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PANCE 2.0 > GI #3 > Flashcards

GI #3 Flashcards

1
Q

What is the pathophysiology of chronic mesenteric ischemia?

A

Ischemic bowel disease due to mesenteric atherosclerosis: hypo perfusion related to eating (increased demand during eating + decreased blood supply)

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2
Q

Symptoms of chronic mesenteric ischemia

A
  • Chronic, dull abdominal pain worse after meals (intestinal angina)
  • Anorexia (aversion to eating) leading to weight loss
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3
Q

What is the definitive diagnostic test for chronic mesenteric ischemia?

A

-Angiography

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4
Q

Definitive management for chronic mesenteric ischemia

A

-Revascularization (angioplasty with stenting or bypass

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5
Q

What is the MC cause of acute mesenteric ischemia?

A

-Acute arterial occlusion (embolism from A-fib)

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6
Q

What artery is MC occluded in an acute mesenteric ischemia?

A

-Superior mesenteric artery

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7
Q

Symptoms of acute mesenteric ischemia

A
  • Severe abdominal pain out of proportion to physical findings
  • Pain poorly localized
  • Nausea, vomiting, diarrhea
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8
Q

What is the initial test to assess ischemia for acute mesenteric ischemia?

A

-CT angiography

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9
Q

However, to get a definitive diagnosis for acute mesenteric ischemia, what should be done?

A

-Conventional arteriography

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10
Q

Treatment for acute mesenteric ischemia

A
  • Surgical revascularization

- Anticoagulation in patients with A-fib

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11
Q

Ischemic colitis is

A

decreased colonic perfusion, leading to inflammation

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12
Q

What is the MC etiology of ischemic colitis

A

-Transient systemic hypotension or atherosclerosis involving the superior and inferior mesenteric arteries

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13
Q

Ischemic colitis occurs MC at watershed areas (between 2 arteries with decreased collaterals) such as the _____ and _______

A

splenic flexure and rectosigmoid junction

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14
Q

Symptoms of ischemic colitis

A
  • LLQ crampy abdominal pain
  • Bloody diarrhea
  • Hematochezia
  • Tenderness (not as severe and more lateral than acute mesenteric ischemia)
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15
Q

What is the first imaging study that is done for ischemic colitis and what does it show?

A

CT of the abdomen: thumb printing (segmental bowel wall thickening)

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16
Q

What is the treatment for ischemic colitis?

A
  • Supportive care: restore perfusion, bowel rest, IVF

- May need empiric broad spectrum ABX, but most resolves without therapy

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17
Q

What type of colon polyp is the MC non-neoplastic polyp?

A

Hyperplastic

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18
Q

Pseudopolyps/Inflammatory polyps are due to

A

Inflammatory bowel disease (UC, Crohn’s)

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19
Q

What type of colon polyp is the MC neoplastic polyp?

A

Adenomatous polyps

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20
Q

How long does it take an adenomatous polyp to become cancerous?

A

10-20 years

21
Q

Which type of adenomatous polyp is associated with the least risk?

A

Tubular Adenoma (MC type and least risk)

22
Q

Which type of adenomatous polyp has the highest risk of becoming cancerous?

A

Villous adenoma

23
Q

Risk factors for colorectal cancer

A
  • Age > 50
  • African Americans
  • Family history of colorectal cancer
  • IBD: UC > Crohn’s
  • Diet (low fiber, high in red or processed meat)
  • Obesity
  • Smoking
  • EtOH
24
Q

Familial Adenomatous Polyposis is a genetic mutation of the _____ gene. Explain what happens with this condition

A

APC gene

Adenomas begin in childhood. Almost all develop cancer by 45 years old. Prophylactic colectomy is best for survival.

25
Q

What is Peutz-Jehgers Syndrome?

A

Autosomal dominant condition associated with hamartomatous polyps, mucocutaneous hyperpigmentation (lips, oral mucosa, and hands), and risk of breast and pancreatic cancer

26
Q

What are some protective factors for colorectal cancer?

A

Physical activity
Regular use of Aspirin
NSAIDs

27
Q

What is the diagnostic of choice for colorectal cancer?

A

Colonoscopy with biopsy

28
Q

Right sided (proximal) lesions for colorectal cancer tend to cause _________

A

Chronic occult bleeding (iron deficiency anemia, positive Guiac) and diarrhea

29
Q

Left sided (distal) lesions in colorectal cancer tend to cause

A

Bowel obstruction, present later, and cause changes in stool diameter

30
Q

Furthermore, those with a left sided (distal) lesion, may develop ______ endocarditis

A

Strep bovis

31
Q

With a barium enema, in colorectal cancer, what is seen?

A

Apple core lesion

-Need a follow up colonoscopy or CT colonography

32
Q

What lab abnormality is expected with colorectal cancer and why?

A

Iron deficiency anemia

-Colorectal cancer is the MCC of occult GI bleeding in adults

33
Q

Most commonly monitored tumor marker in colorectal cancer

A

CEA

34
Q

Management of localized colorectal cancer

A

-Surgical resection followed by postoperative chemotherapy

35
Q

Colon Cancer Screening Guidelines

A
  • Colonoscopy begins at age 50-75 every 10 years (average risk)
  • Colonoscopy begins at 40, every 10 years (1st degree relative > 60)
  • Colonoscopy begins at 40, every 5 years (1st degree relative < 60)
36
Q

If a patient has familiar adenomatous polyposis, what is the screening recommendation for colonoscopies?

A

Initiate screen at 10-12 years with flexible sigmoidoscopy yearly

37
Q

MCC of esophagitis

A

GERD

38
Q

Pill-induced esophagitis occurs frequently with what types of pills?

A

Bisphosphonates, BB, CCB, NSAIDs

39
Q

Infectious esophagitis is most commonly associated with _____, and some causes are ______

A

Immunocompromised states

Candida, CMV, HSV

40
Q

Three classic symptoms of esophagitis are

A

Odynophagia, dysphagia, and retrosternal chest pain

41
Q

What is the diagnostic of choice for esophagitis?

A

Upper endoscopy (allows for direct visualization)

42
Q

What are the three components of pathophysiology of IBS?

A
  • Abnormal motility: chemical imbalance in intestine (of serotonin and acetylcholine) causing abnormal motility and spasm
  • Visceral hypersensitivity: lowered pain thresholds to intestinal distention
  • Psychosocial interactions: altered CNS processing
43
Q

Symptoms of IBS

A
  • Abnormal pain associated with altered defecation/bowel habits
  • Pain often relieved with defecation
44
Q

Name three alarm symptoms of IBS

A
  • Evidence of GI bleeding
  • Anorexia or weight loss, family history of GI cancer, IBD, celiac sprue
  • Persistent diarrhea causing dehydration, onset > 45 years old
45
Q

What is the Rome IV Criteria in regards to IBS?

A
  • Recurrent abdominal pain on average at least 1 day/week in the last 3 months associated with at least 2 of the following:
  • -related to defecation
  • -change in stool frequency
  • -change in stool appearance
46
Q

What is the first-line management of IBS?

A

Lifestyle and dietary changes (low fait, high fiber, unprocessed food diet)

  • Sleep hygiene
  • Smoking cessation
  • Exercise
47
Q

If the patient is experiencing constipation symptoms, what are some medications that can be given?

A
  • Fiber, Psyllium

- Polyethylene Glycol

48
Q

If the patient is experiencing diarrhea symptoms, what are some medications that can be given?

A
  • Loperamide

- Dicyclomine, Hyoscyamine

PANCE 2.0 (62 decks)

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