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clin med III, exam 1 > diverticulosis/itis and colon cancer > Flashcards

diverticulosis/itis and colon cancer Flashcards

1
Q

presence of small mucosal pockets in the colon

A

diverticulosis

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2
Q

diverticulosis is common in western countries due to

A

lack of fiber in diet

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3
Q

describe the colonic distribution of diverticulosis

A
  1. 95% involve sigmoid (most common)
    • 65% isolated to sigmoid
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4
Q

diverticulosis often presents as

A
  • most often asymptomatic
    • coincidental finding on imaging study or colonoscopy
    • occasional abd cramping, diarrhea, constipation, bloating
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5
Q

List the two main complications of diverticulosis

A
  • diverticulitis 15-25%
  • bleeding 5-15%
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6
Q

differentiate between two types of diverticulitis

A
  • simple (75% of cases)
  • complicated (35% of cases)
    • abscess
    • osbstruction
    • perforation
    • fistula
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7
Q

tx of asymptomatic diverticulosis

A
  • high fiber diet (20-35 g/d)
    • ​increases stool bulk reducing work of colon for bowel movement
  • adequate fluid hydration
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8
Q

define diverticulitis

A
  • an acute symptomatic episode corresponding to inflammation of a diverticula
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9
Q

how does diverticulosis develop into diverticulitis

A
  • fecal material obstructs neck of diverticulum or increased luminal pressure results in erosion of diverticular wall -> inflammation -> focal necrosis -> perforation
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10
Q

macroperforation caused by diverticulitis can lead to

A
  • free air
  • peritonitis
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11
Q

clinical presentation

  • progressive steady/aching LLQ pain
  • N/V (20-62%)
  • constipation (50%)
  • diarrhea (25-35%)
  • urinary symptoms (10-15%)
A

diverticulitis

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12
Q

when you see urinary symptoms in diverticulitis, what must you rule out

A
  • signs of colovesicular fistula
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13
Q

if patient presents with LLQ pain, what is an important question to ask them

A

prior h/o diverticulitis

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14
Q

What is the common clinical presentation of peritonitis

A
  • rigid abdomen with guarding
  • rebound tenderness
  • absent bowel sounds
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15
Q

lab studies to evaluate diverticulitis

A
  • CBC, CMP
  • stool for occult blood
  • UA
  • stool cultures if diarrhea
  • urine pregnancy
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16
Q

What is the test of choice for acute diverticulitis

A
  • CT scan with contrast
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17
Q

what tests are contraindicated in acute diverticulitis

A
  • flexible sigmoidoscopy
  • colonoscopy
  • barium enema

**all increase risk of perforation

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18
Q

tx of uncomplicated diverticulitis

A
  • abx: choose gram negative/anaerobic coverage x 10-14 days
    • Ex: metronidazole (flagyl) AND ciprofloxacin
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19
Q

managment of diverticulitis following acute episode

A
  • long term daily fiber intake
  • colonscopy 4-6 weeks following acute episode to r/o colon CA
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20
Q

Describe the bleeding that occurs in 15% of patients with diverticulosis

A
  • painless bleeding
    • ​not an inflammatory process
  • can be large in volume
  • usually resolves spontaneously (75%)
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21
Q

inpatient management of diverticulitis

A
  • IV abx therapy (gram negative and anaerobes)
  • transition to PO abx when pain improves, continue for 10-14 d
  • colonoscopy 4-6 weeks following acute attack
  • fiber supplementation
22
Q

diverticular bleeding usually occurs on what side of the colon

A
  • Rt side (50-90%)
    • diverticulum are wider and have more exposure of vasa recta
23
Q

management of diverticular bleeding

A
  • large volume -> hospitalize, transfusion?
  • locate source of bleeding
    • EGD/ NG gastric lavage (r/o UGI source)
    • Flex seg or colonoscopy
    • RBC scan
24
Q

What are hyperplastic polyps

A
  • non-neoplastic
  • benign
25
Q

What are pseudopolyps

A
  • non-neoplastic
  • inflammatory/IBD
26
Q

List the three types of colon adenomas (polyps)

A
  • tubular adenoma
  • tubulovillous adenoma
  • villous adenoma
27
Q

which type of colon adenomas (polyps) is the most common

A

tubular adenoma

28
Q

which type of colon adenomas (polyps) has the highest cancer risk

A

villous adenoma

29
Q

almost all colorectal cancers develop from . What is the time frame?

A
  • adenomas
    • ​<5% of adenomas -> colorectal cancer
  • time for adenoma to develop into colon cancer is 7-10 yrs
30
Q

what makes an adenoma a high risk for colorectal cancer

A
  • >10mm
  • high grade dysplasia
  • villous component
    • villous or tubulovillous
31
Q

What is the most common site of origin of colorectal cancer

A
  • left sided colon (descending)
32
Q

list the risk factors for colorectal cancer

A
  • personal or family h/o
    • adenoma or colon cancer
    • FAP/HNPCC
  • age > 50
  • Inflammatory bowel disease (colitis longer than 8-10 yrs)
  • obesity
  • diet: high fat/low fiber
  • african american
  • type II DM
33
Q

clinical presentation

  • often asymptomatic
  • abd pain
  • change in bowel habits
  • hematochezia or occult blood in stool
  • weakness and fatigue
  • anorexia
  • weight loss
  • iron deficiency anemia
A

colorectal cancer

34
Q

colon cancer can present with what classic sign using barium enema

A
  • “apple core” lesion
35
Q

What three guidelines are used to screen patients for colorectal cancer

A
  • multisociety task force guidelines
  • united states preventative services task force
  • american college of gastroenterology
36
Q

What is the best test to prevent/screen for colorectal cancer

A
  • colonoscopy
    • ability to visualize, remove polyps, take biopsies
    • requires bowel prep
    • requires sedation
    • perforation/bleeding risk 1/1000
37
Q

list the options for CRC screening

A
  • colonoscopy: every 10 years
  • barium enema: every 5 years
  • flexible sigmoidoscopy: every 5 years
  • CT colonography : every 5 years
38
Q

describe barium enema

A
  • colon coated with barium, air inserted via rectal catheter to distend colon. radiographs taken under fluoroscopy
    • requires bowel prep
    • no sedation
    • positive findings -> colonoscopy
    • can miss polyps
39
Q

describe flexible sigmoidoscopy

A
  • can see distal 1/3 of colon
  • no sedation
  • enema required
  • can remove polyps
    • if polyps found -> colonoscopy
40
Q

describe CT colonography

A
  • produces 2D/3D images of bowel mucosa
  • no sedation
  • no IV contrast
  • requires bowel prep
  • positive -> colonoscopy
  • can miss flat or smaller polyps
41
Q

List the CRC detection tests

A
  • hemoccult testing-guaiac based
    • requires 2 specimens on 3 consecutive stools
  • FIT: fecal immunochemical test
  • fecal DNA
42
Q

What is preferred CRC detection test

A
  • FIT: fecal immunochemical test
    • tests for human globin
    • test annually
43
Q

when should screening for colorectal cancer screening start

A
  • if no risk factors, begin at age 50
44
Q

what is the multi-society task force recommendation for CRC screening if positive FHx

A
  1. 1st degree relative with CRC or adenomatous polyp dx < 60 yo or > or = two 1st degree relatives dx at any age
    • colonoscopy every 5 years beginning at age 40 or ten years prior to age of dx
  2. 1st degree relative with CRC or adenomatous polyp dx > 60 yo or > or = two 2nd degree relatives dx at any age
    • begin screening age 40
45
Q

multi-society task force recommendation for CRC screening if personal history of adenomatous colon polyp or colon cancer

A
  • colonoscopy every 5 yaers
  • stop screening when life expectancy < 10 yrs
46
Q

american college of gastroenterology recommends african americans be screened for CRC at what age

A

45 yo

47
Q

What is familial adenomatous polyps

A
  • autosomal dominant
    • associated with APC gene mutation
  • >100 adenomatous polyps
  • 100% will develop CRC (Average age 45)
48
Q

patients with familial adenomatous polyps also have an increased risk for

A
  • extracolonic cancer
    • duodenoal/ampullary
    • thyroid
    • gastric
    • hepatoblastoma
    • CNS tumors
49
Q

screening recommendations for patients who are gene carriers for or have a family hx of familial adenomatous polyps

A
  • sigmoidoscopy or colonoscopy annually starting at age 10-12 until 35-40 if negative
  • will also require screening for extracolonic cancer
50
Q

what is Hereditary non-polyposis colon cancer (lynch syndrome)? what cancers is this patient at increased risk of getting

A
  • autosomal dominant
  • risk of developing CRC = 70%
    • mean age 40-45
    • usually right sided colon ca
  • increased risk of multiple cancers
    • endometrial (most common)
51
Q

screening recommendations for Hereditary non-polyposis colon cancer

A
  • annual colonoscopy age 20-25 or 10 years prior to earlier age of onset of affected family member
  • also requires annual screening for extracolonic malignancies

clin med III, exam 1 (5 decks)

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