3.07 Structural Disorders Colon Flashcards
Wha increases incidence of diverticulosis in Western societies?
Age
50% >80 yo
Most diverticulosis found incidentally on endoscopy or barium enema are?
asymptomatic
What is thought to contribute to diverticular disease?
high pressure and/or bad wall
How can diverticula be best seen?
barian enema or CT imaging
Treat meant for diverticula?
high fiber diet/supplements
Complications of diverticula?
lower GI bleeding, diverticulitis
What is the most common cause of lower GI bleeding in adults?
diverticulosis
“left-sided appendicitis”
used to describe the symptoms and clinical features that sign with a diverticulitis
What does macroscopic inflammation of the diverticulum seen in diverticulitis encompass?
inflammation, microperforation, macro perforation
Diverticulitis differentials?
perforated colon cancer
infectious colitis
IBD
ischemic colitis
appendicitis
G/U Problems
Diverticulitis tests?
leucocytosis, stool occult positive but frank bleeding unusual (hematochezia)
If people do not improve after a couple of days of empiric therapy with diverticulitis diagnosis (or severe), what next step?
CT scan abdomen
What will you see in a diverticulitis CT scan?
diverticulli, wall thickening, pericolic fat infiltrtation, abscess, extraluminal air, or contrast
Why are endoscopy and colonography contraindicated during initial acute attack stages?
risk of free perforation
Recommendation for mild diverticulitis with NO peritoneal signs?
unrestricted diet
safely without antibiotics
watchful and wait
What are the next steps for severe diverticulitis? high fevers, leukocytosis, abscess, or peritoneal sign
nothing by mouth
Iv fluids + antibiotics
Indications for surgery with diverticulitis?
generalized peritonitis
undrainable abscess large
clinical deterioration
Complications of diverticulitis?
fistula formation,
stricturing of the colon
If a high risk of recurrent diverticulitis?
surgical resection
discrete mass lesions that are flat or protrude into intestinal lumens?
polyps
What is the most common inheritance pattern of polyps?
sporadic
can be part of family syndorme
Two common types of polyps?
hyperplastic polyp and adenoma
What are polyp clinical findings?
mostly asymptomatic OR
chronic occult blood (iron deficiency anemia)
Differential diagnosis of polyps
colorectal cancer or other GI bleeding problems
What test has high specificity but low sensitive for GI bleeding since it test positive for all heme products?
gFOBT (guaiac)
What test measures intact hemoglobin and could only be used to measure bleeding below ligament for triez?
FIT
The test used to measure risk for colorectal cancer but does not measure blood presence in stool?
stool DNA test
High Sn and Sp good screening
Best way to detect and remove adenomatous polyps?
colonoscopy
via polypectomy
What is good for the detection of large polyps (>10mm) but less specific for smaller ones?
CT colonography
Who should be considered for more frequent sometimes yearly routine colonoscopies?
multiple polyps that are high grade in nature (suspect familial condition)
classic “apple core” lesion on barium enema?
colorectal cancer
Almost all colon cancers are?
adenocarcinomas
Most colortectal cnacers arise from malignant transfortaion of?
polyps
5% of colorectal cancers are inherited with what pattern for polyposis syndromes or hereditary nonpolyposis colorectal cancer?
autosomal dominant
Risk factors for colorectal cancer?
age, polyps history, family history, IBD, fats and red meats, race (black>white)
Second leading cause of death due to malignancy in the US?
colorectal cancer
What suggests the metastatic spread of colorectal cancer?
hepatomegaly
What makes relatively early clinical findings of colorectal cancer very difficult?
asymptomatoc, PE is usually normal, weight loss uncommon
Right-sided colon cancers cause?
weaknes form cornic blood loss
left-sided colon cancer causes?
obstructive syndromes and stool streaked in blood
rectal cancers cause?
rectal tenesmus
Labs for colorectal cancers?
CBC, elevated liver enzymes, fecal occult test, etc.
Persistently elevated levels of what may suggest persistent disease and need more investigating of colorectal cancer?
CEA (carcinoembryonic antigen)
What can be used if colonoscopy is not available and can be preoperative staging?
CT chest, abdominal, pelvis
Wha is the diagnostic of choice for colorectal cancer?
colonoscopy
What is beneficial tratment for people with high risk for colorectal occurnac eor stage II disease?
adjuvant chemo
What is used to treat stage III colorectal cancer?
postoperative adjuvant chemo
GOLFOX and CapeOx
Stage IV drug regimen colorectal cancer?
survival improvement 15 months
What would indicate that the cancer has reoccurred?
rise in serum CEA level
When should normal risk patient get a colonoscopy?
> 45 years old and <75 years, old every 10 years
