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PANCE/EOC > GI #2 > Flashcards

GI #2 Flashcards

1
Q

What is the MC type of colon polyp

A

-Adenomatous

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2
Q

What type of adenomatous polyp has the highest risk of becoming malignant

A

Villous adenoma

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3
Q

What type has the LOWEST risk for becoming malignant?

A

Tubular adenoma

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4
Q

Risk Factors for colorectal cancer

A
  • Age > 50
  • AA
  • family history
  • UC
  • Diet (Low fiber, high in red or processed meat)
  • Obesity, Smoking, ETOH
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5
Q

What is Familial Adenomatous Polyposis?

A

Genetic mutation of the APC gene. Adenomas begin in childhood and almost all develop cancer by age 45. Prophylactic colectomy best for survival.

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6
Q

Protective factors for Colorectal Cancer

A
  • Physical activity

- Regular use of Aspirin, NSAIDs

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7
Q

Symptoms of colorectal cancer

A
  • Iron deficiency anemia (fatigue, weakness)
  • Rectal bleeding
  • Change in bowel habits
  • Abdominal pain
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8
Q

Right sided (proximal) vs left sided (distal) symptoms

A
  • Right side: chronic occult bleeding, iron deficiency anemia
  • Left side: bowel obstruction, changes in stool diameter
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9
Q

Diagnostic test of choice for colon cancer

A

Colonoscopy with biopsy

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10
Q

On Barium enema, what is seen with colon cancer?

A

Apple core lesion

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11
Q

What Tumor Marker is monitored with Colon Cancer?

A

CEA

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12
Q

Regarding colonoscopies and fecal occult blood tests, what are the current recommendations?

A
  • Fecal occult blood test annually starting at 50
  • Colonoscopy every 10 years from 50-75
  • Flexible sigmoidoscopy every 5 years, along with occult blood test every 3 years

If patient has FAP, the colonoscopies start at age 10-12 and they have flexible sigmoidoscopy yearly.

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13
Q

MCC of esophagitis

A

-GERD

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14
Q

Symptoms of esophagitis

A
  • Odynophagia (painful swallowing)
  • Dysphagia (difficulty swallowing)
  • Retrosternal Chest Pain
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15
Q

Diagnostic for esophagitis

A

Upper endoscopy

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16
Q

What is the Rome IV Criteria for Irritable Bowel Syndrome

A

Recurrent abdominal pain on average at least 1 day/week in the last 3 months associated with 2 of the 3 following things:

  • 1) Pain with defecation
    2) change in stool frequency
    3) change in stool form/appearance
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17
Q

Treatment for IBS

A
  • Lifestyle and dietary changes are first line (low fat, high fiber, and unprocessed food diet)
  • Sleep hygiene
  • Smoking cessation
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18
Q

What can be given for diarrhea?

What can be given for constipation?

A

Loperamide, Dicyclomine

Psyllium, Polyethylene Glycol

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19
Q

MCC of infectious esophagitis

A

Candida, in immunocompromised patients

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20
Q

Treatment for Candida Esophagitis

A

-PO Fluconazole

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21
Q

What is seen on exam of a patient with candida esophagitis?

A

Linear, white yellow plaques on endoscopy

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22
Q

On endoscopy for eosinophilic esophagitis, what is usually seen?

A

Multiple corrugated rings, white exudates

23
Q

However, for eosinophilic esophagitis, what is the definitive diagnostic?

A

Biopsy: presence of abundance of eosinophils

24
Q

What medications are usual causes of pill esophagitis?

A

NSAIDs, bisphosphonates, BB, CCB, Vitamin C

25
Q

How to manage symptoms of pill esophagitis

A
  • Take pills with at least 4 ounces of water

- Avoid recumbency for at least 30-60 minutes after pill ingestion

26
Q

A sliding hiatal hernia is the MC type. Explain what happens in this type of hernia

A

-GE junction slides into mediastinum

27
Q

Treatment for hiatal hernia

A
  • PPI

- Weight loss

28
Q

Pathophysiology of GERD

A
  • Incompetent lower esophageal sphincter

- Transient relaxation of LES

29
Q

Symptoms of GERD

A
  • Heartburn (pyrosis)
  • Sour taste in mouth, cough, sore throat
  • Wheezing, chest pain, hoarseness (atypical symptoms)
30
Q

Alarm symptoms of GERD

A

-Dysphagia, odynophagia, weight loss, bleeding

31
Q

Diagnostics for GERD

A
  • 24 hour ambulatory pH: GOLD STANDARD
  • Manometry: decreased LES pressure
  • Endoscopy: first line diagnostic test if persistent or alarm symptoms
32
Q

Treatment for GERD

A
  • Lifestyle modifications: elevated head of bed, avoid food in night, weight loss, no alcohol, smoking cessation
  • Antacids and H2 receptor antagonists (Famotidine, Cimetidine)
  • PPI in moderate-severe ( > 2 episodes/week) (Omeprazole)
  • Nissen fundoplication if refractory
33
Q

Pathophysiology of Barrett’s Esophagus

A
  • Esophageal squamous epithelium replaced by precancerous metaplastic columnar cells from cardia of the stomach
  • Complication of long-standing GERD
34
Q

MC type of esophageal carcinoma in the US

MC type of esophageal carcinoma in the world

A
  • Adenocarcinoma (distal esophagus)

- Squamous cell (mid-upper third of esophagus)

35
Q

Risk factors for Adenocarcinoma

A
  • Caucasian males
  • Barrett’s Esophagus
  • Smoking
  • Obesity
36
Q

Squamous Cell Carcinoma of the esophagus occurs ______ and is the MCC worldwide. What are the risk factors for this type of cancer?

A

Mid-upper third of the esophagus

-African American
Smoking
-Alcohol

37
Q

Symptoms of esophageal cancer

A

Progressive dysphagia: solid food dysphagia progressing to include fluids, odynophagia
-Weight loss, anorexia, iron deficiency anemia

38
Q

What is the diagnostic study of choice for esophageal cancer?

A

Upper endoscopy with biopsy

39
Q

What diagnostic is done to stage esophageal cancer?

A

Endoscopic US

40
Q

Pathophysiology of Achalasia

A

Loss of peristalsis and failure of relaxation of lower esophageal sphincter
-Degeneration of Auerbach’s Plexus

41
Q

Symptoms of Achalasia

A

Dysphagia to solids and liquids at same time

-Chest pain, cough, weight loss, dehydration

42
Q

Diagnostics for Achalasia

A
  • Barium esophagram: bird’s beak appearance of LES
  • Manometry: most accurate test (increased LES pressure)
  • Endoscopy: performed prior to starting treatment to rule out SCC
43
Q

Treatment for Achalasia

A
  • Decrease LES pressure: Botox injection, Nitrates
  • Pneumatic dilation of LES
  • Esophagomyomectomy (definitive)
44
Q

Symptoms of a Zenker’s Diverticulum

Pathophysiology of Zenker’s

A
  • Dysphagia
  • Lump in neck
  • Choking Sensation
  • Halitosis (due to food retention in pouch)

-Weakness at Killian’s Triangle (between fibers of the cricopharyngeal muscle and lower inferior pharyngeal constrictor muscle)

45
Q

Diagnostic for Zenker Diverticulum

A
  • Barium Esophagram

- Upper endoscopy for surgical evaluation

46
Q

Symptoms of Diffuse Esophageal Spasm

A
  • Stabbing chest pain worse with hot or cold liquids or food
  • Not exertional pain (similar to angina though)
  • Dysphagia to both solids and liquids
  • Sensation of object stuck in throat
47
Q

Diagnostics for DES

A
  • Esophagram: corkscrew esophagus

- Manometry: definitive (increased premature contractions)

48
Q

Treatment for DES

A
  • Anti-spasmodics: CCB, Nitrates, TCA

- Botox injections, pneumatic dilation

49
Q

Pathophysiology of Mallory Weiss Tear

A

Sudden rise in intra-abdominal pressure due to persistent retching or vomiting after ETOH binge

50
Q

Symptoms of Mallory Weiss Tear

A
  • Upper GI bleeding

- Abdominal pain, back pain, or hydrophobia

51
Q

Diagnostic of choice for Mallory Weiss Tear

A

-Upper endoscopy: shows longitudinal mucosal erosions

52
Q

Treatment for Mallory Weiss Tears

A
  • Non-bleeding: supportive, PPIs

- Bleeding: Band ligation

53
Q

Diagnostic of choice for Esophageal Web or Esophageal Ring

A

Barium Swallow (Esophagram)

54
Q

Treatment for Esophageal Ring

A

Dilation

PANCE/EOC (63 decks)

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