GI #2 Flashcards
What is the MC type of colon polyp
-Adenomatous
What type of adenomatous polyp has the highest risk of becoming malignant
Villous adenoma
What type has the LOWEST risk for becoming malignant?
Tubular adenoma
Risk Factors for colorectal cancer
- Age > 50
- AA
- family history
- UC
- Diet (Low fiber, high in red or processed meat)
- Obesity, Smoking, ETOH
What is Familial Adenomatous Polyposis?
Genetic mutation of the APC gene. Adenomas begin in childhood and almost all develop cancer by age 45. Prophylactic colectomy best for survival.
Protective factors for Colorectal Cancer
- Physical activity
- Regular use of Aspirin, NSAIDs
Symptoms of colorectal cancer
- Iron deficiency anemia (fatigue, weakness)
- Rectal bleeding
- Change in bowel habits
- Abdominal pain
Right sided (proximal) vs left sided (distal) symptoms
- Right side: chronic occult bleeding, iron deficiency anemia
- Left side: bowel obstruction, changes in stool diameter
Diagnostic test of choice for colon cancer
Colonoscopy with biopsy
On Barium enema, what is seen with colon cancer?
Apple core lesion
What Tumor Marker is monitored with Colon Cancer?
CEA
Regarding colonoscopies and fecal occult blood tests, what are the current recommendations?
- 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.
MCC of esophagitis
-GERD
Symptoms of esophagitis
- Odynophagia (painful swallowing)
- Dysphagia (difficulty swallowing)
- Retrosternal Chest Pain
Diagnostic for esophagitis
Upper endoscopy
What is the Rome IV Criteria for Irritable Bowel Syndrome
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
Treatment for IBS
- Lifestyle and dietary changes are first line (low fat, high fiber, and unprocessed food diet)
- Sleep hygiene
- Smoking cessation
What can be given for diarrhea?
What can be given for constipation?
Loperamide, Dicyclomine
Psyllium, Polyethylene Glycol
MCC of infectious esophagitis
Candida, in immunocompromised patients
Treatment for Candida Esophagitis
-PO Fluconazole
What is seen on exam of a patient with candida esophagitis?
Linear, white yellow plaques on endoscopy
On endoscopy for eosinophilic esophagitis, what is usually seen?
Multiple corrugated rings, white exudates
However, for eosinophilic esophagitis, what is the definitive diagnostic?
Biopsy: presence of abundance of eosinophils
What medications are usual causes of pill esophagitis?
NSAIDs, bisphosphonates, BB, CCB, Vitamin C
How to manage symptoms of pill esophagitis
- Take pills with at least 4 ounces of water
- Avoid recumbency for at least 30-60 minutes after pill ingestion
A sliding hiatal hernia is the MC type. Explain what happens in this type of hernia
-GE junction slides into mediastinum
Treatment for hiatal hernia
- PPI
- Weight loss
Pathophysiology of GERD
- Incompetent lower esophageal sphincter
- Transient relaxation of LES
Symptoms of GERD
- Heartburn (pyrosis)
- Sour taste in mouth, cough, sore throat
- Wheezing, chest pain, hoarseness (atypical symptoms)
Alarm symptoms of GERD
-Dysphagia, odynophagia, weight loss, bleeding
Diagnostics for GERD
- 24 hour ambulatory pH: GOLD STANDARD
- Manometry: decreased LES pressure
- Endoscopy: first line diagnostic test if persistent or alarm symptoms
Treatment for GERD
- 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
Pathophysiology of Barrett’s Esophagus
- Esophageal squamous epithelium replaced by precancerous metaplastic columnar cells from cardia of the stomach
- Complication of long-standing GERD
MC type of esophageal carcinoma in the US
MC type of esophageal carcinoma in the world
- Adenocarcinoma (distal esophagus)
- Squamous cell (mid-upper third of esophagus)
Risk factors for Adenocarcinoma
- Caucasian males
- Barrett’s Esophagus
- Smoking
- Obesity
Squamous Cell Carcinoma of the esophagus occurs ______ and is the MCC worldwide. What are the risk factors for this type of cancer?
Mid-upper third of the esophagus
-African American
Smoking
-Alcohol
Symptoms of esophageal cancer
Progressive dysphagia: solid food dysphagia progressing to include fluids, odynophagia
-Weight loss, anorexia, iron deficiency anemia
What is the diagnostic study of choice for esophageal cancer?
Upper endoscopy with biopsy
What diagnostic is done to stage esophageal cancer?
Endoscopic US
Pathophysiology of Achalasia
Loss of peristalsis and failure of relaxation of lower esophageal sphincter
-Degeneration of Auerbach’s Plexus
Symptoms of Achalasia
Dysphagia to solids and liquids at same time
-Chest pain, cough, weight loss, dehydration
Diagnostics for Achalasia
- 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
Treatment for Achalasia
- Decrease LES pressure: Botox injection, Nitrates
- Pneumatic dilation of LES
- Esophagomyomectomy (definitive)
Symptoms of a Zenker’s Diverticulum
Pathophysiology of Zenker’s
- 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)
Diagnostic for Zenker Diverticulum
- Barium Esophagram
- Upper endoscopy for surgical evaluation
Symptoms of Diffuse Esophageal Spasm
- 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
Diagnostics for DES
- Esophagram: corkscrew esophagus
- Manometry: definitive (increased premature contractions)
Treatment for DES
- Anti-spasmodics: CCB, Nitrates, TCA
- Botox injections, pneumatic dilation
Pathophysiology of Mallory Weiss Tear
Sudden rise in intra-abdominal pressure due to persistent retching or vomiting after ETOH binge
Symptoms of Mallory Weiss Tear
- Upper GI bleeding
- Abdominal pain, back pain, or hydrophobia
Diagnostic of choice for Mallory Weiss Tear
-Upper endoscopy: shows longitudinal mucosal erosions
Treatment for Mallory Weiss Tears
- Non-bleeding: supportive, PPIs
- Bleeding: Band ligation
Diagnostic of choice for Esophageal Web or Esophageal Ring
Barium Swallow (Esophagram)
Treatment for Esophageal Ring
Dilation
