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PRCM Clerkship > Adult Medicine _ Gastroenterology/Hepatology > Flashcards

Adult Medicine _ Gastroenterology/Hepatology Flashcards

1
Q

Colon cancer screening begins at age ___ years. If one first-degree relative has colon cancer, begin screening at age ___ years, or ___ years before the age of onset of the relative.

A

Colon cancer screening begins at age 50 YEARS. If one first-degree relative has colon cancer, begin screening at age 40 YEARS, or 10 YEARS before the age of onset of the relative.

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2
Q

Colorectal cancer tumor marker?

A

Carcinoembryonic antigen (CEA)

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3
Q

Utilities (2) of CEA tumor marker?

A
  1. Useful for baseline and recurrence surveillance

2. Prognostic significance: Patients with pre-operative CEA > 5 ng/mL have a worse prognosis

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4
Q

Colorectal cancer metastasizes via hematogenous spread to what 2 organs?

A
  1. Liver via portal circulation - Liver is MOST COMMON SITE of distant metastasis
  2. Lungs via lumbar/vertebral veins
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5
Q

Gastrointestinal disease a/w colorectal cancer?

A

Inflammatory bowel disease

  • Ulcerative colitis
  • Crohn’s disease
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6
Q

Which inflammatory bowel disease poses a higher risk of colorectal cancer?

A

Ulcerative colitis

Incidence of colorectal cancer:

  • 5-10% after having UC for 20 years
  • 12-20% after having UC for 30 years
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7
Q

Colorectal cancer:

- Most common presenting symptom?

A

Abdominal pain 2/2 partial obstruction or peritoneal dissemination

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8
Q

Most common cause of large bowel obstruction in adults?

A

Colorectal cancer

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9
Q

Colorectal cancer:

- Most life-threatening complication of CRC that presents with large bowel obstruction?

A

Colonic perforation leading to peritonitis

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10
Q

Cardiovascular diagnosis that invites workup/evaluation for colorectal cancer?

A

Streptococcus bovis endocarditis

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11
Q

Signs/symptoms of right-sided colorectal cancer (4)?

A

Melena
RLQ pain and/or palpable mass
Iron-deficiency anemia
Weakness

Notes

  • Obstruction is uncommon b/c of the large luminal diameter of the right-sided colon
  • Changes in bowel habits uncommon
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12
Q

Signs/symptoms of left-sided colorectal cancer (4)?

A

Hematochezia
LLQ pain
Alternating constipation/diarrhea
Decreased stool caliber (pencil thin stools)

Notes
- Obstruction is common b/c of the small luminal diameter of the left-sided colon

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13
Q

Left-sided colorectal cancer finding on barium x-ray?

A

“Apple-core” lesion

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14
Q

Signs/symptoms of rectal cancer (4)?

A

Hematochezia
Tenesmus
Palpable rectal mass on DRE
Sensation of incomplete evacuation of stool

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

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15
Q

Colorectal cancer:

Treatment?

A

Surgical resection of tumor-containing bowel as well as resection of regional lymphatics

Notes
- Pre-operative CEA level should be obtained

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16
Q

Colorectal cancer:

Post-resection follow up (3)?

A
  1. Annual CT abdomen/pelvis and CXR for 5 years
  2. Colonoscopy at 1 year and then every 3 years
  3. Periodic CEA levels (every 3-6 months)

Notes

  • Post-operative increase in CEA level is a sensitive marker of recurrence
  • Approximately 90% of recurrences occur within 3 years after surgery
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17
Q

Colonic polyps:

- Two categories?

A
  1. Non-neoplastic polyps
    - Benign lesions with NO malignant potential
  2. Adenomatous polyps
    - Benign lesions with SIGNIFICANT malignant potential
    - Precursors for adenocarcinoma
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18
Q

Non-neoplastic colonic polyps:

- Three types?

A
  1. Hyperplastic polyps
  2. Juvenile polyps
  3. Inflammatory polyps (pseudopolyps)
19
Q

Adenomatous colonic polyps:

- Three types?

A
  1. Tubular
  2. Tubulovillous
  3. Villous
20
Q

Adenomatous colonic polyps:

- Malignancy potential of each type?

A

Villous > tubulovillous > tubular

  1. Tubular
    - Smaller, pedunculated
    - Most common type of adenomatous polyp (60-80% of cases)
    - Approx. 5% malignancy potential
  2. Tubulovillous
    - Approx. 20% malignancy potential
  3. Villous
    - Larger, sessile
    - Approx. 40% malignancy potential
21
Q

Malignancy potential factors (4)?

A
  1. Size
    - Larger the polyp, greater the malignancy potential
  2. Histologic type
  3. Atypia of cells
  4. Shape
    - Sessile v. pedunculated
    - Sessile (flat) more likely to be malignant
22
Q

Colonic polyps:

Most common anatomic site?

A

Rectosigmoid region

23
Q

Colonic polyps:

  • Most patients are asymptomatic
  • In symptomatic patients, what is the most common symptom?
A

Rectal bleeding

24
Q

Diverticulosis

A

Diverticula:

  • Outpouchings of colonic mucosa and submucosa into/through muscularis propria (false diverticulum)
  • Arise where the vasa rectae (blood vessels) traverse muscularis propria
  • –> Area of weakness in colonic wall
  • Caused by increased intraluminar pressure and wall stress
  • A/w constipation, straining, and low fiber diet
25
Q

Diverticulosis:

Most common site of diverticula?

A

Sigmoid colon

26
Q

Diverticulosis:

  • Most patients are asymptomatic
  • Occasionally may present with vague LLQ abdominal pain
  • Complications (2)?
A
  1. Hematochezia
    - Painless rectal bleeding in up to 40% of patients with diverticulosis
    - Diverticulosis is the most common cause of hematochezia
  2. Diverticulitis
    - 15-25% of patients
27
Q

Diverticulosis:

- Diagnostic test of choice?

A

Barium enema

28
Q

Diverticulitis:

- Diagnostic test of choice?

A

CT abdomen/pelvis with IV and oral contrast

29
Q

Diverticulitis:

- Contraindicated diagnostic tests (2)?

A

Barium enema
Colonoscopy

  • Risk of perforation
30
Q

Diverticulitis:

- Signs/symptoms (3)?

A

LLQ pain
Fever
Leukocytosis

Notes

  • “Left-sided appendicitis”
  • Other signs/symptoms may include alternating constipation/diarrhea, vomiting
  • Lower GI bleeding (melena, hematochezia) VERY RARE in diverticulitis
31
Q

Diverticulitis:

- Treatment/management (4)?

A
  1. NPO –> Bowel rest
  2. IV fluids w/ potassium
  3. IV antibiotics
  4. NG tube placement if abdominal distention and/or vomiting present
  • Mild cases of uncomplicated diverticulitis may be treated on an outpatient basis if the patient is reliable and has no/few co-morbidities

Notes
- Diverticulitis recurs in about 30% of patients treated medically, usually within the first 5 years

32
Q

Diverticulitis:

- Complications (4)?

A
  1. Colovesical fistula
    - Fistula b/w colon and bladder
    - Presents w/ air (pneumaturia) and/or stool in urine
    - A/w recurrent UTIs
  2. Abscess formation
  3. Bowel obstruction
  4. Colonic perforation –> Peritonitis
33
Q

Age-related prevalence of adenomatous colonic polyps:

  • ___% at age 50 years
  • ___% at age 60 years
  • ___% at age 70 years
  • ___% at age 80 years
A

Age-related prevalence of adenomatous polyps:

30% at age 50 years
40% at age 60 years
50% at age 70 years
55% at age 80 years

34
Q

Diverticulitis:

- Bacterial organisms (2)?

A

E. coli

Bacteroides fragilis

35
Q

Angiodysplasia

A
  • Acquired malformation of mucosal/submucosal venules in colonic wall
  • Very common cause of lower GI bleeding in patients > 60 years old
36
Q

Angiodysplasia:

- Most common anatomic sites (2)?

A

Cecum and proximal ascending colon

37
Q

Angiodysplasia:

- Diagnostic test of choice?

A

Colonoscopy

38
Q

Angiodysplasia:

- Treatment?

A
  • Bleeding self-resolves in 90% of patients
  • If bleeding persists, treat with colonoscopic coagulation
  • If bleeding continues to persist, consider right hemicolectomy
39
Q

Angiodysplasia:

- A/w what 2 medical conditions?

A
  • von Willebrand’s disease (vWD)
  • Calcified aortic stenosis
  • -> As many as 25% of patients with angiodysplasia have aortic stenosis
  • -> However, no cause-and-effect relationship has been proven
40
Q

Prophylactic therapy for cirrhotic patients with known esophageal varices?

A

Beta-blockers to prevent bleeding

41
Q

Management of ascites in cirrhotic patients?

A
  • Low-sodium diet
  • Diuretics - Furosemide + spironolactone
  • Therapeutic paracentesis if tense ascites, SOB, or early satiety
42
Q 
Hepatocellular adenoma:
Risk factors (3)?
A

Benign liver tumor

  • Female sex
  • Oral contraceptive use
  • Anabolic steroid use
43
Q 
Jaundice: 
Main causes (3)?
A
  • Hemolysis
  • Liver disease
  • Biliary obstruction
44
Q

Total bilirubin level at/above which clinical jaundice usually becomes evident?

A

Total bilirubin > 2 mg/dL

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