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GEM > 3.07 Structural Disorders Colon > Flashcards

3.07 Structural Disorders Colon Flashcards

1
Q

Wha increases incidence of diverticulosis in Western societies?

A

Age
50% >80 yo

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2
Q

Most diverticulosis found incidentally on endoscopy or barium enema are?

A

asymptomatic

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3
Q

What is thought to contribute to diverticular disease?

A

high pressure and/or bad wall

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4
Q

How can diverticula be best seen?

A

barian enema or CT imaging

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5
Q

Treat meant for diverticula?

A

high fiber diet/supplements

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6
Q

Complications of diverticula?

A

lower GI bleeding, diverticulitis

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7
Q

What is the most common cause of lower GI bleeding in adults?

A

diverticulosis

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8
Q

“left-sided appendicitis”

A

used to describe the symptoms and clinical features that sign with a diverticulitis

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9
Q

What does macroscopic inflammation of the diverticulum seen in diverticulitis encompass?

A

inflammation, microperforation, macro perforation

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10
Q

Diverticulitis differentials?

A

perforated colon cancer
infectious colitis
IBD
ischemic colitis
appendicitis
G/U Problems

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11
Q

Diverticulitis tests?

A

leucocytosis, stool occult positive but frank bleeding unusual (hematochezia)

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12
Q

If people do not improve after a couple of days of empiric therapy with diverticulitis diagnosis (or severe), what next step?

A

CT scan abdomen

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13
Q

What will you see in a diverticulitis CT scan?

A

diverticulli, wall thickening, pericolic fat infiltrtation, abscess, extraluminal air, or contrast

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14
Q

Why are endoscopy and colonography contraindicated during initial acute attack stages?

A

risk of free perforation

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15
Q

Recommendation for mild diverticulitis with NO peritoneal signs?

A

unrestricted diet
safely without antibiotics
watchful and wait

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16
Q

What are the next steps for severe diverticulitis? high fevers, leukocytosis, abscess, or peritoneal sign

A

nothing by mouth
Iv fluids + antibiotics

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17
Q

Indications for surgery with diverticulitis?

A

generalized peritonitis
undrainable abscess large
clinical deterioration

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18
Q

Complications of diverticulitis?

A

fistula formation,
stricturing of the colon

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19
Q

If a high risk of recurrent diverticulitis?

A

surgical resection

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20
Q

discrete mass lesions that are flat or protrude into intestinal lumens?

A

polyps

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21
Q

What is the most common inheritance pattern of polyps?

A

sporadic
can be part of family syndorme

22
Q

Two common types of polyps?

A

hyperplastic polyp and adenoma

23
Q

What are polyp clinical findings?

A

mostly asymptomatic OR
chronic occult blood (iron deficiency anemia)

24
Q

Differential diagnosis of polyps

A

colorectal cancer or other GI bleeding problems

25
Q

What test has high specificity but low sensitive for GI bleeding since it test positive for all heme products?

A

gFOBT (guaiac)

26
Q

What test measures intact hemoglobin and could only be used to measure bleeding below ligament for triez?

A

FIT

27
Q

The test used to measure risk for colorectal cancer but does not measure blood presence in stool?

A

stool DNA test
High Sn and Sp good screening

28
Q

Best way to detect and remove adenomatous polyps?

A

colonoscopy
via polypectomy

29
Q

What is good for the detection of large polyps (>10mm) but less specific for smaller ones?

A

CT colonography

30
Q

Who should be considered for more frequent sometimes yearly routine colonoscopies?

A

multiple polyps that are high grade in nature (suspect familial condition)

31
Q

classic “apple core” lesion on barium enema?

A

colorectal cancer

32
Q

Almost all colon cancers are?

A

adenocarcinomas

33
Q

Most colortectal cnacers arise from malignant transfortaion of?

A

polyps

34
Q

5% of colorectal cancers are inherited with what pattern for polyposis syndromes or hereditary nonpolyposis colorectal cancer?

A

autosomal dominant

35
Q

Risk factors for colorectal cancer?

A

age, polyps history, family history, IBD, fats and red meats, race (black>white)

36
Q

Second leading cause of death due to malignancy in the US?

A

colorectal cancer

37
Q

What suggests the metastatic spread of colorectal cancer?

A

hepatomegaly

38
Q

What makes relatively early clinical findings of colorectal cancer very difficult?

A

asymptomatoc, PE is usually normal, weight loss uncommon

39
Q

Right-sided colon cancers cause?

A

weaknes form cornic blood loss

40
Q

left-sided colon cancer causes?

A

obstructive syndromes and stool streaked in blood

41
Q

rectal cancers cause?

A

rectal tenesmus

42
Q

Labs for colorectal cancers?

A

CBC, elevated liver enzymes, fecal occult test, etc.

43
Q

Persistently elevated levels of what may suggest persistent disease and need more investigating of colorectal cancer?

A

CEA (carcinoembryonic antigen)

44
Q

What can be used if colonoscopy is not available and can be preoperative staging?

A

CT chest, abdominal, pelvis

45
Q

Wha is the diagnostic of choice for colorectal cancer?

A

colonoscopy

46
Q

What is beneficial tratment for people with high risk for colorectal occurnac eor stage II disease?

A

adjuvant chemo

47
Q

What is used to treat stage III colorectal cancer?

A

postoperative adjuvant chemo
GOLFOX and CapeOx

48
Q

Stage IV drug regimen colorectal cancer?

A

survival improvement 15 months

49
Q

What would indicate that the cancer has reoccurred?

A

rise in serum CEA level

50
Q

When should normal risk patient get a colonoscopy?

A

> 45 years old and <75 years, old every 10 years

GEM (28 decks)

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