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Spring Round II Exams > clin med- first two lectures > Flashcards

clin med- first two lectures Flashcards

1
Q

DiverticulOSIS

A

the presence of diverticula (sac like protrusion of colon wall)

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2
Q

Diverticulosis

A

prev increases w age
usually SIGMOID colon

often No sx, discovered incidentally

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3
Q

Worsening factors of Diverticulosis

A

Weak points in wall, vasa recta penetrate

Low fiber diet –> constipation –> increase pressure –> herniation

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4
Q

Diverticulosis sx (if present, usually not)

A

Abd cramp, constipation, diarrhea, bloating

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5
Q

DiverticulOSIS
Labs/imaging
Tx

A

Labs/image: none

Tx: High FIBER (and water)

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6
Q

Diverticulitis

A

ACUTE, symptomatic episode d/t inflammation of diverticula

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7
Q

Pathophys of DiverticulITIS

A

impaction obstructs the neck of diverticulum OR increased pressure —> erosion of wall –> inflammation and necrosis –> Perforation

(Micro vs Macro perforation)

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8
Q

Free air/peritonitis

A

result of Diverticulitis

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9
Q

Subtypes of Diverticulitis

A

Uncomplicated

Complicated: abscess, fistula, obstruction, perforation

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10
Q

ACUTE diverticulitis sx

A

Progressive, steady, ACHING pain (LLQ)
Fever/chills

maybe the following: n/v, change bowel habits, urinary sx,

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11
Q

Rectal/ Pelvic exam in Diverticulitis

A

Rectal may reveal mass or tender (GET STOOL GUIAIC)

Perform pelvic on women

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12
Q

Acute Diverticulitis labs

A

CBC: might show Leukocytosis

Also order: CMP, amylase, lipase, UA/culture, preg test, stool study (if diarrhea), stool occult

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13
Q

Imaging Test of choice for Diverticulitis

A

CT WITH contrast

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14
Q

CT (with contrast) of Diverticulitis will show

A

Wall thickening/fat stranding

Colonic diverticula

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15
Q

If worried about obstruction or perforation, can also order

A

X Ray (abd or CXR)

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16
Q

CONTRA tests in Diverticulitis

do NOT order these

A

Colonoscopy/flex sigmoid (could cause Perf)

Barium Enema (could worsen inflammation if Perf present)

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17
Q

Acute UNCOMPLICATED Diverticulitis tx

A

Gram neg/Anaerobic coverage x7-10d

Close F/u in 2 days

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18
Q

Acceptable regimens for Acute UNCOMPLICATED diverticulitis

A

Metronidazole + Cipro
Metronidazole + Bactrim
Augmentin, OR
Moxifloxacin

Gram neg/ Anaerobic

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19
Q

Acute Diverticulitis INPATIENT tx

A 
NPO
IVF
Analgesics
IV abx (transition to PO to complete total of 10-14d)
GI, surgery, consult

Repeat imaging IF not improving in 2-3 d of abx

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20
Q

When to refer Acute diverticulitis to surgery

A
  • Perforation with peritonitis
  • Worsen or fail to improve within 3d of meds
  • Complicated case
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21
Q

Acute diverticulitis Long term tx

A

High fiber (once acute episode resolved)

Colonoscopy 6-8 wks later (r/o CA or IBD)

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22
Q

Diverticular bleeding is common cause of

A

OVERT lower GI bleeding

Usually resolved spont

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23
Q

Which side of colon is usually involved with Diverticular bleeding?

A

RIGHT side

diverticulum are wider and vasa recta more exposed here

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24
Q

Clinical sx of diverticular bleeding

A 
PAINLESS hematochezia (fresh blood in stool)
Blood on rectal exam

May have bloating, cramping, TTP

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25
Q

Imp thing to do with diverticular bleeding

A

Once resuscitation complete, LOCATE source of bleeding w/ flex sig/ colonoscopy

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26
Q

Tx for diverticular bleeding

A

USUALLY resolves on its own

Main goal: maintain blood volume (transfuse prn)

Tx of bleeding site prn: Endoscopic, Angiographic, +/- surgery

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27
Q

Flat polyp

A

Sessile

28
Q

Hyperplastic polyp

A

Non-CA
completely benign
Usually distal colon

29
Q

Pseudopolyp

A

Non-CA
Inflammatory

usually d/t IBD

30
Q

Adenoma

A

Neoplastic, “Pre-CA”

31
Q

Adenoma subtypes

A

Tubular adenoma- most common
Tubulovillous adenoma
Villous adenoma

32
Q

Sessile serrated polyps

A

emerging type of Pre-CA
Usually R side colon
Flat, few surface blood vess
difficult to see

33
Q

70% of Colorectal CA arise from adenoma

A

Progression from Adenoma –> CA takes about 10 years

34
Q

High Risk Adenoma (#, size, histoloty)

A

> 1 cm
Villous or tubulovillous
High grade dysplasia

35
Q

Most common side of Colon CA

A

LEFT side

36
Q

Risk factors CRC

not modifiable

A

IBD >8-10 yrs
>50 YO
African American

Personal or family hx:

  • Adenoma or Colon CA
  • Familial ademomatous polyposis
  • HNPCC
37
Q

Risk factors CRC

modifiable

A 
TOBACCO
alc
diet (high fat, low fiber)
red meat
obesity
DM
38
Q

CRC usually A-sx, but RED FLAGS are:

A 
Change bowel habit
Hematochezia or occult blood in stool
Iron def anemia
Anorexia/weight loss
Abd pain (refer to GI for Colonoscopy)
39
Q

CRC sx (if present)

A 
Cachectic
Pallor
Lymphadenopathy
Abd distention, ascites, mass, organomegaly
DRE: hemoccult + stool, rectal mass
40
Q

CRC diagnostic

A

CBC: look for anemia

Liver test: ALP may be elevated w Liver METs

41
Q

What is CEA (carcinoembryonic antigen) used for?

A

Prognostic indicator

Monitor recurrence

42
Q

“apple core lesions”

A

Colon CA

43
Q

Colonoscopy and CT

A

Colonoscopy: biopsy for pathologic confirmation

CT chest/abd/pelvis: show tumor extension/complication, METs

44
Q

CRC staging “TNM” system

A

Tumor- depth
Node- regional lymph node involvement
METs- yes or no

stage 0-4

45
Q

CRC tx options

A

Partial colectomy w wide margins and adjacent lymph node removal

Chemo (if METs)

Radiation (Rectal adenocarcinoma)

46
Q

CRC surveillance

A

Serial CEA levels
Annual CT (depend on stage)
Colonoscopy periodically

47
Q

Visualization tests

A

Colonscopy
Flex sig
CT colonography

48
Q

Stool based tests

A

gFOBT (hemoccult SENSA)
FIT (fecal immuno test)
FIT-DNA (cologuard)

49
Q

CRC screening Gold standard

A

Colonoscopy (diagnostic and therapeutic)

can remove polyps, take biopsy

50
Q

Do you need bowel prep for Colonoscopy

A

Yes

51
Q

CT Colonography

A

“Virtual colonscopy”

dont have to sedate, but CAN MISS FLAT OR SMALL POLYPS

still need bowl prep
cannot remove polyps

52
Q

gFOBT stool test

“Hemoccult SENSA”

A

requires 3 consecutive stools

Annual use recommended (one time screening doesn’t tell us much)

53
Q

FIT stool test*

test for human hgb

A

PREFERRED CRC detection test!

single specimen, non invasive
BUT annual use still recommended

54
Q

FIT-DNA stool test
(Cologuard)

like the FIT but also test for DNA mutation biomarkers in cells shed by CRC

A

MAIN CONCERN: false positives

if +, get colonscopy ASAP rocky

requires entire bowel movement

55
Q

Overall, stool tests

A

have lower sensitivity
sometimes miss polyps that don’t bleed
need to be annual (pt compliance)

56
Q

If you have IBD, when should you have first Colonoscopy

A

8-10 yrs after sx onset

57
Q

If 1st deg family hx of CRC or Advanced adenoma, when to get YOUR first colonscopy?

A

If relative <60 YO (or two 1st deg relatives any age)
-every 5 yrs starting at 40YO or 10 yrs younger than dx of relative

If relative >60 YO
-start at 40, if normal continue on as normal indiv

58
Q

FAP (familial adenomatous polyposis)

A

tons of polyps!
>100 adenomatous poyps

Starts ~16 YO
nearly ALL polyps will become CA by age 39 if untreated

59
Q

Tx for FAP

A

Prophylactic colectomy

Risk of extracolonic CA (stomach, duod, ampullary CA is common)

60
Q

Screening for FAP who are gene carriers or have family hx (even without genetic confirmation)

A

Sigmoid/Colonoscopy start at 10-12 YO and repeat every 1-2 years

+Routine EGD

61
Q

HNPCC

“lynch syndrome”

A

Inc risk for RIGHT sided CRC

age 45-60

62
Q

HNPCC

“lynch synd”

A

multiple family members usually affected

Increased risk of other CA: Endometrial being most common

63
Q

3-2-1 rule diagnosis

Amsterdam criteria for HNPCC

A

At least 3 relatives w Lynch syndrome assoc CA
At least 2 generations in a row
At least 1 before age 50

64
Q

HNPCC screening

A

Annual Colonoscopy starting at age 20-25 OR
2-5 yrs before onset of earliest dx age in family

whichever comes first

65
Q

Other screening to consider with HNPCC

A 
Pelvic exam (endometrial CA)
EGD (start 30-35 YO and every 2-3 yrs)
66
Q

Consider familial Colon CA condition if

A

> 1 fam member hx CRC
Persona/ fmx CRC at age earlier than 50 YO
Personal/fmx of MULTIPLE adenomas (>10-20)
Personal/fmx of multiple Extracolonic CA

Spring Round II Exams (10 decks)

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