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GI > Colon > Flashcards

Colon Flashcards

1
Q

signs of early colorectal cancer?

A

asymptomatic

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2
Q

signs advanced colorectal cancer?

A

vague abdominal pain, iron deficiency anemia

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3
Q

recommended colorectal cancer screens?

A

FOBT annually, colonoscopy Q 10 years starting at age 50.

alternative methods: flex sigmoidoscopt, double Constrast barium enema, CT colonography every 5 years at age 50.

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4
Q

colonic diverticulosis etiology?

A

bulging pockets in intestinal wall, mostly in sigmoid colon.

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5
Q

signs of colonic diverticulosis?

A

inflammation can be present without sympatoms.

Left sidedd abdominal cramping, increased flatus, constipation alternating with diarrhea.

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6
Q

RF of diverituclosis and diverticulitis?

A

CT dx, aging, family hx,

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7
Q

tx of diverticulsosi?

A

high fiber diet with supplements (brain, psyllium, methylcellulose)

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8
Q

signs of acute diverticulitis?

A

inflammed diverticula causing fever, leukocytosis, diarrhea, and LLQ pain. perforation common cause.

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9
Q

diagnostics of acute diverticulitis?

A

CT scan with contrast of abdomen. ( can also see bascess and fistulas)/ plain film can be used to see excess air. DO NOT USE barium enema during acute episode.

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10
Q

what causes diverticular hemmorhage?

A

erosion of vessel by fecalith held in diverticular sac. painless lower GI bleed.

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11
Q

tx of hemmorhage of diverticula?

A

fluid and blood replacement

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12
Q

tx diverticilitis?

A

liquid diet, antimicrobrial therapy. metronidazole 500 mg Q 6 hours 7-10 days + second agent against gram negative.

gram negative choices: TMP-SMX BID, cipro 750 mg BID , levo 750 mg QID ,

alter: moxifloxacin 400 mg daily 7-10 days tigecycline, amox-clav ER 1000/62.5mg 2 tabs bid

recurrent do colectomy.

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13
Q

prevention of colonic diverticulosis?

A

hyration, exercise high fiber diet.

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14
Q

what function does prostaglandins have?

A

stimulate and thicken mucus layer, enhance bicarbonate secretion, and promote cell renewal and blood flow.

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15
Q

common cause of PUD?

A

NSAIDS and systemic corticosteroids. > 60 yo, hx of H2 RA or antacids, cig smoking, cardiac disease, etoh use.

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16
Q

Cox 1 enzyme function?

A

maintenance of protective layer and proper renal perfusion.

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17
Q

COX 2 enzyme function?

A

produces PG in inflammatory response and pain transmission.

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18
Q

risks of long term COX 2 inhibitors?

A

gastric ulcers, cardiovascular and cerebrovascular events.

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19
Q

possible locations of PUD?

A

duodenum, stomach, esophagus, and small intestine

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20
Q

signs PUD r/t gastric ulcer?

A

worse with eating, often reported with or immediately after meals. lessen within 1 hours of food. n/v/weight loss common.

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21
Q

signs PUD r/t duodenal ulcer?

A

epigastric pain, gnawing pain 2-3 hours after meals, worsen after meal. relief with food or antacids.

cluser of symptoms with periods of wellness. waking 1-2am common. tender epigastric, LUQ, slightly hyperactive sounds

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22
Q

H pylori infection etiology

A

gram negative spiral shaped organism, sheathed flagella. transmitted oral-fecal and oral-oral.

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23
Q

first line diagnostic > 50 w/PUD suspect?

A

upper GI endoscopy

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24
Q

diagnostic for H pylori infection?

A

stool antigen testing , repeat > 8 weeks post treatment.

urea breath is ok.

endoscopy with biopsy and urease testing of specimen is GOLD standard!

note seroligical testing can not have + titers 12-18 months after therapy

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25
Q

Tx PUD?

A
  1. H2RA “tidine” - ranitidine (zantac), fomatidine (pepcid), cimetidine (tagamet). suppress acid production.
  2. PPI - prazole. indicated in PUD and GERD when H2RA ineffective.

3.

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26
Q

what H2RA interacts with what drugs?

A

cimetidine (CYP 450), warfarin, diazepam, phenytoin, quinidine, carbamazepine, theophylline, imiparine.

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27
Q

what is best way to PPI?

A

empty stomach 30 minutes prior to breakfasdt.

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28
Q

SE of prolonged PPI or protracted use?

A

protracted –> iron, vitamin B reduced absorption

long term use - fracture risk, r/t decrease ca and mg absorption. increased risk of penum, C diff. can have rebound hyperactivity.

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29
Q

Tx of h pylori w/ PUD?

A

sequential therapy of rabeprazole 20mg BID + amoxicillin 1 g BID x 5 days THEN raberprazole 20 mg BID +clarithromycin + tinidazole 500mg BID x additional 5 days (10 total day tx)

OR

bismuth salicylate 2 tabs QIF + metronidazole 500mg QID + tetracycline 500mg QID + omprazole 20 mg BID (10-14 days total)

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30
Q

signs nonerosive gastritis & chronic type B gastritis

A

nausea, burning pain, limited to upper abdomen w/o reflux.

31
Q

signs of erosive gastritits?

A

burning and pain limited to upper abdomen w/o symptoms reflux. bleeding common. usually not r/t h pylori.

32
Q

GERD definition? symptoms?

A

acid reflux when symptoms or evidence of tissue damage. dyspesia, chest pain at rest, postprandial fullness. chronic hoarseness, sore throat, nocturnal cough, and wheezing.

33
Q

medications as RF for GERD?

A

estrogen, progesterone, theophylline, CCB, and nicotine.

34
Q

management of GERD?

A
  1. reduce trigger foods - etog, tomato based foods, chocolate, peppermint, colas, citrus juices, high fat.

avoid supine position 3 hour post meal.
2. antacids after mreal and at bedtime - 1-3 hours after meal. use them two hours apart from other meds.

  1. H2RA can use BID
  2. no response –> PPI
  3. alter: could just start with PPI . after 8 weeks if not resolved refer to GI specialist.
35
Q

warning signs for further GERD eval?

A

dysphagia, odynophagia, GI bleed, unexplained weight loss, persistent chest pain. IDA! could be erosive esophagitis or cancer. need upper endoscopy.

36
Q

complications of GERD?

A

esophageal strciture, columnare epitherlial metaplasia, or Barrett esophagus.

37
Q

screening and testing for BE?

A

BE - requires upper endoscopy.

screen for dysplasia. none 2 consecutive screenings in 1 year, can screen every 3 years.

38
Q

where is squamous cell cancer found?

A

upper esophagus

39
Q

where is adenocarcinoma found?

A

junction of esoph and stomach.

cancers suspect do upper GI endoscopy.

40
Q

IBS description?

A

abdominal pain or discomfort and altered bowel habits in absence of detectable structural abnormalities. altred bowls, freq, form, or passage accompanied by mucorrhea and abdominal bloating.

41
Q

Rome III criteria for IBS?

A

recurrent abdominal pain or discomfort at least 3 days/month in last 3 months associated with 2 of the following:

  1. discomfort relieved by defecation
  2. change in stool freq
  3. change in stool form or appearance
42
Q

IBS - D pattern description?

A

small volumes of loose stool,

43
Q

IBS -C pattern description?

A

episidc then become intractable to laxatives with hard narrowed stool cailber and sense of incomplete evacuation for weeks or months interrupted by periods of diarrhea.

44
Q

IBS A pattern?

A

alternating constipation and diarrhea, eventually one becoming dominant

45
Q

IBS M pattern?

A

mixed diarrhea or constipation

46
Q

etiology of IBS?

A

mutlifactorial, abnormal motor and sensory activity of gut , Cental neural dysfunction, psychological distburnaces, mucosal inflamm, stress, and luminal factors

some IBS-D have elevated serotonin containing enterochromaffin cells.

47
Q

Triggers of IBS?

A

coffee, disaccharides, legumes, cabbage, high carb diet, excessive fructose, artifical sweeteners.

48
Q

tx IBS?

A

avoid food triggers
fiber supplementation - fiber con or psyllium
hydration

Diarrhea dominant:
loperamide (imodium)

anticholinergics/antispoasmaids such as dicyclomine (bentyl).

altering pain threshold - tricyclic antdepp or selective serotonin reuptake inhibitor
* tricyclics can limit stool freq but worsen constipation.

Constipation dominant:
prokinetics or promobility - lubiprostone (amitiza)

metoclopramide and erythromycin

49
Q

IBD description?

A

autoimmune response to GI tract.

two types: ulcerative colitis and crohns disease

50
Q

ulcerative colitis description.

A

chronic inflammation of distal colon, colon only! can begin at recutm and diffuse and continuous entire colon .

some can involve rectum only.

51
Q

crohn disease signs?

A

bloody diarrhea with tenesmus, abdominal pain, involuntary weight loss, diarrha, occass signs of obstruction. anterior or posterior anal fissures suspect.

can also have , fever, chills, joint pain, n/v, mouth sores, fatgiue. fisutlas, and abscess. .

52
Q

diagnostics for crohns dx?

A

CT with contrast or upper endoscopy w/biopsy,
can do colonoscopy as well.

CRP and ESR elevated

leukocytosis

53
Q

coproblems in IBD

A

anemia - IDA r/t to blood loss, ACD r/t inflammation. acute blood loss r.t GI hemmorhage during flare.

vitamin B deficiency r/t crohns.

nondestructive axial or peripheral arthritis 15%, renal caculi in crohns disease.

54
Q

triggers in crohns dx

A

tobacco, lactulose,

55
Q

TX IBD?

A

BOTH:
1. oral aminosalicylates (5 ASA) - sulfasalazine (azulfidine) and mesalamine (apriso)

  1. oral or parenteral corticosteroids
    use in moderate to severe siease. once remission taper off. usually use 10-14 days if rectally.
    *mesalamine and corticosteroids rectally for UC
  2. monoclonocal antibody - infliximab

biologics - adalimumab (huira), certolizumab (cimzia), natalizumab (tysabri)

  1. immunomodulators = methotrexate and cyclosporine
    effect can take 4-5 months.
    dc if leukopenia, thrombocytopena, etc.
  2. probiotics.
  3. surgery - total colectomy in UC; crohns, small bowel or colon obstructions, fistuals, abscess repair.

Crohns: above + on occassional antimicrobials

UC: above + immune modulators - 6 mercaptopurine and azathioprine

56
Q

when is metronidazole and ciprofloxacin used in crohns diease?

A

chrohns - when perineal diease or inflamm mass

57
Q

why is antibiotic use in UC discouraged?

A

risk of C diff.

58
Q

cancer surveilliance in IBD?

A

UC increased risk, after 8-10 years recommend colonoscopt every 2 years.

59
Q

antispasmodics used for IBD?

A

dicyclomine, hyoscyamine, methscopolamine

60
Q

antidiarrheals used for IBD?

A

loperamide

61
Q

osmotic laxatives for IBD?

A

miralax, milk of magnesiua, lubiprostone

62
Q

tricyclic antidepressants (not recomm for constipation domin) IBD?

A

nortriptyline, desipramine, imipramine

63
Q

SSRI for predom diarrhea IBD?

A

sertraline, flouxetine, citralopram, paroxetine

64
Q

crohns description?

A

mouth to anus inflammation. skip lesions on imagine and cobblestone mucosal pattern.

65
Q

what is celiac disease?

A

permanent dietary disorder caused by immunological response to gluten. causes damage to proximal small intestinal mucosa w/malabsorption

66
Q

Which imaging studies have no radiation?

A

US and MRI

67
Q

which imagine studies have background radiation for 3 years?

A

CT scan

68
Q

which imaging studies have 62-88 days of of back ground radiation.

A

xray.

69
Q

peak of onset of IBD?

A

15-25 years.

70
Q

pancreatic cysts signs?

A

hx pancreatitis epidsode. persistent abdominal pain, anorexia, abdominal mass. juamdice or sepsis are rare but can occur.

tender abdomen, fever, schleral icterus, pleural efusion

71
Q

signs of diverticulitis?

A

LLQ pain usually tenderness in sigmoid area, change in bowel habits, N/V, constipation, diarrhea, flatulence, bloating

complication can be mass r/t abscess.

72
Q

how confirm diverticulits diagnosis?

A

CT scan!

73
Q

tx diverticulitis?

A

clear liquid diet, 7-10 days antimicrobrial, diet slowly introduced

antimicrobials poss: cipro + metro; TMP-SMX + metro; moxifloxacin; amox-clauv

GI (6 decks)

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