gi 3.2 Flashcards by Morgan C

Q

Intussusception

A

Telescoping of one part of the intestines onto another

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Q

Intussusception is mc here

A

Ileocolic region

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Q

Intussusception is more common in this pop

A

peds

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Q

lead pt in peds or adults

A

adults

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Q

Intussusception pediatric

sx

A

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

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Q

Intussusception pediatric

dx

A

Abdomen US

“Target sign” in transverse view

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Q

dx and therapeutic intusseception peds

A

Hydrostatic enema-

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Q

what is the lead pt in adults Intussusception

A

malignancy

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Q

chronic Intussusception adults is really hard to _____

A

dx

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Q

dx and trmt for Intussusception adults

A

CT then surgery

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Q

Volvulus ?

A

Organ twists on itself

Stomach, spleen, GB, SI, colon

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Q

Volvulus is MC here

A

sigmoid colon then cecum

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Q

this volvulus is Common in endemic areas

A

Acute fulminating sigmoid volvulus

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Q

Acute fulminating sigmoid volvulus

sx

A

Young pt, sudden onset, rapid progression

Minimal distension

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Q

Subacute progressive sigmoid volvulus

sx

A

Older pt, slower onset, distended abdomen

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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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Q

Bent inner tube sign

A

Subacute progressive sigmoid volvulus

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Q

whirl sign

A

Subacute progressive sigmoid volvulus

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Q

bird’s beak or ace of spades sign

A

Subacute progressive sigmoid volvulus

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Q

Trmt for Acute fulminating and Subacute progressive sigmoid volvulus

A

Endoscopic reduction

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Q

Cecal volvulus

2 rotations?

A

mesoaxial, organoaxial

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Q

Mesoaxial rotation

A

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

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Q

Organoaxial rotation

A

Cecal bascule

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

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Q

Cecal volvulus

dx

A

XR- Large cecum, large air fluid levels, SBO

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Cecal volvulus | types

Acute fulminant Acute obstructive Intermittent/recurrent

Cecal volvulus | trmt

Gold Std- right colectomy

Most are colon CA are ____

sporadic

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

8-10

this can turn into carcinoma in colon

polyps

inheritance pattern colon cancer

autosomal dominant

colon CA linked to this gene

FAP on 5q21 and HNCCP

benign polyps can be ___ or ___

villous or tubular

which benign polyps are more likely to become malignant

villous

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 ```

Suspicious polyps- 6 features

Synchronicity cancer?

2 + cancers occurring at the same time

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

45

when do we start screening for colon ca in highrisk pop

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

CT colonography/virtual colonoscopy probs

misses flat cancers, not FDA approved

best way to screen for colon CA

colonoscopy

2 types of colon CA

Polypoid/exophytic- goes into lumen | Ulcerating- grows out of lumen

which colon ca grows out of the lumen

ulcerating

colon CA spread

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

colon CA sx

Rectal bleeding, change in bowel habits | R side CA may present as anemia

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

→ check colon CA

colon CA dx

``` 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 ```

colon CA trmt

Surgery- colectomy Chemo Radiation

Synchronous CA-

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

Only colon CA gene with 100% penetrance

FAP (Familial adenomatous polyposis)

Metachronous CA-

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

FAP (Familial adenomatous polyposis) | inheritance

Dominant inheritance

FAP (Familial adenomatous polyposis) | is common in this pop

teens

Deletion in 5q21 gene

FAP (Familial adenomatous polyposis)

FAP (Familial adenomatous polyposis) | dx

Minimum 100 polyps

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

few

HNPCC (hereditary nonpolyposis colon cancer) AKA Lynch Syndrome location

CA proximal to splenic flexure

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

Synchronous

2 MMR genes mutated

HNPCC (hereditary nonpolyposis colon cancer) AKA Lynch Syndrome

MMR genes control

DNA replication

Dx: Amsterdam Criteria | HNPCC (hereditary nonpolyposis colon cancer) AKA Lynch Syndrome

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

Muir Torre syndrome

HNPCC and sebaceous gland tumors

STK11 gene mutation

Peutz Jegher Syndrome (PJS)

Peutz Jegher Syndrome (PJS) | sx

Hyperpigmentation on lips and buccal mucosa

Common anorectal signs and sx

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

Any anorectal complaint needs _____

proctosigmoidoscopy

where are internal and external hemorrhoids located

Proximal vs distal to dentate line