Diverticulosis/itis, Colon CA Flashcards by Wendy Pitts

Diverticulum is?

outpouching from colon wall

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Diverticulosis is?

At least one diverticulum

Most C involves sigmoid

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Diverticulitis is?

ACUTE SYMPTOMATIC episode of inflamed diverticulum

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Diverticulosis develops how?

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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Diverticulosis presentation?

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

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Diverticulosis management: Asympt?

High fiber

Hydration

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Diverticulitis caused by?

fecal obstruction of diverticulum or

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

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Microperforation U results in?

immediate walling-off of perf by pericolic fat/mesentary

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Macroperforation may result in?

free air

peritonitis

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Complicated Diverticulitis may include? (4)

Abscess
Fistula
Obstruction
Perforation

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Diverticulitis presentation?

Progressive/constant/aching LLQ pain

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

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

colovesicular fistual

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Peritonitis probable if? (3)

rigid abdomen w/ guarding
rebound tender
no BS

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Diverticulitis DDX?

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

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Diverticulitis Labs? (6)

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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Diverticulitis imaging: CT

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

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Diverticulitis imaging: Other? (4)

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

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Diverticulitis management: Uncomplicated

ABX?

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

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Diverticulitis management: Uncomplicated

Diet?

Edu?

F/U?

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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Diverticulitis hospitalization when? (8)

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

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Diverticulitis management: In-pt non-surg?

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

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Diverticulitis management: In-pt surg EMERGENT?

Severe complications

No improvement 3-4 day w/ therapy

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

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

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Diverticular bleeding caused by?

Injury to artery running length of diverticulum,

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

Diverticular bleeding management: Large volume?

Hospitalization Transfusion (P) surg

Colon Polyps: Types? (3)

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

Colon Polyps: Adenoma types? (3)

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

Colon Polyps: Adenoma epidemiology?

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

High risk Adenoma characteristics? (3)

>10mm High grade dysplasia Villous or tubulovillous

Colorectal CA characteristics?

glandular cells lining colon/rectum | 5 yr survival rate

Colon CA U found where?

Left side of colon

Colon CA risk factors? (8)

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

Colon CA presentation?

Asymtp is common ``` Abd pain Bowel ∆s Hematochezia Weak/fatigue Anorexia Weight loss Fe-deficiency anemia ```

Colon CA common physical exam findings: General? Vitals? Skin? Lymph? Abd? Rectal?

General: cachexia (ill/wasting) Vitals: wgt loss Skin: pallor (anemia), dehydration LAD Abd: distention, ascites, mass, organomegaly Rec: blood+ stool, mass

Colon CA common lab findings: CBC? LFT? Carcinoembryonic Antigen? Chest/Abd/Pelvic CT?

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

Colon CA common finding on X-Ray?

apple core lesion

AJCC staging system?

Tumor/Node/Metastasis

Colon CA management? (3)

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

Colon CA F/U? (3)

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

Colon CA screening tests? (4)

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

Colonoscopy benefits?

Visualize entire colon Remove polyps Take bx

Colonoscopy disadv?

Req bowel prep Req sedation Perforation

Barium Enema benefits? Disadv?

No sedation Barium Req prep Can miss polyps/CA + findings req colonoscopy

Flexible Sigmoidoscopy benefits?

No sedation Limited prep Remove polyps Low risk of perf

Flexible Sigmoidoscopy disadv?

See only distal 1/3 | + polyp req colonosc to clear proximal colon

CT colonoscopy benefits?

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

CT colonoscopy disadv?

Need prep + polyps req colonsc Can miss small polyps

Colorectal CA detection tests: Hemoccult

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

Colorectal CA detection tests: Fecal Immunochemical test

``` PREFERRED TEST Tests for globin More specific than guaiac Low false + Less stool req ```

Colon CA screening recommendations: No risk pts?

colonoscopy age 50 Q 10 yrs

Colon CA screening recommendations: FHx?

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

Colon CA screening recommendations: Pt hx of CA?

adenomatous polyp or colon CA scopy Q 5yrs

Colon CA screening test frequency by test?

``` Polyps and CA ------------------------ colonoscopy Q 10yrs flex sig Q 5yrs BE Q 5yrs CT colonography Q 5yrs ``` CA detection only -------------------------- Hemoccult annually FIT annually

Familial Adenomatous Polyps (FAP)?

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

FAP tx?

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

Hereditary Non-polyposis Colon CA (HNPCC)?

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

HNPCC presentation?

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

HNPCC screening?

Annual scopy @ 20yo or 10yrs younger than earliest member's onset Annual screening for extracolonic CA