Step-Up To Medicine Ch 3 Diseases Of The Gi System

Front 1

Most sensitive and specific test for colorectal cancer

Back 1

Colonoscopy

Front 2

most common site of distant spread for colorectal cancer

Back 2

liver via hematogenous

Front 3

what is Gardner's syndrome

Back 3

colon Polyps plus osteomas, dental abnormalities, benign soft tissue tumors, desmoid tumors, sebaceous cysts

Front 4

what is Turcot's syndrome

Back 4

Polyps plus cerebellar medulloblastoma or glioblastoma multiforme

Front 5

what is Peutz-Jeghers

Back 5

GI hamartomas (low malignant potential), Pigmented spots around lips, oral mucosa, face, genitalia, and palmar surfaces

Front 6

types of Hereditary nonpolyposis CRC

Back 6

* Lynch syndrome I (site-specific CRC)—early onset CRC; absence of antecedent multiple polyposis
* Lynch syndrome II (cancer family syndrome)—all features of Lynch I plus increased number and early occurrence of other cancers (e.g., female genital tract, skin, stomach, pancreas, brain, breast, biliary tract)

Front 7

Dukes' Staging

Back 7

Staging for Colorectal Cancer
* Stage A limited to muscularis mucosa
* Stage B past muscularis mucosa without node involvement
o B1: into submucosa/muscularis propria
o B2: through bowel wall
o B3: into adjacent structures
* Stage C positive regional lymph nodes
* Stage D distant metastases

Front 8

most common presenting symptom of CRC

Back 8

Abdominal pain because CRC is the most common cause of large bowel obstruction in adults.

Front 9

in CRC where is obstrucion the most likely

Back 9

on left side because on the right side the diameter is larger

Front 10

clinical features of right side CRC

Back 10

NO Obstruction
melena
NO change in bowel habits
Triad of anemia, weakness, RLQ mass (occasionally) is present.

Front 11

clinical features of left side CRC

Back 11

obstruction
Change in bowel habits
Hematochezia

Front 12

Rectal cancer vs colon cancer prognosis

Back 12

Rectal cancer has a higher recurrence rate and a lower 5-year survival rate than colon cancer.

Front 13

use of CEA

Back 13

* Postoperative CEA <2 to 3 is associated with excellent prognosis.
* A subsequent increase in CEA is a sensitive marker of recurrence.
* Often, second-look operations are based on high CEA levels postresection.
* Very high elevations of CEA suggest liver involvement.

Front 14

Adjuvant therapy for colon versus rectal cancer

Back 14

* colon cancer: Postoperative chemo (5-FU and leucovorin) indicated. Radiation therapy is not effective.
* rectal cancer: Both chemotherapy (5-FU) and radiation therapy postoperatively are used.

Front 15

F/U tests after CRC

Back 15

# Annual CT scan of abdomen/pelvis and CXR for up to 5 years
# Colonoscopy at 1 year and then every 3 years

Front 16

Juvenile polyps

what and what to do

Back 16

Juvenile polyps (typically in children younger than 10 years) are highly vascular and common, so they should be removed.

Front 17

Polyps prognosis wrt shape

Back 17

sessile (flat, more likely to be malignant) versus pedunculated (on a stalk)

Front 18

Complications of diverticulitis

Back 18

* Abscess formation
* Colovesical fistula
* Obstruction—due to chronic inflammation
* Free colonic perforation—uncommon but catastrophic (leads to peritonitis)

Front 19

diverticulosis clinical features

Back 19

Usually asymptomatic 80-90%

Vague LLQ discomfort, bloating, constipation/diarrhea may be present
Painless rectal bleeding

Front 20

Diverticulitis Diagnostic tests

Back 20

CT scan (abdomen and pelvis) with oral and IV contrast is the test of choice; it

Front 21

Treatment of diverticulitis

Back 21

Initial episode—Use IV antibiotics, bowel rest (NPO), IV fluids

Second and subsequent episodes—Surgery is recommended

Front 22

DX of Diverticulosis vs Diverticulitis

Back 22

* Diverticulosis—barium enema is test of choice
* Diverticulitis—CT scan is test of choice (barium enema and colonoscopy contraindicated)

Front 23

Dx of Angiodysplasia of the Colon

Back 23

Diagnosed by colonoscopy (preferred over angiography)

Front 24

what is Angiodysplasia of the Colon

Back 24

Tortuous, dilated veins in submucosa of the colon (usually proximal) wall

Front 25

association with Angiodysplasia of the Colon

Back 25

As many as 25% of patients with bleeding arteriovenous malformations have aortic stenosis.

Front 26

causes of Acute Mesenteric Ischemia

Back 26

# Arterial embolism (50% of cases):
# Arterial thrombosis (25% of cases)
# Nonocclusive mesenteric ischemia (20% of cases)
# Venous thrombosis (<10% of cases)

Front 27

The overall mortality rate for Acute Mesenteric Ischemia

Back 27

for all types is about 60% to 70%. If bowel infarction has occurred, the mortality rate can exceed 90%.

Front 28

Differences in presentation of types of acute mesenteric ischemia

Back 28

* Embolic—sudden and painful
* Arterial thrombosis—gradual and less severe
* Nonocclusive ischemia— typically occurs in critically ill patients
* Venous thrombosis— may be present for several days or even weeks

Front 29

main Clinical features for Acute Mesenteric Ischemia

Back 29

abdominal pain disproportionate to physical findings.

Front 30

Dx of Acute Mesenteric Ischemia

Back 30

* Mesenteric angiography is the definitive diagnostic test.
* plain film of the abdomen to exclude other causes
* "Thumbprinting" on barium enema due to thickened edematous mucosal folds

Front 31

Tx of Acute Mesenteric Ischemia

Back 31

-IV fluids and broad-spectrum antibiotics
-Direct intra-arterial infusion of papaverine (vasodilator) , throbolytics
-if venous give heparin
-surgery

Front 32

what to avoid in mesenteric ischemia

Back 32

vasopressors because they worsen the ischemia.

Front 33

Chronic Mesenteric Ischemia

Back 33

# Caused by atherosclerotic occlusive disease
# Abdominal angina—dull pain, typically postprandial w/ weight loss
# Mesenteric arteriography confirms the diagnosis.
# Surgical revascularization

Front 34

Ogilvie's Syndrome

what

Back 34

signs, symptoms, and radiographic evidence of large bowel obstruction are present, but there is no mechanical obstruction.

Front 35

Ogilvie's Syndrome

Tx

Back 35

1.stop offending agent
2. decompression w/ enema NG or colonoscopy
3.surgical decompression

Front 36

when to decompress colon immediately.

Back 36

Whenever there is colonic distention and when the colon diameter exceeds 10 cm,

Front 37

most frequently implicated antibiotics in Pseudomembranous Colitis

Back 37

clindamycin, ampicillin, and cephalosporins.

Front 38

Complications of severe pseudomembranous colitis

Back 38

* Toxic megacolon
* Colonic perforation
* Anasarca, electrolyte disturbances

Front 39

type of diarrhea in pseudomembranous colitis

Back 39

Profuse watery diarrhea (usually no blood or mucus)

Front 40

Dx of pseudomembranous colitis

Back 40

1 C. difficile toxins in stool
2 Flexible sigmoidoscopy
3 Abdominal radiograph (to rule out toxic megacolon and perforation)
4 Leukocytosis (very common)

Front 41

Tx of pseudomembranous colitis

Back 41

-Stop the Ab
-Metronidazole (unless baby or preggers)
-vanc is flagyl alternative
-Cholestyramine may be used as an adjuvant treatment to improve diarrhea.

Front 42

what is a lab to check if acute mesenteric ischemia is suspected

Back 42

Lactate because there can be lactic acidosis

Front 43

who gets cecal volvulus

Back 43

is due to congenital lack of fixation of the right colon and tends to occur in younger patients.

Front 44

clinical features of volvulus

Back 44

* Acute onset of colicky abdominal pain
* Obstipation
* Anorexia, nausea, vomiting

Front 45

Dx of volvulus

Back 45

Sigmoidoscopy—preferred diagnostic and therapeutic test for sigmoid volvulus

Front 46

volvulus and plain films

Back 46

* Sigmoid volvulus—Omega loop sign (or bent inner-tube shape) indicates a dilated sigmoid colon.
* Cecal volvulus (distention of cecum and small bowel)—Coffee bean sign indicates a large air-fluid level in RLQ.

Front 47

Tx for a cecal volvulus

Back 47

Emergent surgery

Front 48

wrt vovulus when to avoid a barium enema

Back 48

if strangulation is suspected!

Front 49

long term Tx for Esophageal/gastric Varices

Back 49

Give β-blockers as long-term therapy to prevent rebleeding.

Front 50

how to determin the cause of ascites

Back 50

Measure the serum ascites albumin gradient. If it is >1.1 g/dL, portal HTN is very likely. If <1.1 g/dL, portal HTN is unlikely, and other causes must be considered.

Front 51

Tx of Hepatic encephalopathy

Back 51

# Lactulose prevents absorption of ammonia.
# Neomycin (antibiotic): kills bowel flora,
# Diet: Limit protein to 30 to 40 mg/day.

Front 52

Etiologic agents of SBP

Back 52

* Escherichia coli (most common)
* Klebsiella
* Streptococcus pneumoniae

Front 53

Dx of SBP

Back 53

* WBC > 500, PMN > 250
* Positive ascites culture; culture-negative spontaneous bacterial peritonitis is common as well

Front 54

Tx of SBP

Back 54

Broad-spectrum antibiotic therapy: Give specific antibiotic once organism is identified.

Front 55

Tx of Coagulopathy from liver failure origin

Back 55

fresh frozen plasma.