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clin med > gi 3.2 > Flashcards

gi 3.2 Flashcards

1
Q

Intussusception

A

Telescoping of one part of the intestines onto another

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2
Q

Intussusception is mc here

A

Ileocolic region

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3
Q

Intussusception is more common in this pop

A

peds

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4
Q

lead pt in peds or adults

A

adults

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5
Q

Intussusception pediatric

sx

A

Severe abdominal crampy pain
Emesis and red current jelly stool (blood and mucus)
Palpable mass

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6
Q

Intussusception pediatric

dx

A

Abdomen US

“Target sign” in transverse view

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7
Q

dx and therapeutic intusseception peds

A

Hydrostatic enema-

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8
Q

what is the lead pt in adults Intussusception

A

malignancy

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9
Q

chronic Intussusception adults is really hard to _____

A

dx

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10
Q

dx and trmt for Intussusception adults

A

CT then surgery

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11
Q

Volvulus ?

A

Organ twists on itself

Stomach, spleen, GB, SI, colon

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12
Q

Volvulus is MC here

A

sigmoid colon then cecum

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13
Q

this volvulus is Common in endemic areas

A

Acute fulminating sigmoid volvulus

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14
Q

Acute fulminating sigmoid volvulus

sx

A

Young pt, sudden onset, rapid progression

Minimal distension

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15
Q

Subacute progressive sigmoid volvulus

sx

A

Older pt, slower onset, distended abdomen

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16
Q

Subacute progressive sigmoid volvulus

dx

A

Bent inner tube sign
Gastrografin enema- bird’s beak or ace of spades sign (don’t do today)
CT scan- whirl sign

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17
Q

Bent inner tube sign

A

Subacute progressive sigmoid volvulus

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18
Q

whirl sign

A

Subacute progressive sigmoid volvulus

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19
Q

bird’s beak or ace of spades sign

A

Subacute progressive sigmoid volvulus

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20
Q

Trmt for Acute fulminating and Subacute progressive sigmoid volvulus

A

Endoscopic reduction

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21
Q

Cecal volvulus

2 rotations?

A

mesoaxial, organoaxial

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22
Q

Mesoaxial rotation

A

Rotation around ileocolic vessels
Volvulus involves cecum, asc colon, and TI
Cecum ends up in LUQ

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23
Q

Organoaxial rotation

A

Cecal bascule

Cecum flipped over asc colon and ends up in RUQ under liver

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24
Q

Cecal volvulus

dx

A

XR- Large cecum, large air fluid levels, SBO

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25
Q

Cecal volvulus

types

A

Acute fulminant
Acute obstructive
Intermittent/recurrent

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26
Q

Cecal volvulus

trmt

A

Gold Std- right colectomy

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27
Q

Most are colon CA are ____

A

sporadic

28
Q

Colon CA is a slow process… takes ____ yrs to develop

A

8-10

29
Q

this can turn into carcinoma in colon

A

polyps

30
Q

inheritance pattern colon cancer

A

autosomal dominant

31
Q

colon CA linked to this gene

A

FAP on 5q21 and HNCCP

32
Q

benign polyps can be ___ or ___

A

villous or tubular

33
Q

which benign polyps are more likely to become malignant

A

villous

34
Q

what is this?

Polyp with granular or friable surface
Polyp with ulcerated head
Size of head and stalk are very disproportionate
Discoloration on surface
Concave surface 
Deformed head
A

Suspicious polyps- 6 features

35
Q

Synchronicity cancer?

A

2 + cancers occurring at the same time

36
Q

when do we start screening for colon ca in low risk pop

A

45

37
Q

when do we start screening for colon ca in highrisk pop

A

start colonoscopy at age 40 or 10 yrs before family cancer was dx

38
Q

CT colonography/virtual colonoscopy probs

A

misses flat cancers, not FDA approved

39
Q

best way to screen for colon CA

A

colonoscopy

40
Q

2 types of colon CA

A

Polypoid/exophytic- goes into lumen

Ulcerating- grows out of lumen

41
Q

which colon ca grows out of the lumen

A

ulcerating

42
Q

colon CA spread

A

Direct, lymphatic (MC), blood (in rectal CA Batson’s plexus), transperitoneal, implantation

43
Q

colon CA sx

A

Rectal bleeding, change in bowel habits

R side CA may present as anemia

44
Q

S bovis and e coli come back on culture what do you do nect

A

→ check colon CA

45
Q

colon CA dx

A 
Check CEA (carcinoembryonic Ag)- not specific for colon CA but useful for following up after therapy 
CT scan
Bone scan
MRI
PET scan
US- rectal CA
46
Q

colon CA trmt

A

Surgery- colectomy
Chemo
Radiation

47
Q

Synchronous CA-

A

2 diff CA at the same time ex: sigmoid and thyroid at same time

48
Q

Only colon CA gene with 100% penetrance

A

FAP (Familial adenomatous polyposis)

49
Q

Metachronous CA-

A

cancer you eradicate then it comes back later ex: R breast CA then L breast CA

50
Q

FAP (Familial adenomatous polyposis)

inheritance

A

Dominant inheritance

51
Q

FAP (Familial adenomatous polyposis)

is common in this pop

A

teens

52
Q

Deletion in 5q21 gene

A

FAP (Familial adenomatous polyposis)

53
Q

FAP (Familial adenomatous polyposis)

dx

A

Minimum 100 polyps

54
Q

HNPCC (hereditary nonpolyposis colon cancer) AKA Lynch Syndrome has this many polyps

A

few

55
Q

HNPCC (hereditary nonpolyposis colon cancer) AKA Lynch Syndrome
location

A

CA proximal to splenic flexure

56
Q

what type of ca is HNPCC (hereditary nonpolyposis colon cancer) AKA Lynch Syndrome

A

Synchronous

57
Q

2 MMR genes mutated

A

HNPCC (hereditary nonpolyposis colon cancer) AKA Lynch Syndrome

58
Q

MMR genes control

A

DNA replication

59
Q

Dx: Amsterdam Criteria

HNPCC (hereditary nonpolyposis colon cancer) AKA Lynch Syndrome

A

3 relatives with biopsy proven colorectal cancer
2 successive generations involved
1 relative 1st degree
1 CRC dx under age 50

60
Q

Muir Torre syndrome

A

HNPCC and sebaceous gland tumors

61
Q

STK11 gene mutation

A

Peutz Jegher Syndrome (PJS)

62
Q

Peutz Jegher Syndrome (PJS)

sx

A

Hyperpigmentation on lips and buccal mucosa

63
Q

Common anorectal signs and sx

A

Pain, bleeding, protrusion, seepage and soilage, itching, change in BM
Tenderness, fluctuance, erythema, mass

64
Q

Any anorectal complaint needs _____

A

proctosigmoidoscopy

65
Q

where are internal and external hemorrhoids located

A

Proximal vs distal to dentate line

clin med (35 decks)

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