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Clin Med 2 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Patho of nausea/vomiting

A

Visceral afferent fibers
Vestibular system
High CNS (amygdala, like sights or smells)
Area postrema (CTZ)

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2
Q

Acute vomiting

A

Less than 1 week, usually gastroenteritis, febrile illness or drugs

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3
Q

Cyclic vomiting syndrome

A

Idiopathic disorder, recurrent, stereotypical bouts of vomiting with intervening periods of normal health

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4
Q

Boerhaave syndrome

A

Rupture of the esophagus due to vomiting

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5
Q

Non pharm nausea traetment

A

Ginger or acupressure at P6 on wrist

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6
Q

Bout of hiccups

A

Less than 48 hours

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7
Q

Intractable hiccups

A

Greater than 1 month of hiccups

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8
Q

Common clinical setting for intractable hiccups

A

Chronic renal failure

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9
Q

Singultus

A

Hiccups

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10
Q

Organic versus psychogenic hiccups

A

Organic- hiccups do not go away when you sleep

Psychogenic- hiccups do go away when you sleep

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11
Q

Belching is not a symptom of…

A

Organic disease

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12
Q

Aeorophagia

A

Excessive swallowing of air (sucking air into the stomach)

Functional GI disorder caused by many things

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13
Q

Volume problem in gas

A

Hydrogen nitrogen and methane

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14
Q

Odor problem with gas

A

Sulfur gases and short chain fatty acids

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15
Q

Gas production

A

Bacterial fermentation of unabsorbed foods

Malabsorption (lactose and fructose)

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16
Q

FODMAPS

A

Foods that causes gas formation

Fermentable, oligosaccharides, disaccharides, monosaccharides, polyols

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17
Q

Constipation definition

A

Disturbance in defecation that may include

Infrequent stools less than 3 times a week

Difficult stool passage

Abdominal discomfort/bloating

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18
Q

Normal transit time

A

34-35 hours and up to 72 hours

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19
Q

Normal transit constipation

A

Incomplete evacuation

Psychosocial distress

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20
Q

Slow transit constipation

A

Infrequent stools, lack of urge, poor response to fiber and laxatives

Colonic motor dysfunction or inadequate caloric intake

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21
Q

Diagnosis of chronic constipation

A

Symptoms for >3 months (with onset >6 months prior to diagnosis)

  1. 2 or more of the long list
  2. Loose stools are rarely present without the use of laxatives
  3. Insufficient criteria for IBS
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22
Q

Alarm symptoms

A

Fever, anorexia, n/v, blood in stool, anemia, weight loss >10 lbs, colon cancer hx, constipation after age 50, acute constipation in an elderly patient

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23
Q

Diagnostic tools for defecatory disorders

A

Anorectal manometry (pressure in the different sphincters)

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24
Q

Acute diarrhea definition

A

Increased stool frequency (>3 BM/day) or liquidity of stool less than 2 weeks

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25
Q

Non inflammatory diarrhea symptoms

A 
Watery
Cramping, bloating, N/V
Small bowel source
Vomiting (food poisoning)
Mild to voluminous
No fecal leukocytes
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26
Q

Inflammatory diarrhea symptoms

A 
Blood or pus
Fever
LLQ cramps
Urgency, tenesmus
Distinguish from ulcerative colitis
Tissue damage from invasive organism or toxin
Smaller volume
Fecal leukocytes with invasive organisms
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27
Q

Antidiarrheal agents

A

Opioid agents

Bismuth subsalicylate

Anticholinergics

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28
Q

Chronic diarrhea

A

Decrease in fecal consistency lasting for >4 weeks

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29
Q

Secretory or osmotic?

A

Fecal osmotic gap < 50 is a secretory diarrhea caused by incomplete electrolyte absorption

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30
Q

Secretory diarrhea

A

Excessive stool water due to presence of Extra electrolytes resulting from reduction of electrolyte absorption or stimulation of electrolyte secretion in the intestine

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31
Q

Osmotic diarrhea

A

Due to ingestion of poorly absorbed cations, anions or carbohydrate malabsorption

Increased stool osmotic gap

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32
Q

Evaluating osmotic diarrhea

A

Stool pH, increased with malabsorbed carbs

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33
Q

Clues to malabsorptive diarrhea

A

Weight loss, steatorrhea, abnormal lab values, fecal fat >10 g in a day

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34
Q

Maldigestive diarrhea causes

A

Pancreatic enzyme insufficiency

Lipase inhibitor

Bile acid deficiency

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35
Q

Vibrio cholerae

A

Food and salt water

1-7 day course

Rice water stool, could be up to 1 L in an hour

Curved GNR!

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36
Q

Staph food borne dz

A

Toxin causes vomiting and diarrhea

Custards, canned foods/meat

1-2 day course, starts 2-6 hours after eating contaminated food

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37
Q

Bacillus cereus

A

Spores on grains, rice and veggies

It is identical to staph aureus disease

Diarrheal disease, 12 hours post ingestion, gets farther through the gut

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38
Q

Clostridium perfringens

A

Severe dz in soft tissue, toxin produced in gut after LARGE inoculum

Better within 24 hours

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39
Q

Shigella

A

Low infectious dose, high attack rate

Inflammatory, causes shiga toxin, bloody mucoid small volume stools

Usually self limited but can progress to dysentery

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40
Q

Shigella complications

A

Reiter’s syndrome

Hemolytic uremic syndrome

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41
Q

Campylobacter jejuni

A

Raw milk, undercooked chicken

Only one with prodrome!! Fever, HA, myalgia, malaise

Can cause guillan barre

Usually self limited

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42
Q

Salmonella gastroenteritis

A

From animals

Can disseminate from gut into circulation

Abrupt onset of fever, chills, cramps, diarrhea, HA and vomiting

Symptomatic treatment

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43
Q

Enterotoxigenic E Coli

A

Traveler’s diarrhea

Watery diarrhea that lasts 1-3 days

Pepto is an effective preventative measure

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44
Q

Shigatoxin producing E. coli aka 0157 H7

A

Food borne, warm months, kids and elderly

Bloody diarrhea, causes hemolytic uremic syndrome

Toxic effects that are made worse by antibiotics

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45
Q

Protozoan infections

A

Low infectious doses

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46
Q

Giardia

A

Trophozoites block absorption of fat and protein

Greasy, foul smelling stool

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47
Q

Cryptosporidiosis

A

Profuse, watery diarrhea

5-10 days

Bad in immunocompromised

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48
Q

Cyclospora

A

Dangerous in immunodeficient patients

Found on imported fruits

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49
Q

Entamoeba histolytica

A

Can cause liver abscesses

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50
Q

Viral gastroenteritis

A

Osmotic diarrheas, like rotavirus

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51
Q

Norovirus

A

Fecal/oral

2-3 day course

Sudden N/V/D

Self limited but careful disinfection needed

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52
Q

Taenia solium

A

In pork

Can migrate to eyes and brain, causes punched out lesions in the brain

Common in Latinos

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53
Q

Tapeworm treatment

A

Praziquantel

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54
Q

Enterobiasis

A

Pinworm

Females migrate to anus to lay eggs at night, causes intense pruritis

Scotch tape test, look under microscope

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55
Q

Ascaris lumbricodes

A

Eggs ingested and hatch in small intestine

Migrate to liver, heart and lungs and are free swimming and cause damage

Intense hypersensitivity reactions (eosinophilia)

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56
Q

Upper and lower esophageal spinchter pressures

A

UES is 60

LES is 10-45

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57
Q

Unique property of esophagus

A

No serosa, doesn’t protect the esophagus

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58
Q

Esophageal mucosal layers

A

Squamous epithelium for most, transitions to columnar epithelium at the Z line

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59
Q

Peristalsis of esophagus

A

Vagus nerve

Myenteric plexus- acetycholine is excitatory and NO is inhibitory

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60
Q

Afferent sensory input for the esophagus

A

Meissner’s complex

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61
Q

Esophageal etiology of chest pain

A

> 1 hour of pain

Postprandial, non radiating pain

Associated symptoms like heartburn or regurg

Relieved by antacid

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62
Q

Candida esophagitis

A

Usually C albicans, highest risk if HIV. Patients with CD4 less than 100

Barium swallow looks shaggy

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63
Q

CMV esophagitis

A

Serious complication of AIDS

Reactivation of latent disease

Large, flat and shallow ulcers with high risk of perforation

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64
Q

Herpetic esophagitis

A

HSV type 1, reactivation via vagus nerve or direct oral pharyngeal infection

Bone marrow and organ transplant recipient

Well circumscribed ulcers with volcano like appearance, multinulceated giant cells

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65
Q

Medication induced esophagitis

A

Usually at anatomical sites of esophageal narrowing, near aortic arch

Direct irritant effect causing caustic injury

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66
Q

Caustic esophageal injury

A

Accidental injury usually in children <5 years old

Usually strong alkali substance which is worse than acid

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67
Q

Eosinophilic esophagitis

A

Inflammatory response from food allergies, genetics, etc

Peripheral eosinophilia

Endoscopy with bx is key

Rule out GERD!

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68
Q

Achalasia

A

Global esophageal motor disorder causing slowly progressive dysphagia with episodic regurgitation and cheat pain

Loss of peristalsis and failure of LES relaxation

**bird beaked appearance on barium swallow

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69
Q

Achalasia patho

A

Degeneration of ganglion cells in myenteric plexus of esophageal wall

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70
Q

Achalasia diagnostics

A

Conventional manometry is required for diagnosis

Aperistalsis in distal 2/3 of esophagus, incomplete LES relaxation

Elevated resting LES pressure >45

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71
Q

Type 1 achalasia

A

Swallowing results in no significant change in esophageal pressurization

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72
Q

Type 2 achalasia

A

Swallowing results in simultaneous pressurization that spans the entire length of the esophagus

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73
Q

Type 3 achalasia

A

Swallowing results in abnormal lumen obliterating contractions or spasms

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74
Q

Achalasia management

A

Decrease resting LES pressure, mechanical disruption of muscles or biochemical reduction

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75
Q

Distal esophageal spasm

A

Rare

Dysphagia is most common symptom

Malfunction in nitrous oxide

Excess numbers of simultaneous contractions in the distal esophagus is the hallmark finding on manometry

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76
Q

DES on manometry

A

Simultaneous contractions in the distal esophagus with normal relaxation of the LES

Normal mean integrated relaxation pressure, >20% premature contractions

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77
Q

Barium radiography in DES

A

Can show rosary bead or corkscrew esophagus

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78
Q

Nutcracker esophagus

A

High amplitude peristaltic contractions in the distal 10 cm of esophagus

Average distal esophageal peristaltic pressures >220 after 10 or more 5 mL swallows

Vigorous contractions with normal relaxation of LES

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79
Q

Scleroderma esophagus

A

Smooth muscle atrophy and fibrosis

Replaced by scar tissue

Heartburn, regurgitation, dysphagia

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80
Q

Zenker’s diverticulum

A

Posterior outpouching of esophageal mucosa through killian’s triangle

Debilitating dysphagia and regurgitation of food

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81
Q

Schatzki ring

A

Circumferential at lower esophageal ring

Solid dysphagia

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82
Q

Esophageal webs

A

Non circumferential, thin membrane of squamous mucosa

Mid or upper esophagus

Congenital or acquired, usually asymptomatic

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83
Q

Plummer Vinson sydrome

A

Triad: severe iron deficiency, dysphagia, cervical esophageal web

White women 4th decade of life

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84
Q

Esophageal cancer etiologies

A

Squamous cell- proximal two thirds of esophagus

Adenocarcinoma- most common in US, distal third of esophagus

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85
Q

Risk factors of esophageal cancer

A

Male, >50 years old, smoking and alcohol (most common), etc

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86
Q

Common sites of mets for esophageal cancer

A

Liver, lungs, bones and adrenal glands

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87
Q

Esophageal cancer treatment

A

Palliative care, like adequate swallowing and nutritional status

Consider esophagectomy unless tumors, distant mets or invasion

Chemo if inoperable

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88
Q

Esophageal cancer prognosis

A

Less than 20% 5 year survival rate

2 most important predictors of poor outcomes - adjacent mediastinal spread, lymph node involvement

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89
Q

Dyspepsia

A

Upper abdominal pain/discomfort

ROME III criteria

No structural dz can explain symptoms

90
Q

Rome III criteria

A

Epigastric pain/burning

Early satiety

Postprandial fullness

91
Q

Diagnostics of dyspepsia patients >55 OR with alarm symptoms

A

Endoscopy

92
Q

Gastropathy

A

Epithelial/endothelial damage without inflammation

93
Q

Gastritis

A

Damage with inflammation

94
Q

Diagnosis of gastritis

A

May see drop in Hgb/HCT, endoscopy if GI. Bleed expected

No correlation between symptoms and severity

95
Q

Helicobacter pylori infection

A

Spiral gram negative rod

Inflammation and injury

Can be an acute illness or a chronic infection that is asymptomatic, gastritis, etc.

96
Q

H pylori diagnostics

A

Fecal Ag immunoassay or urea breath test

97
Q

NSAID gastritis

A

Chronic NSAIDs, be aware of alarm symptoms

Change to a Cox 2 because it decreases ulcer chances but try to discontinue NSAIDs

98
Q

Stress gastritis

A

Gastric mucosa erosions present in 75% of critically ill patients

Stress is medical or physiological, like septic shock

99
Q

Pernicious anemia gastritis

A

Autoimmune destruction

Decreased intrinsic factor secretion and b12 malabsorption

Decreased acid production, elevated gastrin production, can lead to tumor formation

100
Q

Portal hypertensive gastropathy

A

Congestion of vessels of stomach from portal HTN

Rarely significant

BBs to reduce portal pressure and reduce risk of bleeding

101
Q

Diagnosis of GERD

A

Clinical dx, heartburn that is relieved with antacids, worse at night and worst after 30-60 minutes after meals

102
Q

Atypical clinical findings of GERD

A

Asthma/cough/sore throat

Noncardiac chest pain

Globus sensation

103
Q

Barrett’s esophagus

A

Complication of GERD

Squamous epithelium replaced by columnar epithelium

11-30x increased risk of esophageal cancer

Aggressive PPI therapy!

104
Q

Peptic stricture

A

Complication of GERD

Progressive dysphagia to solids over months to years

105
Q

Nissen fundoplication

A

Wrap fundus around lower 6 cm of esophagus, helps constrict the LES

90% resolution of GERD sx, but same as long term PPI

106
Q

PUD

A

Break in gastric mucosa or duodenum extending through the muscle

Usually > 5 mm in size

107
Q

Causes of PUD and most common site

A

H pylori

NSAIDs

Antrum is the most common site

108
Q

PUD manifestations

A

Dyspepsia/epigastric pain

May wake patient up, gnawing dull and aching

Constant pain is at risk for perforation

Usually better with antacids

109
Q

Zollinger ellison syndrome

A

Around 41 years old

Gastric secreting neuro endocrine tumor, MEN-1 25%

Usually in duodenum

“Gastrinoma triangle”

110
Q

Gastrinoma aka zollinger Ellison syndrome

A

Over 2/3 of the tumors are malignant

Fasting serum gastrin level (will be incrased)

Check gastric pH

111
Q

Zollinger Ellison diagnostics

A

Secretin stimulation test

Secretin inhibits gastic G cells, increases gastrin secretion in Gastrinoma

112
Q

Zollinger Ellison syndrome diagnostics

A

Somatostatin receptor scintigraphy

Radiolabeled octreotide

Will be revealed what was not seen on CT scan

113
Q

Gastric cancer types

A

Intestinal (most common), H pylori

Diffuse or signet cell, dismal prognosis

114
Q

Gastric cancer diagnosis

A

Alarm sx

Gastric mass maybe

Signs of mets, like virchow node, sister mary Joseph nodule (umbilical node), rigid rectal shelf, ovarian mets

115
Q

Gastric cancer treatment

A

Palliative care is key cause not usually curable

116
Q

Ligament of treitz

A

Dividing line for upper and lower GI bleed

Suspensions ligament of the duodenum, marks the start of the jejunum

117
Q

Upper GI bleed general

A

More common than lower

Ulcer disease is a common cause

118
Q

Dieulafoy’s lesion

A

Abnormal dilated submucosal artery that erodes overlying mucosa and bleeds

In stomach

119
Q

Mallory Weiss tear

A

Non penetrating mucosal tear in the esophagus, usually at GE junction

Occurs with forceful vomiting or retching, causing painless hematemesis

120
Q

Esophageal varices

A

Dilated submucosal veins, generally distal esophagus

Portal HTN

Asymptomatic until they bleed, more significant bleeding than Mallory Weiss

121
Q

Upper GI bleed clinical findings

A

Hematemesis- frank blood or coffee grounds emesis

Melena 50-100 mL of blood in GI tract

122
Q

Upper GI bleed lab findings

A

CMP- increased BUN without change in Cr from digestion of blood in small bowel

Hb levels usually normal in early bleed

123
Q

Lower GI bleed findings

A

Hematochezia- brown stools with blood mixed or streaked

Large volume bright red blood- colon

Maroon stools- small bowel or ascending colon

124
Q

Painless large volume bleed

A

Diverticular dz

125
Q

Small bowel bleeding dx

A

Capsule endoscopy is the main stay

126
Q

Pyloric stenosis general

A

Acquired (not congenital)

Hypertrophy and spasm of pyloric muscle causing gastric outlets obstruction

127
Q

Pyloric stenosis symptoms

A

Vomiting that is forceful and projectile

Nonbilious vomit- undigested milk

Kids will be lethargic and dehydrated, and stomach becomes enlarged

Olive mass palpated

128
Q

Pyloric stenosis diagnostics

A

Hypochlorite and hypokalemia

Metabolic alkalosis

KUB shows large stomach and no gas in intestines

String sign of barium GI series

129
Q

Gastroparesis

A

Signs/symptoms of gastric or intestinal obstruction WITHOUT mechanical lesion to explain cause

Usually autonomic

130
Q

Gastroparesis presentation

A

Early satiety

N/v 1-3 hours post meal, maybe distension

131
Q

Gastroparesis diagnostics

A

Dilation (location variable)

Gastric scintigraphy very helpful because it measure gastric retention after a meal

132
Q

Ileus

A

Loss of peristalsis in intestine without obstruction

Could be post surgery, medication

Mild, diffuse abdominal discomfort, N/V, bowel sounds diminished or absent

133
Q

Ileus diagnostics

A

Distended gas filled loops of intestine

NPO then advance diet as bowel function returns

134
Q

Ogilvie syndrome

A

“Pseudo obstruction”

Massive cecal/ascending colon dilation

High risk of perforation, most common in critically ill patients

More severe version of ileus

135
Q

Intestinal atresia general

A

Developmental defect with partial or complete blockage of intestine

Hx of polyhydramnios, bilious vomiting

136
Q

Intestinal atresia diagnostics

A

Double bubble sign- gas in stomach and proximal duodenum

Rule out CF

137
Q

Meckel diverticulum

A

Outpouching o distal ileum

Usually asymptomatic, can gas massive painless GI bleed

Technetium scan to diagnose

138
Q

Celiac disease

A

Immunological response to gluten that can cause diffuse damage to proximal small intestine

139
Q

Celiac disease presentaiton

A

GI- diarrhea, malabsorption, nutrient deficiencies, dyspepsia and distension

Weight low, growth retardation, anemia

Dermatitis herpetiformis, psoriatic distribution of pruritic papulovesicles

140
Q

Celiac disease diagnosis

A

Serology of IgA tissue transglutaminase

Biopsy of tissue

141
Q

Whipple disease

A

Infection by tropheryma whippellii

Arthralgias, diarrhea, abdominal pain, fever, LAD, hyperpigmentation

FATAL IF UNTREATED

142
Q

Bacterial overgrowth

A

Less bacteria in small intestine as opposed to large, overgrowth leads to malabsorption

Diagnosed by breath test

143
Q

Short bowel syndrome

A

Post resection of large amounts of small intestine, decreased surface area for absorption

May need B12 supplements or low fat diet

144
Q

Lactase deficiency

A

Lactase is at brush border, lack of it causes bloating, cramps, flatulence

Could cause an osmotic diarrhea

145
Q

Lactase deficiency diagnostics

A

Hydrogen breath test (positive if more concentrated )

Try 2 weeks of lactose free diet

146
Q

Mesenteric ischemia

A

Bowel or intestinal ischemia/angina

Could acutely be thrombotic or embolism occlusion, or chronic inadequate perfusion of intestines with increased pain with metabolic demand

147
Q

Ischemic colitis

A

LLQ pain and tenderness, cramping, bloody diarrhea

Dz of inferior mesenteric artery

148
Q

Mesenteric ischemia workup

A

CT of abdomen/pelvis with contrast

Need urgent evaluation for acute cases

149
Q

Small bowel obstruction

A

Disruption of flow of intraluminal contents, commonly from post op adhesions

Leads to proximal dilation

Peristalsis increased above and below obstruction

150
Q

SBO presentation

A

N/V, crampy pain, diarrhea (early), constipation (late), fever, sepsis, tachy, surgery recently

Distension, hyperactive BS like tinkling, blood, peritoneal signs

151
Q

SBO on x ray

A

Coiled. Spring sign

Conniventes go across the bowel fully

152
Q

LBO common causes

A

Neoplasms, volvulus, stricture etc

153
Q

LBO diagnostics

A

X-rays are useful, CT scans are better

154
Q

String of pearls sign

A

Small pearls for SBO

Large pearls for LBO

155
Q

Perforated ulcer

A

Sudden onset of severe pain, sometimes epigastric

Chemical peritonitis, patient will look sick with a rigid abdomen and peritoneal signs

156
Q

Wandering spleen

A

Risk of torsion

Splenomegaly

157
Q

Splenic rupture

A

Dangerous because of how vascular it is

Need CT with LUQ pain

158
Q

Appendicitis

A

Most common surgical emergency

10-30 years old

Obstruction of appendix, eventually gangrene and perforation

159
Q

Appendicitis signs symptoms

A

Peritonitis

Periumbilical pain that migrates to RLQ over 12 hours

Low grade temp, anorexia, may draw knees up

McBurney’s point

Will not want to move

160
Q

Peritoneal signs

A

Rebound tenderness

Pain on percussion

Guarding

161
Q

Obturator sign

A

Pain with flexion and internal rotation of right hip

Best with pelvic location of appendix

162
Q

Psoas sign

A

Pain with extension of right hip

Best with retrocecal appendix

163
Q

Abdominal abscess

A

Anything from stoool leaking causing body to wall it off

Treat aerobes and anaerobes

Drain it!!

164
Q

Psoas abscess

A

Rare

Usually incidental finding

High grade bacteremia, diskitis

165
Q

Peritonitis more often with…

A

Aerobes

166
Q

Abscess more often with…

A

Anaerobes

167
Q

Diastasis recti

A

Separation of rectus abdominis muscles with intact fascia

Buldges like a hernia, but not defect hole is present

168
Q

Umbilical hernia

A

Often in kids, caused by increased intraabdominal pressure

Usually fat herniates

169
Q

Spigelian hernia

A

Semilunar lines along lateral edge of rectus

Hard to find on exam, swelling in mid to lower abdomen with sharp pain or tenderness

Prone to incarceration

170
Q

Indirect hernia

A

Through inguinal ring

More common on right side

Feel it at the tip of finger on exam

171
Q

Direct hernia

A

Protrude within hesselbach’s triangle

Side of finger touched on exam

172
Q

Femoral hernia

A

More common in females

40% present with incarceration or strangulation

173
Q

C diff risk factors

A

Antibiotic use (hepatically metabolized)

Advanced age

Immunocompromised

Increased gastric pH

174
Q

C diff microbiology

A

Gram positive anaerobe
Spore forming
Toxin producing (must have for disease, causes pseudomembranous colitis)

175
Q

C diff signs and symptoms

A

Moderate- watery diarrhea, crampy pain, anorexia, maybe fever

Severe- fever, pain, distension

Complicated- dehydration, pan colitis, perforation, sepsis, toxic megacolon

176
Q

WBC 60-90 K

A

C diff!!

177
Q

Diagnostics for c diff

A

PCR- expensive

EIA for toxins- quick and cheap, need high toxin burden

EIA for bacterial Ag- may have normal flora

Culture- good but takes time

178
Q

Fecal microbiota transplant

A

Restores normal flora, helps decolonize c diff

Very little recurrence!

179
Q

Diverticular disease

A

Diverticulosis- formation of outpouching of large intestine

Increased frequency with age

180
Q

Diverticulitis

A

Inflammation of diverticulum, leading to LLQ pain, heme + stool, fever

Can lead to perforation

181
Q

Diverticulitis surgery

A

One stage- resection of bowel, immediate re anastamosis

Two stage- resection of affected bowel, takedown to ostomy, delayed anastomoses

182
Q

Intussiception

A

Telescoping of proximal bowel into downstream bowel

Small bowel into cecum is common

Most common in infants 1-2 years old

183
Q

Intussiception findings

A

Sudden onset of crampy pain, crying, pallor, colic, refusal to feed

Currant jelly stools, sausage shaped mass

184
Q

Intussiception treatment

A

Pneumatic enema dx and treat! Pressure reduces the invagination

185
Q

Hirschprung disease

A

Aganglionic distal colon

Delayed meconium passage

186
Q

Irritable bowel syndrome background

A

Chronic abdominal pain and altered bowel habits without organic cause

187
Q

Clinical manifestations of IBS

A

Chronic abdominal pain- location varies, crampy, defecation gives relief

Altered bowel habits- diarrhea, constipation, maybe GERD, dyspepsia, CP

188
Q

Ulcerative colitis basics

A

Bloody diarrhea is the hallmark

Starts in rectum, can ascend but only affects the colon

Colectomy can be curative

189
Q

Crohn’s basics

A

Terminal ileum most common site, but skip lesions can occur anywhere from mouth to anus

Transmural inflammation

Variable symptoms

190
Q

IBD and colorectal cancer

A

Increased risk of cancer

Scope 8 years after IBD dx, follow up every 1-3 years after the first one

191
Q

Apthous ulcers

A

More common in crohn’s

Canker sores

192
Q

Pyoderma gangrenosum

A

Neutrophilic dermatitis leading to inflammation and ulceration

Not infectious or gangrenous

Pathergy is common (worse after biopsy or tissue injury)

193
Q

Erythema nodosum

A

Most common skin disorder with IBD

Red to violet sub Q pretibial nodules

194
Q

Clubbing in IBD

A

From disordered inflammation/macrophage recruitment rather than hypoxia

Schamroth sign

195
Q

Crohn’s clinical manifestations

A

Fatigue, weight loss, fever, intestinal stricture/obstruction

Non bloody diarrhea, perianal disease, heme + stool

196
Q

Crohn’s diagnosis

A

Cobblestoning, granulomas, found in colonoscopy

Serologies of pANCA or ASCA

197
Q

Ulcerative colitis

A

Inflammation of mucosal surface of colon, bleeding and friability

Rectal involvement (unlike crohn’s)

Smoking is protective

198
Q

Ulcerative colitis manifestations

A

Diarrhea that is bloody, small and frequent bowel movements

Weight loss, maybe fever, maybe anemias, all depending on extent of the disease

199
Q

Polyps definition

A

Discrete protuberances projecting into the intestinal lumen

Can be adenomatous (progress to cancer) serrated also progresses

200
Q

Advanced adenoma

A

Take 5 years to develop

> 1 cm, villous features or high grade dysplasia

Greater liklihood of malignant transformation, which takes 10 years

of polyps effects overall risk

201
Q

Polyps in proximal colon maybe be associated with…

A

More advanced neoplasia

202
Q

Clinical findings of polyps

A

usually asymptomatic but can ulcerate or bleed

FIT- fecal immunochemical test, detects noncancerous polyps

203
Q

CTC

A

Virtual colonoscopy, good sensitivity for polyps >1 cm

204
Q

Follow up of polyps

A

30-40% will have adenoma as or serrated polyps 3-5 years after initial exam

If 1-2 small ones, follow up in 5 years

If 3-10 rescope in 3 years

> 10, familial polyposis syndrome

205
Q

% of colorectal cancers caused by genetic mutations

A

4%

206
Q

Familial adenomatous polyposis

A

Gene testing used to diagnose

Autosomal dominant mutations

Hundreds to thousands of polyps

207
Q

FAP presentation

A

Polyps by 15 years

Cancer by 40 years, inevitable by 40 years

Can also develop in stomach or duodenum

Tumors exist elsewhere in the body!

208
Q

FAP diagnosis

A

> 10 polyps

Gene testing or first degree relative with FAP

209
Q

FAP treatment

A

Prophylactic complete proctocolectomy usually before age 20

Ileoanal anastamosis
Ileorectal anasatmosis (better bowel function but still risk of rectal cancer)

EGD every 1-3 yeras to watch for upper GI tumor

210
Q

Hamartomatous polyposis syndromes

A

Rare!

Familial juvenile polyposis

Cowden disease

Peutz-jegher’s syndrome- autosomal dominant

211
Q

Lynch syndrome

A

Hereditary nonpolyposis colon cancer

Autosomal dominant- family hx is critical!

212
Q

Lynch syndrome problem

A

Only a few adenomas develop, but progress to cancer in 1-2 years instead of 10

Consider genetic testing with Bethesda criteria

213
Q

Screening with lynch syndrome

A

C scope at 25 for relatives

Subtotal colectomy if cancer is found

214
Q

Colorectal cancer epidemiology

A

6% will develop if, 40% of those people will die from it

Majority are adenocarcinomas

P53 loss

215
Q

Clinical manifestations of cancer

A

Asymptomatic early on

Obstruction is uncommon, but found in advanced disease

Rectal cancer- tenesmus, urgency, blood

Apple core lesion on barium enema

216
Q

CEA in cancer

A

CEA >5 is bad prognostic factor

217
Q

Mets in colon cancer

A

Peritoneum
Liver
Lung

218
Q

Screening tests for colon cancer

A

Fecal occult blood test - guaiac or fecal immunochemical test

Cancer prevention (preferred)- colonoscopy

FIT- is a cancer detection test

219
Q

Screening algorithm

A

Start at 50 years old, 45 in black patients

CRC is fatal in 50%!

<50% of population is appropriately screened

220
Q

Colorectal cancer until proven otherwise:

A 
Patient over 40:
Change in bowel habits 
Hematochezia
Unexplained Fe deficiency
Unexplained occult bleeding

Clin Med 2 (8 decks)

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