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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
Q

lynch syndrome

A
  • most common of inherited polyposis syndromes
  • very likely to turn malignant
  • mainly adenoma polyps
  • usually involves right colon
  • metachronous cancer common
26
Q

typical metachronous cancer with lynch syndrome

A
  • endometrial carcinoma
27
Q

lynch syndrome treatment

A
  • colectomy

- start monitoring with yearly colonoscopys at age 20-35

28
Q

familial adenomatous polyposis (FAP)

A
  • APC gene mutation
  • > 100 adenomas
  • 100% cancer prognosis, usually 20-30 years after dx
  • risk of extracolonic cancers, esp duodenum
29
Q

gardner syndrome

A
  • FAP with extracolonic manifestations

- desmoid tumors common

30
Q

turcot syndrome

A
  • FAP with brain tumors

- medulloblastomas

31
Q

FAP screening

A
  • genetic testing
  • yearly sigmoidoscopy at age 10-12
  • yearly colonoscopy once polyp detected
32
Q

FAP treatment

A
  • colectomy
  • remaining rectum and ileal pouch screened q 6 mo- 2 years
  • EGD q 1-3 years
  • ppx with NSAIDs and COX2
33
Q

hamartomatous polyposis syndromes

A
  • very rare
  • famililal juvenile polyps
  • peutz- jeghers polyps
34
Q

average risk for colorectal cancer

A
  • 50-75 years old

- no si/sx of CRC and no RF

35
Q

when do you stop screening for colorectal cancer in the elderly?

A
  • 76-85 provider discretion

- > 85 stop screening

36
Q

what is the most common etiology of colorectal cancer

A
  • sporadic (75% of cases)
37
Q

where is colorectal cancer most commonly found

A
  • left side of colon
38
Q

where are inherited colorectal cancers most commonly found

A
  • right side of colon
39
Q

where does colorectal cancer spread to?

A
  • LN
  • liver
  • lungs
  • peritoneum
40
Q

risk factors for colorectal cancer

A
  • western diet- red meat, high fat
  • obesity
  • smoking and alcohol
  • AA > caucasian
  • hereditary polyposis syndromes
  • family hx
  • pt age
  • IBD
  • childhood abdominal radiation
41
Q

colorectal cancer prevention

A
  • diet rich in fruits, veggies, fiber
  • limit red meat
  • physical activity
  • NSAIDs and low dose ASA
42
Q

clinical presentation of colorectal cancer

A
  • 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
Q

what is the gold standard for dx colorectal cancer

A
  • colonoscopy with biopsy
44
Q

what is CEA

A
  • blood marker
  • used as indicator of recurrence of colorectal cancer
  • NOT to be used as initial screening
45
Q

what type of cancer is anal cancer most often?

A
  • squamous cell- similar to skin cancer

- very rare type of cancer

46
Q

what is the most common cause of anal cancer

A
  • HPV
47
Q

risk factors for anal cancer

A
  • HPV
  • female
  • life time number of partners
  • warts
  • smoking
  • HIV infection
  • receptive anal intercourse
  • chronic immunosuppressive conditions
48
Q

si/sx of anal cancer

A
  • rectal bleeding, perianal itching
  • anorectal pain
  • rectal mass sensation
  • may be asymptomatic
  • mass felt on DRE
49
Q

diagnosis of anal cancer

A
  • anoscopy*
  • endoscopy with biopsy
  • rigid proctosigmoidoscopy
50
Q

lymphatic drainage for anal cancer

A
  • tumors above dentate line -> mesorectal and iliac nodes

- tumors below dentate line -> superficial inguinal and external iliac nodes

51
Q

what is the difference between an ulcer and an erosion

A
  • erosion- through mucosa, shallow

- ulcer- penetrates into muscularis, higher risk bleed and perforation

52
Q

what are the common causes of PUD?

A
  • h. pylori**
  • NSAIDs
  • alcohol
  • caffeine
  • smoking/ tobacco
  • severe physiologic stress
  • hypersecretory state (rare)
  • genetics
53
Q

types of PUD

A
  • gastric ulcer

- duodenal ulcer

54
Q

gastric ulcers

A
  • pain during or shortly after eating
55
Q

duodenal ulcers

A
  • pain hours after eating or awakens pt at night

- most common type of PUD

56
Q

clinical manifestations of PUD

A
  • 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
Q

PE findings for PUD

A
  • highly variable
  • abdominal tenderness
  • pos guaiac stool test
  • orthostatic BP/ tachycardia
  • chronic -> possible gastric outlet obstruction
58
Q

work up for PUD

A
  • h pylori testing*
  • endoscopy*
  • fasting gastrin levels to r/o hypersecretory syndromes
  • upper GI contrast study- less sensitive, no biopsy
59
Q

treatment for PUD

A
  • 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
Q

what is h pylori triple therapy

A
  • omeprazole
  • clarythromycin
  • amoxicillin or flagyl
61
Q

what is h pylori quadruple therapy

A
  • alt to triple therapy
  • PPI
  • bismuth
  • tetracycline
  • flagyl
62
Q

how do you test for h pylori

A
  • 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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