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GI > Disorders of the Colon & Rectum High Yield > Flashcards

Disorders of the Colon & Rectum High Yield Flashcards

1
Q

MC demographics for UC and CD

A
  • UC: Males
  • CD: Females
  • Caucasians
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2
Q

Smoking is risk factor for which IBD?

A

CD

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3
Q

Characteristic description and location of CD

A

Terminal ileum with skip areas and transmural inflammation (cobblestoning)

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4
Q

Mass in RLQ in an IBD

A

CD

Crohn’s starts at the beginning of the colon

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5
Q

Skin findings seen in CD

A
  • Erythema nodosum
  • Pyoderma gangrenosum

CDE

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6
Q

Diagnosis of CD

A

Colonoscopy with biopsy showing skip areas and cobblestoning.

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7
Q

Goal of therapy in CD

A

Symptomatic relief and reduce flare ups.

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8
Q

Low risk CD treatment for ileum only

A

EC budesonide 9mg for 4 weeks, tapering down by 3mg every 2-4 weeks for 8-12 weeks of total therapy.

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9
Q

Tx for mild-mod CD with diffuse involvement

A

Oral prednisone 40mg 1 week, then 5-10mg taper every week.

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10
Q

Tx of relapse of mild-mod CD

A

Glucocorticoid + immunomodulator/biologic

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11
Q

High-risk criteria for CD

A
  1. Dxd younger than 30
  2. smoker
  3. Elevated CRP
  4. Deep ulcers
  5. Long segments of involvement
  6. Perianal disease
  7. Extra-intestinal manifestations
  8. Hx of bowel resection
  9. Failure to achieve remission
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12
Q

Tx for high-risk CD

A

TNF blocker + Immunomodulator

Infliximab + azathioprine C for combo

Alt is prednisone then maintenance with a biologic/TNF

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13
Q

MC location for UC

A

Rectum + sigmoid

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14
Q

Hallmark sign of UC

A

Bloody diarrhea

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15
Q

Extra-intestinal manifestations of UC

A
  • Arthritis
  • Ankylosing spondylitis
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16
Q

Severity grading for UC

A
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17
Q

MC Demographic for UC

A

Non-smokers

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18
Q

Gold standard for Dx of UC

A

Sigmoidoscopy showing continuous friable mucosa

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19
Q

Diagnosis of UC

A
  1. 4 weeks of chronic diarrhea
  2. Active inflammation of sigmoidoscopy
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20
Q

Who does NOT get a colonoscopy with suspected UC?

A

Severe disease or severe colitis dt/t risk of perf.

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21
Q

Main complications of UC

A
  • Toxic megacolon
  • Cancer
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22
Q

Recommended diet change for UC

A

Cessation of caffeine

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23
Q

Tx of mild-mod UC confined to rectosigmoid

A

Topical mesalamine (via enema or suppository)

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24
Q

Tx of mild-mod UC w/ spread past sigmoid

A

Oral mesalamine + topical mesalamine

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25
Q

Tx of mod-severe UC

A

Prednisone

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26
Q

Curative tx of UC

A

Total proctocolectomy w/ ileostomy

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27
Q

Maintenance tx of UC

A

Mesalamine

28
Q

CI of mesalamine/5-asa

A

ASA or sulfa allergy

29
Q

BBW of immunomodulators

A
  • Mutagenic potential
  • Rapidly growing malignancies or lymphoma

Azathioprine

30
Q

Methotrexate role in IBD

A

Only for CD if azathioprine failed.

Don’t use meth at UC

31
Q

BBW of TNF-blockers

A

Risk of serious infection

mabs

32
Q

ABX for IBD

A

Metronidazole or Ciprofloxacin if risk of abscess

33
Q

Live vaccine timeline if being treated for IBD

A

4 weeks before tx

34
Q

MC type of polyp

A

Mucosal adenomatous

35
Q

MC type of adenomatous polyp to be cancerous

A

Villous

villain = evil

36
Q

Risk factors that make adenomatous polyp more likely to be malignant

A
  1. Polyps > 1 cm
  2. Villous histology
  3. # of polyps
  4. Flat
37
Q

Characteristic of submucosal lesions

A

Made up of multiple tissue types

38
Q

Risk factors for colon cancer

A
  1. > 50
  2. FMHx
  3. High fat
  4. Smoking
  5. Obesity
39
Q

Average age of screening for colon cancer

A

45

40
Q

Presentation of proximal colon cancer

A
  • Anemia
  • Weakness/fatigue
  • Melena, positive FOBT
  • Wt loss
41
Q

Presentation of distal colon cancer

A
  • Change in bowel habits
  • Obstruction
  • Hematochezia
  • Tenesmus
42
Q

Diagnosis and staging of colon cancer

A
  • Diagnosis: Colonoscopy
  • Staging: CT/MRI

CEA is for prognosis

43
Q

Tumor marker to monitor established colon cancer

A

CEA

44
Q

How often is colonoscopy post resection of cancer?

A

1 year after, then 3 years if no more polyps.

45
Q

Classic FAP ages for development and cancer

A
  • Age 15 is polyp development
  • Age 40 will have cancer unless prophylactic colectomy done.
46
Q

Recommendations for suspected FAP

A

Complete proctocolectomy w/ anastomosis by age 20 and EGD every 1-3 years.

47
Q

Characteristics of Lynch syndrome

A
  • Risk inc for multiple cancers
  • Few polyps, but they are likely to be malignant
48
Q

3 tool screening for Lynch

A
  1. 1st degree relative with CRC before age 50
  2. Pt with CRC before age 50
  3. 3+ relatives with CRC

CRC = colorectal cancer

Genetic testing if positive

49
Q

Tx for Lynch

A
  • Subtotal colectomy w/ anastomosis
  • Prophylactic hysterectomy + oophorectomy at 40 or after done with having kids
  • EGD every 2-3 yrs at 30.
  • Colonoscopy every 1-2 yrs at 25.
50
Q

Separates internal and external hemorrhoids

A

Dentate line

51
Q

3 main locations for Hemorrhoids

A
  • Right anterior
  • Right posterior
  • Left Lateral

RAP LL

52
Q

What vein makes external hemorrhoids?

A

Inferior hemorrhoidal veins

53
Q

Presentation of symptomatic internal hemorrhoids

A
  • Bleeding
  • Prolapse
  • Mucoid discharge

Not really painful unless stage 4

54
Q

Conservative tx of hemorrhoids

A

Stage 1-2 is proper toileting and high fiber

55
Q

Tx of recurrent stage 1-2 or 3-4 hemorrhoids

A
  • Rubber band ligation (PREFERRED)
  • Injection sclerotherapy
56
Q

Tx of severe stage 3 or 4 hemorrhoids

A

Hemorrhoidectomy

57
Q

Tx of external hemorrhoids

A
  • Warm sitz
  • Ointment
  • Evacuate clot
58
Q

Main diff in presentation of external vs internal hemorrhoids

A

External hurts (and its external)

59
Q

MC location for anal fissures

A

Posterior midline

Anywhere else suggests disease

60
Q

What causes anal fissures usually?

A

Hard stools

61
Q

Tx of anal fissures

A

Eat fiber like a healthy person

Chronic = surgery

62
Q

MCC of perianal abscesses

A

Perianal fistulas

63
Q

Tx of perianal abscess

A
  • I&D
  • Maybe abx
  • Surgical excision
64
Q

Tx of perianal fistula

A

Surgical fistulotomy under anesthesia

65
Q

Tx of complete rectal prolapse

A

Surgery

Emergent if complete

66
Q

Pilondial disease

A

Like an extra anus

GI (17 decks)

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