bile equilibrium --> sludging --> obstruction --> infection

Front 56

What should be avoided in the elderly to prevent stomach problems?

Back 56

NSAIDs

Front 57

What are small intestine changes in elderly?

Back 57

Possible decreased absorption of vitamin D. Many elders are vitamin D deficient, which contributes to reduced bone density.

Front 58

Think of what as cause for unexplained fever, abdominal pain, anorexia in hospitalized elderly?

Back 58

Secondary onset of cholecystitis in hospitalized elders. Unclear why this happens.

Front 59

What are age-associated rectal changes?

Back 59

Increased compliance and decreased sensitivity mean more fecal material is needed before urge arises.

Front 60

Constipation: defn

Back 60

<2 BMs/week + straining when pewping, hard stools, feeling of incomplete evacuate at least 25% of time

Front 61

Which muscle:
tonically active "involuntary" smooth muscle. Sympathetics stimulate, parasymp inhibits

Back 61

Internal sphincter

Front 62

Which muscle:
Skeletal muscle, blends with puborectalis muscle (part of pelvis floor), both voluntary and reflex control via the pudendal nerve (S2-4)

Back 62

External sphincter

Front 63

Prevention of constipation:

Back 63

Non pharmacologic: water, fiber, exercise, timing (take advantage of GC reflex)

Pharmacologic: many laxative choices

Front 64

Treatment of impaction

Back 64

Manual disimpaction - if stool is distal

Rectal suppository - if mild

Enema

Front 65

Two peak incidence age ranges of Ulcerative Colitis

Back 65

Peak incidence between ages 15 and 30
Second peak between ages 50 and 80

Front 66

What are important sx that warrant further investigation in tx of impaction?

Back 66

Vomiting

Fever

Abdominal Pain

Bloody Diarrhea

Co-morbidities

Age

Front 67

evidence of volume contraction

Back 67

orthostatic hypotension

poor skin turgor

low urine output (oliguria)

Front 68

Blood stool is more associated with (UC, Crohn's)

Back 68

UC

Front 69

Common meds taken by elderly that can cause diarrhea

Back 69

Mg-containing meds (for upset stomach, like mylanta); Metformin; Colchicine

Front 70

Atherosclerosis can cause what urgent bowel problem?

Back 70

Ischemic colitis

Front 71

T/F probiotics may reduce C. diff colitis

Back 71

T

Front 72

Diverticulosis Prevalence is __% by 70 years, but most don't develop symptoms.

Back 72

50

Front 73

Tx for Diverticulosis

Back 73

Fiber

Front 74

Degenerative change in submucosal veins and capillaries

Most common in right colon

Back 74

Colonic angiodysplasia

Front 75

What symptoms can Colonic angiodysplasia cause?

Back 75

Bleeding, usually recurrent and painless. But the bleeding can be severe.

Front 76

Where are most diverticulae located?

Back 76

Sigmoid colon

Front 77

Most common complication of diverticulosis

Back 77

Diverticulitis - infection

Front 78

Symptoms of Diverticulitis in middle age, how does it change with aging?

Back 78

Pain and Fever, but Fever may not be present in elderly

Front 79

Treatment of Diverticulitis

Back 79

Abx and IV fluids

Front 80

What is a typical ischemic colitis patient?

Back 80

Elderly with acute LLQ pain, blood diarrhea, h/o atherosclerosis or CAD

Front 81

Which part of bowel is most vulnerable to ischemic colitis?

Back 81

Splenic flexure

Front 82

Prevalence of adenomas in people >60 yo

Back 82

50%

Front 83

T/F CRC may present as Fe deficiency anemia

Back 83

T

Front 84

When is screening for CRC ok to be discontinued?

Back 84

Recommended until age 70 or longer if life expectancy >10 years

Front 85

How is UC presentation different in elderly?

Back 85

1) May be less extensive than in young

2) May present as severe attack with megacolon