Colon Flashcards
signs of early colorectal cancer?
asymptomatic
signs advanced colorectal cancer?
vague abdominal pain, iron deficiency anemia
recommended colorectal cancer screens?
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.
colonic diverticulosis etiology?
bulging pockets in intestinal wall, mostly in sigmoid colon.
signs of colonic diverticulosis?
inflammation can be present without sympatoms.
Left sidedd abdominal cramping, increased flatus, constipation alternating with diarrhea.
RF of diverituclosis and diverticulitis?
CT dx, aging, family hx,
tx of diverticulsosi?
high fiber diet with supplements (brain, psyllium, methylcellulose)
signs of acute diverticulitis?
inflammed diverticula causing fever, leukocytosis, diarrhea, and LLQ pain. perforation common cause.
diagnostics of acute diverticulitis?
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.
what causes diverticular hemmorhage?
erosion of vessel by fecalith held in diverticular sac. painless lower GI bleed.
tx of hemmorhage of diverticula?
fluid and blood replacement
tx diverticilitis?
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.
prevention of colonic diverticulosis?
hyration, exercise high fiber diet.
what function does prostaglandins have?
stimulate and thicken mucus layer, enhance bicarbonate secretion, and promote cell renewal and blood flow.
common cause of PUD?
NSAIDS and systemic corticosteroids. > 60 yo, hx of H2 RA or antacids, cig smoking, cardiac disease, etoh use.
Cox 1 enzyme function?
maintenance of protective layer and proper renal perfusion.
COX 2 enzyme function?
produces PG in inflammatory response and pain transmission.
risks of long term COX 2 inhibitors?
gastric ulcers, cardiovascular and cerebrovascular events.
possible locations of PUD?
duodenum, stomach, esophagus, and small intestine
signs PUD r/t gastric ulcer?
worse with eating, often reported with or immediately after meals. lessen within 1 hours of food. n/v/weight loss common.
signs PUD r/t duodenal ulcer?
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
H pylori infection etiology
gram negative spiral shaped organism, sheathed flagella. transmitted oral-fecal and oral-oral.
first line diagnostic > 50 w/PUD suspect?
upper GI endoscopy
diagnostic for H pylori infection?
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
Tx PUD?
- H2RA “tidine” - ranitidine (zantac), fomatidine (pepcid), cimetidine (tagamet). suppress acid production.
- PPI - prazole. indicated in PUD and GERD when H2RA ineffective.
3.
what H2RA interacts with what drugs?
cimetidine (CYP 450), warfarin, diazepam, phenytoin, quinidine, carbamazepine, theophylline, imiparine.
what is best way to PPI?
empty stomach 30 minutes prior to breakfasdt.
SE of prolonged PPI or protracted use?
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.
Tx of h pylori w/ PUD?
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)
signs nonerosive gastritis & chronic type B gastritis
nausea, burning pain, limited to upper abdomen w/o reflux.
signs of erosive gastritits?
burning and pain limited to upper abdomen w/o symptoms reflux. bleeding common. usually not r/t h pylori.
GERD definition? symptoms?
acid reflux when symptoms or evidence of tissue damage. dyspesia, chest pain at rest, postprandial fullness. chronic hoarseness, sore throat, nocturnal cough, and wheezing.
medications as RF for GERD?
estrogen, progesterone, theophylline, CCB, and nicotine.
management of GERD?
- 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.
- H2RA can use BID
- no response –> PPI
- alter: could just start with PPI . after 8 weeks if not resolved refer to GI specialist.
warning signs for further GERD eval?
dysphagia, odynophagia, GI bleed, unexplained weight loss, persistent chest pain. IDA! could be erosive esophagitis or cancer. need upper endoscopy.
complications of GERD?
esophageal strciture, columnare epitherlial metaplasia, or Barrett esophagus.
screening and testing for BE?
BE - requires upper endoscopy.
screen for dysplasia. none 2 consecutive screenings in 1 year, can screen every 3 years.
where is squamous cell cancer found?
upper esophagus
where is adenocarcinoma found?
junction of esoph and stomach.
cancers suspect do upper GI endoscopy.
IBS description?
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.
Rome III criteria for IBS?
recurrent abdominal pain or discomfort at least 3 days/month in last 3 months associated with 2 of the following:
- discomfort relieved by defecation
- change in stool freq
- change in stool form or appearance
IBS - D pattern description?
small volumes of loose stool,
IBS -C pattern description?
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.
IBS A pattern?
alternating constipation and diarrhea, eventually one becoming dominant
IBS M pattern?
mixed diarrhea or constipation
etiology of IBS?
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.
Triggers of IBS?
coffee, disaccharides, legumes, cabbage, high carb diet, excessive fructose, artifical sweeteners.
tx IBS?
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
IBD description?
autoimmune response to GI tract.
two types: ulcerative colitis and crohns disease
ulcerative colitis description.
chronic inflammation of distal colon, colon only! can begin at recutm and diffuse and continuous entire colon .
some can involve rectum only.
crohn disease signs?
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. .
diagnostics for crohns dx?
CT with contrast or upper endoscopy w/biopsy,
can do colonoscopy as well.
CRP and ESR elevated
leukocytosis
coproblems in IBD
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.
triggers in crohns dx
tobacco, lactulose,
TX IBD?
BOTH:
1. oral aminosalicylates (5 ASA) - sulfasalazine (azulfidine) and mesalamine (apriso)
- 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 - monoclonocal antibody - infliximab
biologics - adalimumab (huira), certolizumab (cimzia), natalizumab (tysabri)
- immunomodulators = methotrexate and cyclosporine
effect can take 4-5 months.
dc if leukopenia, thrombocytopena, etc. - probiotics.
- 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
when is metronidazole and ciprofloxacin used in crohns diease?
chrohns - when perineal diease or inflamm mass
why is antibiotic use in UC discouraged?
risk of C diff.
cancer surveilliance in IBD?
UC increased risk, after 8-10 years recommend colonoscopt every 2 years.
antispasmodics used for IBD?
dicyclomine, hyoscyamine, methscopolamine
antidiarrheals used for IBD?
loperamide
osmotic laxatives for IBD?
miralax, milk of magnesiua, lubiprostone
tricyclic antidepressants (not recomm for constipation domin) IBD?
nortriptyline, desipramine, imipramine
SSRI for predom diarrhea IBD?
sertraline, flouxetine, citralopram, paroxetine
crohns description?
mouth to anus inflammation. skip lesions on imagine and cobblestone mucosal pattern.
what is celiac disease?
permanent dietary disorder caused by immunological response to gluten. causes damage to proximal small intestinal mucosa w/malabsorption
Which imaging studies have no radiation?
US and MRI
which imagine studies have background radiation for 3 years?
CT scan
which imaging studies have 62-88 days of of back ground radiation.
xray.
peak of onset of IBD?
15-25 years.
pancreatic cysts signs?
hx pancreatitis epidsode. persistent abdominal pain, anorexia, abdominal mass. juamdice or sepsis are rare but can occur.
tender abdomen, fever, schleral icterus, pleural efusion
signs of diverticulitis?
LLQ pain usually tenderness in sigmoid area, change in bowel habits, N/V, constipation, diarrhea, flatulence, bloating
complication can be mass r/t abscess.
how confirm diverticulits diagnosis?
CT scan!
tx diverticulitis?
clear liquid diet, 7-10 days antimicrobrial, diet slowly introduced
antimicrobials poss: cipro + metro; TMP-SMX + metro; moxifloxacin; amox-clauv
