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Clin Med III > colorectal diseases and PUD > Flashcards

colorectal diseases and PUD Flashcards

1
Q

polyp

A
  • benign growth of inner lining of colon
  • best dx on colonoscopy
  • most NOT cancerous but can become malignant
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2
Q

how do you describe the appearance of polyps

A
  • pedunculated/ stalk
  • sessile
  • flat
  • depressed
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3
Q

risk factors for polyps

A
  • high fat, low fiber
  • age > 50
  • family hx or personal hx
  • family syndromes
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4
Q

si/sx of polyps

A
  • usually none
  • stool occult positive
  • palpable mass
  • BRBPR
  • rectal tenesmus
  • change in bowel habits
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5
Q

non-neoplastic polyps

A
  • hyperplastic
  • mucosal
  • inflammatory psuedopolyps
  • submucosal
  • hamartamous
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6
Q

neoplastic polyps

A
  • adenomatous
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7
Q

subtypes of adenomatous polyps

A
  • tubular
  • tubovillous
  • villous
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8
Q

hyperplastic polyps

A
  • most common non-neoplastic polyp
  • usu found in rectosigmoid
  • dont have dysplasia
  • dont dev into CRC
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9
Q

mucosal polyps

A
  • non-neoplastic polyps
  • resemble adjacent tissue
  • no clinical significance
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10
Q

inflammatory pseudopolyps

A
  • irregularly shaped islands of intact mucosa
  • due to mucosal ulceration and regeneration
  • from IBD
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11
Q

submucosal polyps

A
  • non-neoplastic polyps
  • lymphoid, fibromas, or lipomas
  • lipomas most common
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12
Q

hamartamous polyps

A
  • non-neoplastic
  • grow in disorganized fashion
  • can dev dysplasia and lead to CRC
  • many polyposis syndromes derive from this polyp
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13
Q

adenomatous polyps

A
  • neoplastic
  • benign but will lead to cancer in 7-10 years if not removed
  • 2/3 of all colonic polyps
  • larger= more likely to be malignant
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14
Q

adenomatous polyp risk factors

A
  • older age
  • increased BMI, lack of physical activity
  • men > women
  • smoking
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15
Q

ways to prevent adenomatous polyps

A
  • low fat diet, high in fruits/ veggies/ fiber
  • normal body weight and exercise
  • decreased EtOH, esp beer
  • ASA and COX2 inhibitors
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16
Q

what subtype of adenomatous polyps are the worst

A
  • villous
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17
Q

ways to screen for polyps

A
  • colonoscopy*- gold std
  • fecal occult blood testing
  • double contrast barium enema- not common
  • CT colonography
  • flexible sigmoidoscopy
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18
Q

risks of colonoscopy procedure

A
  • perforation
  • significant bleeding
  • intolerance to sedation
  • dehydration or electrolyte imbalances (From prep)
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19
Q

pts that need colonoscopy f/u in 3-6 mo

A
  • large polyps > 2 cm

- concern for incomplete removal

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20
Q

pts that need colonoscopy in f/u in 3 years

A
  • > 1 villous adenoma

- multiple small tubular adenomas

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21
Q

pts that need colonoscopy f/u in 5 years

A
  • 1-2 small tubular adenomas
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22
Q

pts that need colonoscopy f/u in 10 years

A
  • no polyps

- small hyperplastic polyps

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23
Q

types of intestinal polyposis syndromes

A
  • lynch syndrome
  • familial adenomatous polyposis (FAP)
  • hamartomatois polyposis syndromes
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24
Q

when would you consider polyposis syndromes as cause of polyps

A
  • pt with family hx of CRC in more than 1 family member
  • personal or family hx CRC < 50 years old
  • personal or family hx of multiple polyps (> 20)
  • personal or family hx of multiple extracolonic malignancies
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25
lynch syndrome
- most common of inherited polyposis syndromes - very likely to turn malignant - mainly adenoma polyps - usually involves right colon - metachronous cancer common
26
typical metachronous cancer with lynch syndrome
- endometrial carcinoma
27
lynch syndrome treatment
- colectomy | - start monitoring with yearly colonoscopys at age 20-35
28
familial adenomatous polyposis (FAP)
- APC gene mutation - > 100 adenomas - 100% cancer prognosis, usually 20-30 years after dx - risk of extracolonic cancers, esp duodenum
29
gardner syndrome
- FAP with extracolonic manifestations | - desmoid tumors common
30
turcot syndrome
- FAP with brain tumors | - medulloblastomas
31
FAP screening
- genetic testing - yearly sigmoidoscopy at age 10-12 - yearly colonoscopy once polyp detected
32
FAP treatment
- colectomy - remaining rectum and ileal pouch screened q 6 mo- 2 years - EGD q 1-3 years - ppx with NSAIDs and COX2
33
hamartomatous polyposis syndromes
- very rare - famililal juvenile polyps - peutz- jeghers polyps
34
average risk for colorectal cancer
- 50-75 years old | - no si/sx of CRC and no RF
35
when do you stop screening for colorectal cancer in the elderly?
- 76-85 provider discretion | - > 85 stop screening
36
what is the most common etiology of colorectal cancer
- sporadic (75% of cases)
37
where is colorectal cancer most commonly found
- left side of colon
38
where are inherited colorectal cancers most commonly found
- right side of colon
39
where does colorectal cancer spread to?
- LN - liver - lungs - peritoneum
40
risk factors for colorectal cancer
- western diet- red meat, high fat - obesity - smoking and alcohol - AA > caucasian - hereditary polyposis syndromes - family hx - pt age - IBD - childhood abdominal radiation
41
colorectal cancer prevention
- diet rich in fruits, veggies, fiber - limit red meat - physical activity - NSAIDs and low dose ASA
42
clinical presentation of colorectal cancer
- usually asymptomatic - pos fecal occult blood test - change in bowel habits, narrowing of stool - tenesmus - dark stool, rectal bleeding - weight loss - intestinal obstruction, GI bleed, peritonitis- emergencies
43
what is the gold standard for dx colorectal cancer
- colonoscopy with biopsy
44
what is CEA
- blood marker - used as indicator of recurrence of colorectal cancer - NOT to be used as initial screening
45
what type of cancer is anal cancer most often?
- squamous cell- similar to skin cancer | - very rare type of cancer
46
what is the most common cause of anal cancer
- HPV
47
risk factors for anal cancer
- HPV - female - life time number of partners - warts - smoking - HIV infection - receptive anal intercourse - chronic immunosuppressive conditions
48
si/sx of anal cancer
- rectal bleeding, perianal itching - anorectal pain - rectal mass sensation - may be asymptomatic - mass felt on DRE
49
diagnosis of anal cancer
- anoscopy* - endoscopy with biopsy - rigid proctosigmoidoscopy
50
lymphatic drainage for anal cancer
- tumors above dentate line -> mesorectal and iliac nodes | - tumors below dentate line -> superficial inguinal and external iliac nodes
51
what is the difference between an ulcer and an erosion
- erosion- through mucosa, shallow | - ulcer- penetrates into muscularis, higher risk bleed and perforation
52
what are the common causes of PUD?
- h. pylori** - NSAIDs - alcohol - caffeine - smoking/ tobacco - severe physiologic stress - hypersecretory state (rare) - genetics
53
types of PUD
- gastric ulcer | - duodenal ulcer
54
gastric ulcers
- pain during or shortly after eating
55
duodenal ulcers
- pain hours after eating or awakens pt at night | - most common type of PUD
56
clinical manifestations of PUD
- epigastric pain- gnawing burning s/p meals - dyspepsia - chest pain or heart burn - hematemesis, coffee ground emesis, melena, hematochezia - anemia sx - if sudden onset either perforation or peritonitis
57
PE findings for PUD
- highly variable - abdominal tenderness - pos guaiac stool test - orthostatic BP/ tachycardia - chronic -> possible gastric outlet obstruction
58
work up for PUD
- h pylori testing* - endoscopy* - fasting gastrin levels to r/o hypersecretory syndromes - upper GI contrast study- less sensitive, no biopsy
59
treatment for PUD
- h pylori positive -> triple therapy - PPI 6-8 weeks or at least 1 year if pt has RF - d/c any irritants - endoscopy- epi injections, hemoclips, thermal coagulation
60
what is h pylori triple therapy
- omeprazole - clarythromycin - amoxicillin or flagyl
61
what is h pylori quadruple therapy
- alt to triple therapy - PPI - bismuth - tetracycline - flagyl
62
how do you test for h pylori
- urea test* - fecal Ag testing - serum IgG- not as sensitive if pt has been infected in last 3 years - rapid urease test via EGD bx

Clin Med III (26 decks)

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