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Surgery Rotation > EOR GI part 9- IBD, HCC, jaundice > Flashcards

EOR GI part 9- IBD, HCC, jaundice Flashcards

1
Q

At-risk population for Crohn’s dz

A

High in the Jewish population
Low in the African black population
Similar rates between AA and US white populations

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2
Q

Sex risk for Crohn’s

A

F>M

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3
Q

Distribution for age in Crohn’s

A

Bimodal
Peak incidence at 25-40 yrs
Second peak at 50-65 yrs

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4
Q

At-risk population for ulcerative colitis

A

High in the Jewish population
Low in the AA population
Pos FHx in 20% of cases

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5
Q

Sex risk for ulcerative colitis

A

M>F

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6
Q

Age distribution in ulcerative colitis?

A

Bimodal at 20-35 and 50-65

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7
Q

Initial sx of Crohn’s

A 
Abdominal pain
Diarrhea
Fever
Wt loss
Anal dz
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8
Q

Initial sx of ulcerative colitis?

A

Bloody diarrhea (hallmark)
Fever
Wt loss

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9
Q

Anatomic distribution of Crohn’s

A

Mouth to anus
Small bowel only (20%)
Small bowel and colon (40%)
Colon only (30%)

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10
Q

Anatomic distribution of ulcerative colitis

A

Colon only

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11
Q

Route of spread of Crohn’s

A

Small bowel, colon or both with skip areas

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12
Q

Route of spread of ulcerative colitis

A

Almost always involves the rectum and spreads proximally always in a continuous route without skip areas

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13
Q

What is backwash ileitis?

A

Mild inflammation of the terminal ileum in ulcerative colitis
Thought to be backwash of inflammatory mediators from the colon into the terminal ileum

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14
Q

Bowel wall involvement in Crohn’s

A

Full thickness (transmural involvement)

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15
Q

Bowel wall involvement in ulcerative colitis

A

Mucosa/submucosa only

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16
Q

Anal involvement in Crohn’s

A

Common (fistulae, abscesses, fissures, ulcers)

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17
Q

Anal involvement in ulcerative colitis

A

Uncommon

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18
Q

Rectal involvement in Crohn’s

A

Rare

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19
Q

Rectal involvement in ulcerative colitis

A

100%

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20
Q

Mucosal findings in Crohn’s

A 
Aphthoid ulcers
Granulomas
Linear ulcers
Transverse fissures
Swollen mucosa
Full-thickness wall involvement
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21
Q

Mucosal findings in ulcerative colitis

A 
Granular, flat mucosa
Ulcers
Crypt abscess
Dilated mucosal vessels
Pseudopolyps
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22
Q

Diagnostic tests for Crohn’s

A

Colonoscopy with bx
Barium enema
UGI with small bowel follow through
Stool cultures

23
Q

Diagnostic tests for ulcerative colitis

A

Colonoscopy
Barium enema
UGI with small bowel follow through (to look for Crohn’s dz)
Stool cultures

24
Q

Complications of Crohn’s

A 
Anal fistula/abscess
Fistula
Stricture
Perforation
Abscesses
Toxic megacolon
Colovesical fistula
Enterovaginal fistula
Hemorrhage
Obstruction
CA
25
Q

Complications of ulcerative colitis

A 
CA
Toxic megacolon
Colonic perforation
Hemorrhage
Strictures
Obstruction
Complications of surgery
26
Q

CA risk for Crohn’s

A

Overall increased risk, but about half that of ulcerative colitis

27
Q

CA risk for ulcerative colitis

A

~5% risk of developing colon CA at 10 yrs; then risk increases ~1% per year

28
Q

Indications for surgery in Crohn’s dz

A 
Obstruction
Massive bleed
Fistula
Perforation
Suspicion of CA
Abscess (refractory to medical tx)
Toxic megacolon (refractory to medical tx)
Strictures
Dysplasia
29
Q

Indications for surgery in ulcerative colitis

A 
Toxic megacolon refractory to medical tx
CA prophylaxis
Massive bleed
Failure of child to mature because of dz and steroids
Perforation
Suspicion of or documented CA
Acute severe sx refractory to medical tx
Inability to wean off of chronic steroids
30
Q

What are the common surgical options for ulcerative colitis?

A

Total proctocolectomy, distal rectal mucosectomy and ileoanal pull through
Total proctocolectomy and Brooke ileostomy

31
Q

What is toxic megacolon?

A

Toxic pt: sepsis, febrile, abdominal pain

Megacolon: acutely and massively distended colon

32
Q

What are the medication options for treating IBD?

A 
Sulfasalazine, mesalamine (5-aminosalicylic acid)
Steroids
Metronidazole
Azathioprine
6-mercaptopurine
Infliximab
33
Q

What meds are used fro Crohn’s but not ulcerative colitis?

A

Methotrexate

Antibiotics

34
Q

What are infliximab, adalimumab, certolizumab, anatlizumab?

A

Monoclonal antibodies versus TNF-alpha

35
Q

What is the most common primary malignancy of the liver?

A

Hepatocellular carcinoma (HCC)

36
Q

By what name is HCC also known?

37
Q

What is the incidence of HCC?

A

80% of all primary malignant liver tumors

38
Q

What are the associated RFs of HCC?

A

Hep B
Cirrhosis
Aflatoxin

39
Q

S/sx of HCC

A

Dull RUQ pain

Hepatomegaly

40
Q

What tests should be ordered for HCC?

A

U/s
CT
Angiography
Tumor marker elevation

41
Q

What is the tumor marker for HCC?

A

Elevated alpha-fetoprotein

42
Q

What is the MC way to get a tissue dx with HCC?

A

Needle bx with CT scan, u/s, or laparoscopic guidance

43
Q

What is the MC site of metastasis with HCC?

44
Q

Tx of HCC

A

Surgical resection , if possible

Liver transplant

45
Q

What are the tx options if an HCC pt is not a surgical candidate?

A

Percutaenous ethanol tumore injection
Cryotherapy
Intra-arterial chemo

46
Q

What are the indications for liver transplantation?

A

Cirrhosis and NO resection candidacy as well as no distant or LN metastases and no vascular invasion
The tumor must be single <5 cm tumor or have three nodules, with none >3 cm

47
Q

At what level of serum total bilirubin does one start to get jaundiced?

48
Q

Classically what is thought to be the anatomic location where one first finds evidence of jaundice?

A

Under the tongue

49
Q

What are the s/sx of obstructive jaundice?

A 
Jaundice
Dark urine
Clay-colored stools
Pruritis
Loss of appetite
Nausea
50
Q

What is obstructive jaundice?

A

Jaundice (hyperbilirubinemia >2.5) from obstruction of bile flow to the duodenum

51
Q

DDx of proximal bile duct obstruction

A 
Cholangiocarcinoma
LAD
Metastatic tumor
Gallbladder carcinoma
Sclerosing cholangitis
Gallstones
Tumor embolus
Parasites
Postsurgical stricture
Heptatoma
Benign bile duct tumor
52
Q

DDx of distal bile duct obstruction

A 
Choledocholithiasis
Pancreatic carcinoma
Pancreatitis
Ampullary carcinoma
LAD
Pseudocyst
Postsurgical stricture
Ampulla of Vater dysfunction/stricture
Lymphoma
Benign bile duct tumor
Parasites
53
Q

Whatis the initial study of choice for obstructive jaundice?

54
Q

What lab results are associated with obstructive jaundice?

A

Elevated alk phos

Elevated bilirubin with or without elevated LFTs

Surgery Rotation (19 decks)

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