GI Flashcards
F/U colorectal cancer surgery
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
treatment for colorectal cancer
surgery and resesction of regional lymphatics
right side CRC and left side CRC which has melana and which has hematochezia more commonly
right side melena
left side hematochezia
nonneoplastic polyps types
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)
adenomatous polyps are what lesions and malignancy?
benign, but have significant malignant potential, precursor of adenocarcinoma
(think adam is harmless but can turn evil bc he lies)
diverticulosis caused by what
increased intraluminal pressure and colon bulges through an area of weakness in colon wall
risk factors for diverticululosis
lower fiber diet, constipiation increases pressure
positive fam hx
age
most common location of diverticulosis
sigmoid colon
risk factors colon cancer
adenmatous polyps
over 50
IBD (UC>crohns)
high fat, low fiber diet
clinical features of diverticulosis
usually asx
vague LLQ discomfort, bloating, constipation/diarrhea
dx diverticulosis
barium enema
treating diverticulosis
high fiber foods and psyllium
complications of diverticulosis
1) painless rectal bleed, usually self limiting
2) diverticulitis
diverticulitis occurs when
occurs when feces becomes impacted in diverticulum and leads to erosion and microperforation
complications of diverticulitis
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
clincial features of diverticulitis
fever, LLQ, leukocytosis
can have: alt BMs, vomit, painful mass on rectal exam
diagnosing diverticulitis
CT scan (ab and pelvis) with oral and IV contrast xray can rule out other things
barium enema and colonoscopy CONTRAINDICATED
treatment of diverticulitis
IV Abx, npo, IV fluids
if sx persist after 3-4 days may need surgery
recurrent episodes may need bowel resection too
tortusous dilated veins in submucosa of colon and bleeding in pts over 60
dx
tx
angiodysplasia of colon
dx: colonscopy
tx: 90% pts bleeding stops spont
- can use colonoscopic coag and if bleeding persists, right hemicolectomy
acute mesenteric ischemia cuases
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
diagnosing mesneteric ischemia
mesenteric angiography
common cuauses of ogilvie syndrome
recent srg or trauma
malignancy, meds
