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Q4 Clin Med III (GI) > Diverticulosis/itis, Colon CA > Flashcards

Diverticulosis/itis, Colon CA Flashcards

1
Q

Diverticulum is?

A

outpouching from colon wall

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2
Q

Diverticulosis is?

A

At least one diverticulum

Most C involves sigmoid

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3
Q

Diverticulitis is?

A

ACUTE SYMPTOMATIC episode of inflamed diverticulum

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4
Q

Diverticulosis develops how?

A

At weak point in colon wall where vasa recta penetrates mm layer

Mucosa/Submucosa herniates thru mm layer

(P) due to ↑ colon pressure, low fiber

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5
Q

Diverticulosis presentation?

A

(U) asympt
Cramp, D/C, bloat
Bleeding

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6
Q

Diverticulosis management: Asympt?

A

High fiber

Hydration

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7
Q

Diverticulitis caused by?

A

fecal obstruction of diverticulum or

↑ pressure -> divrt wall erosion -> necrosis -> perf

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8
Q

Microperforation U results in?

A

immediate walling-off of perf by pericolic fat/mesentary

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9
Q

Macroperforation may result in?

A

free air

peritonitis

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10
Q

Complicated Diverticulitis may include? (4)

A

Abscess
Fistula
Obstruction
Perforation

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11
Q

Diverticulitis presentation?

A

Progressive/constant/aching LLQ pain

N/V
D/C
Urinary sxs
Fever
Tachy (from pain)
LLQ tender and/or mass
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12
Q

Diverticulitis: if presents w/ urinary sxs, what must be r/o?

A

colovesicular fistual

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13
Q

Peritonitis probable if? (3)

A

rigid abdomen w/ guarding
rebound tender
no BS

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14
Q

Diverticulitis DDX?

A 
Colon CA
IBD
Pyeloneph/UIT
Pancreatitis
Cholecystitis
Nephrolithiasis
Ectopic pregnancy
Ovarian absc/torsion
PID
PUD
Appendicits
Ischemic Colitis
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15
Q

Diverticulitis Labs? (6)

A 
CBC
Stool occult (r/o rectal mass)
CMP (r/o other dz)
UA (r/o UTI)
Stool cx if D
hCG if W
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16
Q

Diverticulitis imaging: CT

A 
CT (TOC for acute):
Fat stranding
Bowel wall thickness
Diverticulosis
Complications (absc, fist, obst, perf)
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17
Q

Diverticulitis imaging: Other? (4)

A

Plain film (free air, obst, mass)
Compression US
Flex sig/colonoscopy (NOT for acute)
BE (NOT for acute)

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18
Q

Diverticulitis management: Uncomplicated

ABX?

A

Abx (G-/anaerob) 10-14d:
Metro (Flagyl) + Cipro or
Augmentin or
Flagyl + Bactrim

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19
Q

Diverticulitis management: Uncomplicated

Diet?

Edu?

F/U?

A

Clear liquids x 2-3 days,
Long term fiber

Watch for ↑ fever/pain, ↓ PO tolerance

Close F/U,
Colonoscp 4-6 wks post (r/o CA)

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20
Q

Diverticulitis hospitalization when? (8)

A 
Significant leukocytosis
High fever
Unmanageable pain
No PO tolerance
Comorbids
Immunocomp
Elderly
Complications
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21
Q

Diverticulitis management: In-pt non-surg?

A

IV abx to PO when pain ↓
(P) colonoscp
Edu: fiber, return if sxs

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22
Q

Diverticulitis management: In-pt surg EMERGENT?

A

Severe complications

No improvement 3-4 day w/ therapy

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23
Q

Diverticulitis management: In-pt surg non-emergent? (2)

A

1) Single attack in immunocomp or w/ evidence of complication
2) r/o CA

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24
Q

Diverticular bleeding caused by?

A

Injury to artery running length of diverticulum,

(U) R sided -> R diver wider w/ more vasa recta exposure

25
Q

Diverticular bleeding management: Large volume?

A

Hospitalization
Transfusion
(P) surg

26
Q

Colon Polyps: Types? (3)

A

1) Hyperplastic (Non-neopl/benign)
2) Pseudopolyps (Non-neopl -> Inflamm/IBD)
3) Adenoma (Neoplastic)

27
Q

Colon Polyps: Adenoma types? (3)

A

1) Tubular (most C)
2) Tubulovillous
3) Villous (highest CA risk)

28
Q

Colon Polyps: Adenoma epidemiology?

A

2/3 of all polyps
(C) >50 yo
(U) asympt
Source of almost all colon CA w/i 7-10 yrs

29
Q

High risk Adenoma characteristics? (3)

A

> 10mm
High grade dysplasia
Villous or tubulovillous

30
Q

Colorectal CA characteristics?

A

glandular cells lining colon/rectum

5 yr survival rate

31
Q

Colon CA U found where?

A

Left side of colon

32
Q

Colon CA risk factors? (8)

A 
Personal/FHx
>50yo
IBD >8yrs
Obesity
Smoking/Alcohol
High fat/low fiber/red meat diet
DM II
AfroAmer
33
Q

Colon CA presentation?

A

Asymtp is common

Abd pain
Bowel ∆s
Hematochezia
Weak/fatigue
Anorexia
Weight loss
Fe-deficiency anemia
34
Q

Colon CA common physical exam findings:

General?

Vitals?

Skin?

Lymph?

Abd?

Rectal?

A

General: cachexia (ill/wasting)

Vitals: wgt loss

Skin: pallor (anemia), dehydration

LAD

Abd: distention, ascites, mass, organomegaly

Rec: blood+ stool, mass

35
Q

Colon CA common lab findings:

CBC?

LFT?

Carcinoembryonic Antigen?

Chest/Abd/Pelvic CT?

A

CBC: Fe-defic anemia from blood loss

LFT: ↑alk phos w/ liver mets

CEA: use for monitoring, not screening

CT: r/o metastasis once diagnosed

36
Q

Colon CA common finding on X-Ray?

A

apple core lesion

37
Q

AJCC staging system?

A

Tumor/Node/Metastasis

38
Q

Colon CA management? (3)

A

1) Part colectomy w/ adjacent lymphnode
2) Chemo
3) Radiation (U) for rectal involvement

39
Q

Colon CA F/U? (3)

A

1) CEA levels Q 3-6mo for 3-5yrs post
2) CT chest/abd/pelvis annually
3) Colonoscopy w/i 1 yr of removal, if N repeat in 3 yrs then every 5

40
Q

Colon CA screening tests? (4)

A

1) colonoscopy
2) BE
3) flex sig
4) CT colon

41
Q

Colonoscopy benefits?

A

Visualize entire colon
Remove polyps
Take bx

42
Q

Colonoscopy disadv?

A

Req bowel prep
Req sedation
Perforation

43
Q

Barium Enema benefits?

Disadv?

A

No sedation

Barium
Req prep
Can miss polyps/CA
+ findings req colonoscopy

44
Q

Flexible Sigmoidoscopy benefits?

A

No sedation
Limited prep
Remove polyps
Low risk of perf

45
Q

Flexible Sigmoidoscopy disadv?

A

See only distal 1/3

+ polyp req colonosc to clear proximal colon

46
Q

CT colonoscopy benefits?

A

Produces 3D images
No sedation
No contrast
Very sensitive for polyps > 1cm

47
Q

CT colonoscopy disadv?

A

Need prep
+ polyps req colonsc
Can miss small polyps

48
Q

Colorectal CA detection tests: Hemoccult

A

Guaiac-based
Req 2 specimen on 3 consecutive stools
False + possible

49
Q

Colorectal CA detection tests: Fecal Immunochemical test

A 
PREFERRED TEST
Tests for globin
More specific than guaiac
Low false +
Less stool req
50
Q

Colon CA screening recommendations: No risk pts?

A

colonoscopy age 50 Q 10 yrs

51
Q

Colon CA screening recommendations: FHx?

A

1° relative w/ CRC/adeno polyps < 60yo
or
≥ two 1° relatives dx at any age

scopy every 5 yrs, @ 40yo or 10 yrs younger than age of relative's dx
---------
1° relative w/ CRC/adeno polyps ≥ 60yo
or
≥ two 2nd relatives dx at any age

scopy @ 40, if N screen as no risk pt

52
Q

Colon CA screening recommendations: Pt hx of CA?

A

adenomatous polyp or colon CA

scopy Q 5yrs

53
Q

Colon CA screening test frequency by test?

A 
Polyps and CA
------------------------
colonoscopy Q 10yrs
flex sig Q 5yrs
BE Q 5yrs
CT colonography Q 5yrs

Hemoccult annually
FIT annually

54
Q

Familial Adenomatous Polyps (FAP)?

A

Auto dominant APC mutation
>100 adeno polyps
100% WILL DEVELOP CRC
↑ risk of other CAs

55
Q

FAP tx?

A

Sig/colonscopy annually from 10yo - 40yo if neg
prophylactic colectomy if adeno > 1cm or villous
extracolonic CA screenings

56
Q

Hereditary Non-polyposis Colon CA (HNPCC)?

A 
"Lynch Synd"
Auto dominant
Multiple family members
70% develop CRC
↑ risk of other CAs (esp Endometrial)
57
Q

HNPCC presentation?

A

CRC onset young
(U) promixal tumor
Multiple CRCs or related CA

58
Q

HNPCC screening?

A

Annual scopy @ 20yo or 10yrs younger than earliest member’s onset

Annual screening for extracolonic CA

Q4 Clin Med III (GI) (32 decks)

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