Colon Flashcards
intussusception
in adults, managed operatively
Patient with diarrhea
lymphocytic colitis
1st line therapy- budesonide 9mg/day for 8 weeks, then 6mg for 2 weeks, then 3mg for 2 weeks
for recurrence give 6mg taper over 6 months
Collagenous colitis
1st line therapy- budesonide 9mg/day for 8 weeks, then 6mg for 2 weeks, then 3mg for 2 weeks
for recurrence give 6mg taper over 6 months
Thumbprinting of the bowel
concerning for severe colitis
ischemic colitis, UC, c. diff, etc
Single stripe sign of ischemic colitis
Sigmoid volvulus
Coffee bean sign
volvulus
Whirl sign
Cecal volvulus
cecal volvulus
intussusception
target sign
intussusception
target sign or bulls eye
what is the anorectal inhibitory reflex?
when stool reaches rectum,
involuntary relaxation of internal anal sphincter
voluntary contraction of external anal sphincter to maintain continence
RAIR is absent in hirschprung’s
What are the mechanism of actions for and doses in CIC and IBS-C?
-linaclotide
-plecanitide
-lubiprostone
-prucalopride
-linaclotide - increase Cl secretion via GC-C/ CFTR (max 145microgm in CIC, 290microgm in IBS-C)
-plecanitide- CFTR pathway - 3mg daily
-lubiprostone - increase CL secretion via CCL2 pathway -24microgm in CIC vs 8microgm in IBS-c
-prucalopride - 5HT agonist 1-2mg daily in CIC, not approved for IBS-C
Pathology seen in GVHD
epithelial cell apoptosis with apoptotic bodies, as well as loss of crypts and crypt necrosis
SMAD4
CHD1
CHEK2
SMAD4 - juvenile polyposis syndrome; CRC, stomach
CHD1- diffuse gastric cancer, lobular breast cancer
CHEK2- breast cancer, low risk of CRC
Who should be screened for pancreatic cancer and when do you start?
2 family members with pancreatic cancer including 1 FDR
ATM
BRCA 1 or 2
STK11 (Peutz-Jeghers syndrome) 35yo
PALB2
mismatch repair genes (Lynch syndrome) +one FDR with pancreatic cancer
CKDN2A mutation 40
hereditary pancreatitis -PRSS1*40
otherwise age 50 or 10 years before youngest relative was diagnosed.
What is necessary to diagnosed dyssynergistic defecation?
2 of 3
ARM
balloon expulsion test
imaging (like defacography)
Severe abdominal pain in patient with CKD, HTN, DM
Acute mesenteric ischemia
LLQ fat stranding
portal venous gas
Seen in the rectum
rectal NET
if <1cm remove with polypectomy
antibiotic-associated hemorrhagic colitis ; not c. diff
Klebsiella oxytocain
will not respond to PO vanc
treat by removing the antibiotic
how do you test for c. diff?
sensitive test (GHD, NAAT) –> followed by specific test (ELISA)
treatment of thrombosed external hemorrhoid?
<72hour- incision and drainage
>72hours conservative measures
