GI

Question 1

F/U colorectal cancer surgery

Answer 1

colonoscopy year 1 then Q3 years

CT abdomen/Pelvis and CXR for first 5 years

Follow CEA: if super elevated = liver involvement

Guaiac stool test

Question 2

treatment for colorectal cancer

Answer 2

surgery and resesction of regional lymphatics

Question 3

right side CRC and left side CRC which has melana and which has hematochezia more commonly

Answer 3

right side melena

left side hematochezia

Question 4

nonneoplastic polyps types

Answer 4

hyperplastic MC, usually small and asx, can be removed bc don’t know

juvenile polyps = highly vascular and removed

inflammatory are associated with UC (pseudopolyps)

Question 5

adenomatous polyps are what lesions and malignancy?

Answer 5

benign, but have significant malignant potential, precursor of adenocarcinoma

(think adam is harmless but can turn evil bc he lies)

Question 6

diverticulosis caused by what

Answer 6

increased intraluminal pressure and colon bulges through an area of weakness in colon wall

Question 7

risk factors for diverticululosis

Answer 7

lower fiber diet, constipiation increases pressure

positive fam hx

age

Question 8

most common location of diverticulosis

Answer 8

sigmoid colon

Question 9

risk factors colon cancer

Answer 9

adenmatous polyps
over 50
IBD (UC>crohns)
high fat, low fiber diet

Question 10

clinical features of diverticulosis

Answer 10

usually asx

vague LLQ discomfort, bloating, constipation/diarrhea

Question 11

dx diverticulosis

Answer 11

barium enema

Question 12

treating diverticulosis

Answer 12

high fiber foods and psyllium

Question 13

complications of diverticulosis

Answer 13

1) painless rectal bleed, usually self limiting

2) diverticulitis

Question 14

diverticulitis occurs when

Answer 14

occurs when feces becomes impacted in diverticulum and leads to erosion and microperforation

Question 15

complications of diverticulitis

Answer 15

usually uncomplicated but can have

abscess formation (drain with CT or surgically)
colovesical fistula
obstruction: from chronic inflammation + bowel thckng
Colonic perforation: uncommon but leads to peritonitis

COPA

Question 16

clincial features of diverticulitis

Answer 16

fever, LLQ, leukocytosis

can have: alt BMs, vomit, painful mass on rectal exam

Question 17

diagnosing diverticulitis

Answer 17

CT scan (ab and pelvis) with oral and IV contrast
xray can rule out other things

barium enema and colonoscopy CONTRAINDICATED

Question 18

treatment of diverticulitis

Answer 18

IV Abx, npo, IV fluids

if sx persist after 3-4 days may need surgery

recurrent episodes may need bowel resection too

Question 19

tortusous dilated veins in submucosa of colon and bleeding in pts over 60

dx
tx

Answer 19

angiodysplasia of colon

dx: colonscopy
tx: 90% pts bleeding stops spont
- can use colonoscopic coag and if bleeding persists, right hemicolectomy

Question 20

acute mesenteric ischemia cuases

Answer 20

arterial embolism from cardiac origin

arterial thrombosis from CAD

nonoccluisve mesenteric ischemia (splanchnic vasoconstriction from low CO in old ill pts)

venous thrombosis: hypercoag, OCs, portal HTN, malignancy etc

Question 21

diagnosing mesneteric ischemia

Answer 21

mesenteric angiography

Question 22

common cuauses of ogilvie syndrome

Answer 22

recent srg or trauma

malignancy, meds