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55 Cards in this Set

  • Front
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Most sensitive and specific test for colorectal cancer
Colonoscopy
most common site of distant spread for colorectal cancer
liver via hematogenous
what is Gardner's syndrome
colon Polyps plus osteomas, dental abnormalities, benign soft tissue tumors, desmoid tumors, sebaceous cysts
what is Turcot's syndrome
Polyps plus cerebellar medulloblastoma or glioblastoma multiforme
what is Peutz-Jeghers
GI hamartomas (low malignant potential), Pigmented spots around lips, oral mucosa, face, genitalia, and palmar surfaces
types of Hereditary nonpolyposis CRC
* 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)
Dukes' Staging
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
most common presenting symptom of CRC
Abdominal pain because CRC is the most common cause of large bowel obstruction in adults.
in CRC where is obstrucion the most likely
on left side because on the right side the diameter is larger
clinical features of right side CRC
NO Obstruction
melena
NO change in bowel habits
Triad of anemia, weakness, RLQ mass (occasionally) is present.
clinical features of left side CRC
obstruction
Change in bowel habits
Hematochezia
Rectal cancer vs colon cancer prognosis
Rectal cancer has a higher recurrence rate and a lower 5-year survival rate than colon cancer.
use of CEA
* 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.
Adjuvant therapy for colon versus rectal cancer
* 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.
F/U tests after CRC
# Annual CT scan of abdomen/pelvis and CXR for up to 5 years
# Colonoscopy at 1 year and then every 3 years
Juvenile polyps

what and what to do
Juvenile polyps (typically in children younger than 10 years) are highly vascular and common, so they should be removed.
Polyps prognosis wrt shape
sessile (flat, more likely to be malignant) versus pedunculated (on a stalk)
Complications of diverticulitis
* Abscess formation
* Colovesical fistula
* Obstruction—due to chronic inflammation
* Free colonic perforation—uncommon but catastrophic (leads to peritonitis)
diverticulosis clinical features
Usually asymptomatic 80-90%

Vague LLQ discomfort, bloating, constipation/diarrhea may be present
Painless rectal bleeding
Diverticulitis Diagnostic tests
CT scan (abdomen and pelvis) with oral and IV contrast is the test of choice; it
Treatment of diverticulitis
Initial episode—Use IV antibiotics, bowel rest (NPO), IV fluids

Second and subsequent episodes—Surgery is recommended
DX of Diverticulosis vs Diverticulitis
* Diverticulosis—barium enema is test of choice
* Diverticulitis—CT scan is test of choice (barium enema and colonoscopy contraindicated)
Dx of Angiodysplasia of the Colon
Diagnosed by colonoscopy (preferred over angiography)
what is Angiodysplasia of the Colon
Tortuous, dilated veins in submucosa of the colon (usually proximal) wall
association with Angiodysplasia of the Colon
As many as 25% of patients with bleeding arteriovenous malformations have aortic stenosis.
causes of Acute Mesenteric Ischemia
# Arterial embolism (50% of cases):
# Arterial thrombosis (25% of cases)
# Nonocclusive mesenteric ischemia (20% of cases)
# Venous thrombosis (<10% of cases)
The overall mortality rate for Acute Mesenteric Ischemia
for all types is about 60% to 70%. If bowel infarction has occurred, the mortality rate can exceed 90%.
Differences in presentation of types of acute mesenteric ischemia
* 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
main Clinical features for Acute Mesenteric Ischemia
abdominal pain disproportionate to physical findings.
Dx of Acute Mesenteric Ischemia
* 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
Tx of Acute Mesenteric Ischemia
-IV fluids and broad-spectrum antibiotics
-Direct intra-arterial infusion of papaverine (vasodilator) , throbolytics
-if venous give heparin
-surgery
what to avoid in mesenteric ischemia
vasopressors because they worsen the ischemia.
Chronic Mesenteric Ischemia
# Caused by atherosclerotic occlusive disease
# Abdominal angina—dull pain, typically postprandial w/ weight loss
# Mesenteric arteriography confirms the diagnosis.
# Surgical revascularization
Ogilvie's Syndrome

what
signs, symptoms, and radiographic evidence of large bowel obstruction are present, but there is no mechanical obstruction.
Ogilvie's Syndrome

Tx
1.stop offending agent
2. decompression w/ enema NG or colonoscopy
3.surgical decompression
when to decompress colon immediately.
Whenever there is colonic distention and when the colon diameter exceeds 10 cm,
most frequently implicated antibiotics in Pseudomembranous Colitis
clindamycin, ampicillin, and cephalosporins.
Complications of severe pseudomembranous colitis
* Toxic megacolon
* Colonic perforation
* Anasarca, electrolyte disturbances
type of diarrhea in pseudomembranous colitis
Profuse watery diarrhea (usually no blood or mucus)
Dx of pseudomembranous colitis
1 C. difficile toxins in stool
2 Flexible sigmoidoscopy
3 Abdominal radiograph (to rule out toxic megacolon and perforation)
4 Leukocytosis (very common)
Tx of pseudomembranous colitis
-Stop the Ab
-Metronidazole (unless baby or preggers)
-vanc is flagyl alternative
-Cholestyramine may be used as an adjuvant treatment to improve diarrhea.
what is a lab to check if acute mesenteric ischemia is suspected
Lactate because there can be lactic acidosis
who gets cecal volvulus
is due to congenital lack of fixation of the right colon and tends to occur in younger patients.
clinical features of volvulus
* Acute onset of colicky abdominal pain
* Obstipation
* Anorexia, nausea, vomiting
Dx of volvulus
Sigmoidoscopy—preferred diagnostic and therapeutic test for sigmoid volvulus
volvulus and plain films
* 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.
Tx for a cecal volvulus
Emergent surgery
wrt vovulus when to avoid a barium enema
if strangulation is suspected!
long term Tx for Esophageal/gastric Varices
Give β-blockers as long-term therapy to prevent rebleeding.
how to determin the cause of ascites
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.
Tx of Hepatic encephalopathy
# Lactulose prevents absorption of ammonia.
# Neomycin (antibiotic): kills bowel flora,
# Diet: Limit protein to 30 to 40 mg/day.
Etiologic agents of SBP
* Escherichia coli (most common)
* Klebsiella
* Streptococcus pneumoniae
Dx of SBP
* WBC > 500, PMN > 250
* Positive ascites culture; culture-negative spontaneous bacterial peritonitis is common as well
Tx of SBP
Broad-spectrum antibiotic therapy: Give specific antibiotic once organism is identified.
Tx of Coagulopathy from liver failure origin
fresh frozen plasma.