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Clin Medicine > GI > Flashcards

GI Flashcards

1
Q

Bristol stool char describe

A 
1-separate hard lumps hard to pass
2-sausage with lumps
3-sausage with cracks
4-soft snake
5-soft blobs
6-fluffy blobs
7-entirely liquid
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2
Q

Most common causes of constipation

A

Inadequate fiber

Poor bowel habits

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3
Q

Fecal impaction

A

Impaction in rectal vault leading to bowel obstruction

  • opoids, psych, bed rest, neurogenic disorders of colon,
  • nauseas vomiting, decreased appetite, overflow incontinence (paradoxical diarrhea)
  • stercoral ulcer
  • do digital rectal
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4
Q

Treat fecal impaction

A

Saline, mineral oil,
Digital disruption

Long term try to have soft stools and regular bowel movements

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5
Q

Chronic use of laxatives

A

Melanesia coli

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6
Q

Acute vs chronic diarrhea timing

A

Less than 2 weeks greater than 4

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7
Q

Common causes chronic diarrhea

A

Medications, IBS, lactaste deficiency

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8
Q

Chronic diarrhea
What does poop look like for malabsorptive
Inflammatory
Secretory

A

Greasy/malodorous
Plus blood
Watery

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9
Q

What if have chronic diarrhea with abdominal pain

A

IBS IBD

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10
Q

What are signs that warrant further examination with chronic diarrhea

A

Nocturnal diarrhea, weight loss, anemia, positive results on fecal occult blood test

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11
Q

Routine lab test for chronic diarrhea

A

CBC, serum electrolytes, liver function test, calcium, phosphorus, albumin, thyroid stimulating hormone, vitamin a and d levels, INR, erythrocyte sedimentation rate, and c reactive protein

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12
Q

Serologic test for celiac disease

A

IgA tissue transglutiminase

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13
Q

Who with chronic diarrhea has anemia

A

Malabsorption (folate, iron defiency, b12)

Inflammatory convictions

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14
Q

Who with chronic diarrhea has hypoalbuminemia

A

Malabsorption, protein losing enteropathy ex’s and inflammatory diseases

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15
Q

Hyponatremia and non anion gap metabolic acidosis

A

Secretory diarrhea

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16
Q

Increased erythrocyte sedimentation rate or c reactive protein

A

Suggests inflammatory bowel disease

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17
Q

Osmotic gap over 50

A

Osmotic and malabsorptive diarrhea

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18
Q

Sudan test

A

Stinking for fat

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19
Q

Leukocytes, calprotectin and lactoferrin in poo

A

IBD

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20
Q

Wet mounts

A

Giardia and e histolytica

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21
Q

Fecal antigen for

A

Giardia and e histolytica are more sensitive and specific

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22
Q

Acid strain

A

Cryptosporidium and cyclospora

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23
Q

Colonoscopy with mucosal biopsy is done to exclude what

A

IBD
Microscopic colitis
Colonic neoplasia

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24
Q

Upper endoscopy is preformed when

A

A small intestinal malabsorptive disorder is suspected (celiac or whipple)

AIDS to document cryptosporidium, microspordia, and M avium

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25
Q

What do is all poop studies/ endoscopy.colonoscopy inconclusive

A

24 hour stool collection for weight and fat

Fecal elastase less than 100mcg/g may be caused by pancreatic insuffiency

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26
Q

Calcification on plain abdominal radiograph

A

Chronic pancreatitis

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27
Q

SI intestinal imaging with barium, CT or MRI for diagnosis of what

A

Crohns, small bowel lymphoma, carcinoid, jejunum diverticula

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28
Q

How localize neuroendocrine tumors

A

Somatostatin receptor scinitgraphy

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29
Q

When consider secretory diarrhea due to neuroendocrine tumors

A

Chronic, high volume watery diarrhea with a normal osmotic gap that persists during fasting

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30
Q

Serum chromogranin A

A

Variety of neuroendocrine tumors

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31
Q

VIP

A

VIPoma

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32
Q

Calcitonin

A

Medullary thyroid carcinoma

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33
Q

Gastrin

A

Ze syndrome

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34
Q

Urinary 5-hydroxyindoleacetic acid 5-HIAA

A

Carcinoid

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35
Q

How conform small bowel bacterial overgrowth

A

Breath test for glucose or lactulose

Or get aspirate of SI for quantitative aerobic and anaerobic bacterial culture

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36
Q

How confirm carbohydrate malabsorption

A

Elimination trial 2-3 weeks
Hydrogen breath tests

Lactase drfiency0hydrogen breath test

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37
Q

Medications that cause diarrhea

A

Cholinesterase inhibitors, SSRI, angiotensin II receptor blockers, proton pump inhibitors, NSAIDS

Discontinue culprits

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38
Q

Two types of microscopic colitis

A

Lymphocytic and collagenous

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39
Q

Histology microscopic colitis

A

Chronic inflammation -lymphocytes and plasma cells

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40
Q

Who gets microscopic colitis

A

Women 5-6 decade

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41
Q

Collagenous colitis

A

Thickened band of subepithelial collagen

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42
Q

Meds implicated in microscopic colitis

A

NSAIDS

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43
Q

Treat microscopic colitis

A

Antidiarrheal therapy loperaminde

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44
Q

Osmotic diarrheas

A

Osmotic gap over 50

Indigestion or malabsorption of an osmotically active substance

Mainly carb malabsorption, laxative abuse, malabsorption

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45
Q

Factitious

A

Osmotic or secretory

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46
Q

Causes of osmotic diarrhea

A 
Meds
Disaccharides defiency
Factitious diarrhea (magnesium laxative abuse)
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47
Q

Osmotic diarrhea resolved with fasting

A

Yup

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48
Q

What ask someone with osmotic diarrhea

A

Carbs, lactose, fruits and artificial sweeteners (fructose sorbitol) and alcohol

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49
Q

Ingestion of magnesium

A

Osmotic (laxative and antacids)

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50
Q

Fat substitute olestra

A

Causes diarrhea and cramps

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51
Q

Secretory diarrhea

A

High volume with normal osmotic gap
May get dehydration and electrolyte imbalance

Not fixed with fasting

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52
Q

Causes secretory diarrhea

A

Endocrine tumors (stimulating intestinal or pancreatic secretion, Ze, carcinoid, bile salt malabsorption (stimulating colonic secretion)

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53
Q

Causes of secretory diarrhea

A

Hormone (VIPOMA, carcinoid, medullary carcinoma of thyroid, Ze)

Factitious diarrhea (laxative abuse)
Villous adenoma
Bile salt malabsorption
Meds

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54
Q

Inflammatory diarrhea

A

IBD (UC, CD), microscopic colitis, malignancy, radiation enteritis)

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55
Q

Malabsorption diarrhea

A

Pancreatic insuffiency, small mucosal intestinal diseases, intestinal rejections, lymphatic obstruction, small intestinal bacterial overgrowth

-bile salt malabsorption, celiac, whipple, lactase defiency

Small bowel bacterial overgrowth-glucose or lactlose breath test)

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56
Q

Characteristics malabsorptive

A

Weight loss, osmotic diarrhea, steatorrhea, nutritional defiency

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57
Q

Pancreatic insuffiency malabsorptive

A

Chronic pancreatitis, CF< pancreatic cancer
Steatorrhea due to TG malabsorption

Weight loss, gaseous distention and flatulence large great foul smelling stools

Protein and carb not affected and nutrient defiencies rare

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58
Q

Causes of malabsorption syndromes

A

Small bowel disorders (sprue)
Lymphatic obstruction
Pancreatic disease
Bacterial overgrowth

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59
Q

Bile salt malabsorption cause

A

Biliary obstruction or cholesatic liver diseases

Terminal lien (cd, bacterial overgrowth, hypersecretion, meds bind bile salts)

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60
Q

Signs bile salt malabsorption

A

ADEK impaired

Watery secretory diarrhea

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61
Q

Microcytic anemia and microcytic anemia

A

Micro-iron

Macro-b12, folic acid

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62
Q

Celiac disease

A

Destruction of mucosal enterocytes as a humoral immmune response that results in antibodies to gluten, tTG, and other autoantigens

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63
Q

Symptoms celiac disease

A

Weight loss, chronic diarrhea, dyspepsia, flatulence, abdominal distention, growth retardation (infants)

Older kids less likely to manifest signs of serious malabsorption

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64
Q

Atypical symptoms celiac

A

Dermatitis, herpetiformis, iron defiency anemia, osteoporosis

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65
Q

Extraintestinal celiac

A

Fatigue, depression, iron defiency anemia, osteoporosis , short, delayed puberty, amenorrhea, reduced fertility

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66
Q

Celiac dermatitis herpetiformis

A

Cutaneous celiac disease

Skin rash with pruritis papulovesicles over the extensor surfaces of the extremities and over the trunk, scalp and neck

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67
Q

Treat celiac

A

Gluten free

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68
Q

Who gets celiac

A

Whites 1/100 most undiagnosed

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69
Q

Genetics celiac

A

HLA DQ2
Mainly

DQ8

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70
Q

Lab celiac

A 
Microcytic anemia 
(CBC, iron defiency due to occult blood)

Megaloblastic anemia
(B12, folate)

Impaired calcium or vitamin d absorption with ostomalacia or osteoporosis(ALP up normal GGT)

Impaired fat soluble vitamin absorption (elevated prothrombin time, vitamin a or d down)

Small intestine protein loss or poor nutrition (albumin loss CMP)

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71
Q

Antibodies in celiac

A

IfA tissue transglutiminase IgA tTG antibody

IgG to deamindated gladin) anti-DGP)-low sensitivity though

IgA anti endomysial antibodies-not recommended lack of standardization

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72
Q

Velez of all antibodies become undetectable after _ months of dietary gluten withdrawal

A

3-12

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73
Q

Check antibodies on gluten free diet

A

No

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74
Q

Mucosal biopsy celiac

A

Condirm diagnosis

Atrophy or scalloping of the duodenal folds

Intraepithelial lymphocytosis alone->extensive infiltration of the LP with lymphocytes and plasma cells with hypertrophy of the intestinal crypts and blunting or complete loss of intestinal villi

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75
Q

What happens if have normal mucosal biopsy with celiac

A

Excludes diagnosis

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76
Q

Why dal energy x ray densitometry for all patients with sprue

A

Screen for osteoporosis

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77
Q

Most patients with celiac disease also have __ __

A

Lactose intolerance

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78
Q

Celiac disease association

A

Other autoimmune diseases

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79
Q

What supplements give celiac

A

Folate, iron zinc, calcium A B D E

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80
Q

Symptoms of whipple disease

A

Fever, LAD< arthralgias, weight loss, malabsorption, chronic diarrhea, arthralgias, diarrhea, abdominal pain and weight loss

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81
Q

Diagnose whipple

A

Duodenal biopsy PAS positive macrophages with characteristic bacillus, dilation of lacteals

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82
Q

Cause whipple

A

Gram positive bacillus tropheryma whipplei

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83
Q

Who gets whipple disease

A

White men in 4- decade

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84
Q

Whipple protein

A

Protein lowing enteropathy EDEMA

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85
Q

Physical exam whipple

A

Hypotension, low fever, malabsorption, LAD< heart murmurs , steatorrhea

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86
Q

What does whipple bacillus look like

A

Trilamellar wall

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87
Q

Treat whipple

A

Antibiotic
Ceftriaxone, meropenem, TMP SMX

Then duodenal biopsies every 6 months for at least a year and CSF PCR

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88
Q

Prognosis whipple

A

Fatal if untreated

Prevent progression and neurological signs

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89
Q

Symptoms of bacterial overgrowth

A

Distention, flatulence, diarrhea, weight loss , increased fecal fat, vitamin defiency

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90
Q

Diagnose bacterial overgrowth

A

Breath tests glucose lactulose

Confirmed with jejunum aspiration with quantitative bacterial cultures

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91
Q

Bacterial overgrowth diarrhea

A

Osmotic and secretory

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92
Q

Causes of bacterial overgrowth

A

Gastric achlorhydia (PPI)
Anatomical abnormalities
Motility disorder
Fistula

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93
Q

Treat bacterial overgrowth

A

Oral broad spectrum antibiotics effective against enteric aerobes and anaerobes

Rifaximin 400 mg three times daily

94
Q

Short bowel syndrome

A

Malabsorptive condition arises secondary to removal of significant segments of the small intestine

95
Q

Causes of short bowel syndrome

A

Crohn’s disease, mesenteric infarction, radiation enteritis, volvulus, tumor resection, trauma

96
Q

The type and degree of short bowel syndrome depend on what

A

Length and site of the resection and degree of adaption of the remaining bowel

97
Q

Terminal ideal resection

A

Malabsorption of bile salts and B12

98
Q

Over and under 100 cm of ileum removed short bowel syndrome

A

Less 100-watery diarrhea

Over 100-steatorrhea and malabsorption fat soluble
-need low fat diet and vitamin supplements

99
Q

What happens when have unabsorpbed fatty acids with SBS

A

Bind calcium reducing its absorption and enhancing absorption of oxalate-oxalate kidney stones

Cholesterol gallstones

100
Q

Ho prevent oxylate kidney stones

A

Calcium supplements to bind oxalate and increase serum calcium

101
Q

Ileocolonic valve resection

A

Bacterial overgrowth may occcur in the small intestine usually is well tolerated

Remaking SI can adapt

102
Q

Resection of 40-50% SI

A

Well tolerated

103
Q

Massive small bowel resection

A

Weight loss, diarrhea, due to nutrient and electrolyte malabsorption

104
Q

Colon and 100cm of proximal jejunum removed

A

Maintain adequate oral nutrition
Low fat, high carb diet
Fluid and electrolyte losses may still be significant

105
Q

No colon and 200 cm of proximal jejunum

A

Required to maintain oral nutrition

106
Q

No colon and less than 100-200 cm jejunum

A

Need parenteral nutrition

107
Q

Duodenal resection

A

Folate, iron, calcium malabsorption

108
Q

Lactase defiency symtomis

A

Diarrhea, bloating, flatulence, abdominal pain after ingestion of milky

109
Q

Test lactase defiency

A

Hydrogen breath test

110
Q

What kind of diarrhea with lactase defiency

A

Osmotic diarrhea

111
Q

What is the most common cause of chronic diarrhea in young adults

A

IBS

112
Q

Causes of motility disorders

A

Postsurgical -vagotomy, partial gastrectomy, blind loop with bacterial overgrowth,

Systemic disorders-scleroderma, DM, hyperthyroidism

IBS

113
Q

IBS symptoms

A

Altered bowel habits, abdominal pain, absence fo detectable organic pathology

114
Q

What are the 3 clinical presentations of IBS

A

Spastic colon, alternating constipation and diarrhea, chronic, painless diarrhea

115
Q

Pathophysiology IBS

A

Altered colonic motility at rest and in response to stress, cholinergic drugs, cholecystokinin

Altered small intestinal motility

Enhanced visceral sensation

Increased frequency of physiological disturbances

116
Q

Clinical IBS

A

Females young
Ab pain, cramps, irregular bowel habits,

Relief of pain with bowel movement 
Increased frequency of stools with pain 
Loose stools with pain 
Mucus in stools
Sense of incomplete evacuation
117
Q

Diagnose IBS

A

Over 6 months

118
Q

What are alarm symptoms that make IBS not IBS and suggest another diagnosis

A 
Acute onset 
Nocturnal diarrhea 
Severe constipation or diarrhea
Hematochezia
Weight loss
Fever-incompatible with IBS

Family history of cancer, IBD or celiac should have further evaluation

119
Q

IBS is a diagnosis of ___

A

Exclusion

120
Q

Rome criteria for IBS

A

Improvement with defecation
Onset associated with a change in frequency of stool
Onset associated with a change in form of stool

121
Q

Treat IBS

A

Avoid stress and exercise -fiber doesn’t help

Diet-FODMAPS
Fermentable oligosaccharides, disaccharides, monosaccharides, and polyols

Low FODMAP diet

122
Q

Acute paralytic ileus

A

Neurogenic failure or loss of peristalsis in the intestine in the absence of any mechanical obstruction

Commonly seen in hospitalized patients as a result of surgery, peritonitis, electrolyte abnormalities, meds, severe medical illness

123
Q

Symptoms of acute paralytic ileus

A

NV, obstipation, distention, minimal abdominal tenderness, decreased or absent bowel sounds

124
Q

Treat paralytic ileus

A

Restriction of oral intake with gradual liberization of diet as bowel functions eturns

Severe or prolonged needs nasogastric suction and parenteral administering of fluids and electrolytes

125
Q

Acute colonic pseudo obstruction (ogilvie syndrome)

A

Spontaneous massive dilation of cecum or right colon without mechanical obstruction with severe abdominal distention, absent to mild abdominal pain, minimal tenderness

126
Q

Symptoms acute colonic pseudo obstruction

A

NV

Post operative state or with severe medical illness

127
Q

Consequence acute colonic pseudo obstruction

A

Progressive cell dilation may lead to spontaneous perforation with dire consequences
Perforation risk correlated with cecal size and duration of colonis distention

128
Q

Clinical findings acute colonic pseudo Obstructive

A

Abdominal distention 1st Disney
Plain film with colonic dilation

Bowel movements may be absent

Ab tenderness guarding or rebound tenderness

Bowel sounds may be normal or decreased

Significant fever or leukocytosis raises concern

129
Q

Imaging acute colonic pseudo obstruction

A

X ray ct show colonic dilation , confined to the cecum and proximal colon over 9 cm

10-12 increased risk of colonic perforation

130
Q

What causes toxic megacolon

A

IBD, C diff/ CMV,

Fever, dehydration, significant abdominal pain

131
Q

Treat acutecolonic pseudo obstruction

A

Conservative-is less than 12

Oral laxatives not helpful

Watched for signs of worse

Cecal size radiographs every 12 hours

Intervention if no improvement in 48 hours

132
Q

Chronic infections

A

Giardia, e histolytica , cyclospora

Stronglyloidasus

C diff

Immune-cryptosporidium, CMV< belli, cyclospora, mycobacterium

133
Q

Antibiotic associated diarrhea most not c dif and are mild and self limited)

A

Diarrhea during period of antibiotic exposure, dose related and resolves spontaneously after discontinuation of the antibiotic

Mild self limited

134
Q

Antibiotic associated colitis (C DIFF) an anaerobic

A

Colonized colon and released toxins:TcdA and TcdB

More than 3 days in hospital get

C diff all over hospitals

135
Q

How minimization c diff

A

Hand washing

136
Q

What antibiotics commons for c diff antibiotic related colitis

A

Ampicillin, clindamycin, third generation cephalosporins, fluoroquinolones

137
Q

Prophylaxis antibiotic associated colitis

A

Probiotics

138
Q

Who has a higher risk of getting c diff and developing c diff associated diarrhea

A

Old, immunocompromised, antibiotics, General feeding, PPI, chemo, IBD< higher risk

139
Q

Clinical findings antibiotic diarrhea from C diff

A

Green, foul smelling watery diarrhea 5-15 times a day with lower abdominal cramps

No blood

White count up

140
Q

What should be considered in all hospital causes of leukocytosis

A

C diff

141
Q

What are lab values suggestive of severe diarrhea

A

White count greater 30000
Albumin less than 2.5
Elevated serum lactase or rising creatinine

142
Q

Stool study for C diff

A

TcdA is an enterotoxin and TcdB is a cytotoxic

Do rapid enzyme assay for both
Nuclei acid PCR for TcdB gene

PCR assays superior to EIA high sensitivity

143
Q

Flexible sigmoidoscopy c diff

A

Pseudomembranous colitis

Epithelial ulceration with a classic volcano exudate of fibrin and neutrophils

144
Q

What get is severe fulminant symptoms with c diff

A

CT to detect perforation

145
Q

Complications c diff

A

Severe colitis->fulminant_>megacolon

Weight loss and protein losing enteropathy

146
Q

Treat c diff

A

Metronidazole, vancomycin or fidazomicin

147
Q

What are systemic condition

A

Thyroid disease
Diabetes
Collagen cascular disorders

148
Q

Diverticula disease

A

Herniation or sac like protrusions of the mucosa through the muscularis at points of nutrient artery penetration in the SIGMOID COLON

149
Q

Diverticula disease increases with __

A

Age

150
Q

Who is disposed for diverticula disease

A

Connective tissue disorders

151
Q

Divertoculosis

A

90%
Asymptomatic
If pain recurrent left lower quad relieved by defecation alternating constipation and diarrhea

152
Q

Diagnose diverticulosis

A

Barium enema

153
Q

Hemorrhage diverticulitis

A

Yes

154
Q

Diverticulitis

A

Acute abdominal pain LLQ fever, mass in LLQ, laukocytosis

Constipation first-> loose stools inflammation causing narrowing only liquid stool can pass

155
Q

How get diverticulitis

A

Inflammation->microperfoation->macroperforation with abscess or generalizer peritonitis

156
Q

Physical exam diverticulitis

A

Mild left lower quadrant tenderness with a thickened palpable sigmoid and descending colon

Pain, fever, NV< altered bowel hablite, leukocytosis

157
Q

How see diverticulitis

A

CT with contrast

158
Q

Endoscopy diverticulitis

A

No -risk of perforation

159
Q

Complications uncomplicated diverticulitis

A

Pericolic abscess, perforation, fistula, liver abscess, stricture

160
Q

Treat diverticulosis

A

High fiber, psyllium extract, anticholinergic

161
Q

Treat diverticulitis

A

IV fluids, NPO at first
Antibiotics
Surgical resection

162
Q

Acute mesenteric ischemia

A

Periumbilical pain out of proportion to tenderness

Nausea, vomiting, distention, GI bleeding, altered bowel habits

163
Q

Acute mesenteric ischemia x ray

A

Bowel distention, air fluid levels, thumbprinting (eubmucosal edema), or normal

164
Q

CT with contrast and angiography acute mesenteric ischemia

A

Early celiac and mesenteric

165
Q

Peritoneal signs acute mesenteric ischemis

A

Laparotomy indicated to restore intestinal blood flow obstructed by embolus or thrombosis or to respect necrotic bowel

166
Q

Chronic mesenteric insuffiency

A

Abdominal angina-dull cramps periumbilical pain after a meal and lasting several hours (patients have food fear), weight loss, occasionally diarrhea

Evaluate with mesenteric arteriography for possible bypass graft surgery

Superior mesenteric artery syndrome

167
Q

Ischemic colitis

A

Due to non occlusive disease in patients with atherosclerosis-splenic flexure watershed area

168
Q

Who gets ischemic colitis

A

Cocaine,

169
Q

How does ischemic colitis present

A

Severe lower abdominal pain followed by rectal bleeding

170
Q

Abdominal x ray with ischemic colitis

A

Colonic dilation, thumbpinting

171
Q

Sigmoidoscopy ischemic colitis

A

Submucosal hemorrhage , friability, ulcerations, rectum often spread

172
Q

Treat ischemic colitis

A

NPO IV fluids

Surgical resection for infarction or post ischemic stricture

173
Q

Hemorrhoids cause

A

Increased hydrostatic pressure in hemorrhoidla venous plexus associated with straining at stool and pregnancy

174
Q

Hemorrhoids anoscopic Adam

A

External anal inspection

175
Q

Treat hemorrhoids

A

Bulk laxative and stool softeners, sits baths, witch hazel compress,

176
Q

External hemorrhoid

A

Coughing, heavy lifting, straining

Acute onset painful, bluish perinatal nodule veered with skin

Resolve 2-3 days

Stir bath help

177
Q

Anal fissure

A

Linear or rocket shaped ulcers that are usually small
Treatment o anal canal
Posterior midline

Hematochezia

Visual see

178
Q

Treat anal fissure

A

Fiber , topical anesthetics, relaxation of anal canal with NO or Botox

179
Q

Perinatal pruritus

A

Poor hygiene (fistula, fissures, prolapsed hemorrhoids, skin tad, incontinence)

or

too much hygiene (contact dermatitis)

Or

Infection, std, kin conditions

180
Q

Treat perinatal pruritus

A

Education -spicy food, tomato, coffee, clean after poop, anal ointment

Topical glucocorticoid and antifungal agent

181
Q

Nisseria gonorrhoeae: anorectal infection,

A

Rectal swab
Pharynx urethra men

Pharynx and cervix women

182
Q

Treponema pallidus: anorectal infection

A

Dark field microscopy or fluorescent antibody testing of scraping from the chancre of condylomata

VDRL or RPR test

183
Q

Chlamydia trachomatis: anorectal infection

A

May cause lymphogranuloma venereum
-proctocolitis with fever and bloody diarrhea, painful perianal ulcerations, anorectal strictures and fistulae and inguinal adenopathy

Increasing in MSM

Serology, culture, PCR, rectal ischarge

184
Q

Herpes 2 anorectal infection

A

4-21 days after exposure

Viral pcr or antigen detection of fluid

Symptoms resolve in weeks but viral shedding may continue for several weeks

185
Q

Condylomata acuminata anal condylomata (genial warts)

A

HPV

Treat with liquid nitrogen

186
Q

Perianal or anal warts are seen in what % of MSM

A

25%

187
Q

HIV with condylomata

A

Relapse higher
Higher progression to dysplasia or anal cancer
Detectable serum HIV RNA levels should have anoscopic surveillance every 2-6 months

188
Q

How distinguish wart from condyloma lata or anal cancer

A

Biopsy suspicious lesion

189
Q

Treat condylomata acuminata

A

Sex partners examined and treated
HPV vaccines 9-26
MSM get vaccinated

190
Q

Colorectal cancer screening

A

Start at 45

76-85 depend

Over 85-no longer if don’t have history, family history, FAP, HNPAA, history of radiation

191
Q

First degree relative with colorectal cancer or adenomas under 60

A

Screen colonoscopy every 5 years, beginning at 40 or ten years before the age of youngest affected relative

192
Q

First degree relative diagnosed over 60

A

Screen at 40

193
Q

Inherited syndromes of colorectal cancer

A

FAP-stats 10-12

HNPCC-every 1-2 years at 20-25 or ten years younger than youngest age of colorectal cancer diagnosis

194
Q

Polyps of the colon

A

Discrete mass lesions that protrude into the intestinal lumen

Sporadic or FAP

195
Q

Mucosal adenomatous polyps

A

70%

Tubular , tubulovillous, villous

196
Q

Mucosal serrated polyps

A

Hyperplastic, sessile serrated polyps, traditional serrated adenoma

197
Q

Mucosal nonneoplastic polyps

A

Juvenile polyps, hamartoma, inflammatory polyps

198
Q

Submucosal lesions

A

Lipomas lymphoid aggregates, carcinoid, pneumatosis cystoides intestinalis

199
Q

What polyps have significant clinical implications

A

Adenomatous polyps and serrated polyps

200
Q

Adenomas and serrated polyps

A

Non polyploid
Sessile
Pedunculated

201
Q

Over 90% of adenocarcinoma of the colon are believed to arise from adenomas polyps. Majority?

A

Arise in adenomas after inactivation of APC gene->chromosomal instability and inactivation or loss of other tumor suppressor genes

202
Q

Adenocarcinoma from serrated pathway

A

KRAS or BRAF with methylation of CpG rich promoter regions that lead to inactivation of tumor suppressor genes or mismatch repair genes MHL1

203
Q

Clinical nonfamilial adenomatous and serrated polyps

A

Completely asymptomatic

Chronic occult blood loss may lead to iron defiency anemia

Large polyps may ulcerate, hematochezia

204
Q

FOBT FIT

A

Fecal occult blood test and fecal DNA tests for CRC

205
Q

What is fit

A

Fecal immunochemical test for hemoglobin that is more sensitive than others

206
Q

Cool guard

A

Fecal DNA test with a fecal immunochemical test for stool hemoglobin

207
Q

Barium enema CRC or CT colonography

A

Can see polyps

But need bowel cleansing before

208
Q

See polyps larger than 10 mm

A

Diagnostic but not therapeutic

209
Q

CT radiation

A

Risk that may lead to cancer

210
Q

Colonoscopy CRC

A

Requires colon prep
Diagnostic and therapeutic
Done for all patients with FOBT, FIT< fecal or DNA tests or iron defiency anemia due to neoplasms prevelance in these patients

Polyps detected on radiologic imaging studies adenomas detected on flexible sigmoid
REMAINS BEST TEST IN MOST PATIENTS TO DETECT AND TREAT COLORECTAL POLYPS)

211
Q

TREAT POLYPS

A

Colonoscopy polypectomy-remove with biopsy forceps , but can get perforation or bleeding

Postpolypectomy surveillance-periodic colonoscopies surveillance to detect adematous and serrated polyps for 2-10 years

212
Q

What recent of colorectal cancers are germline genetic mutations

A

4%

213
Q

Who should be screened for hereditary CRC

A

Family history
Family history under 50
Family history of multiple polyps
Family history of multiple extracolinic malignancies

214
Q

Bethesda criteria

A

For screening of hereditary colorectal cancer

215
Q

FAP

A

Early development of hundreds to thousands of colonic adematous polyps and adenocarcinoma

.5% of colorectal cancer

216
Q

Extracolonic manifestsations FAP

A

Duodenal adenomas, Desmond tumors, osteopath

217
Q

Clinical FAP

A

Adenomatous polyps of the duodenum and periampullary area develop

Also soft tissue tumors of the skin, Desmond tumors, osteopath, and congenital hypertrophy of the retinal pigment

218
Q

Genetics FAP

A

APC gene AD

8% MUTYH gene AR

De novo in 15%

219
Q

Treat FAP

A

Prophylactic colectomy recommended to prevent otherwise inevitable colon cancer

Proctocolectomy with ileocecal anastomoses

Colectomy with ileocecal anastomoses is recommended usually before 20 years

220
Q

Lynch syndrome HNPCC

A

CRC
Endometrial cancer
Ovarian, renal or bladder, hepatobiliary, gastric, SI cancer at young age

Polyps undergo RAPID transformation 1-2 years to adenoma to cancer

221
Q

Calincial HNPCC lynch

A

Family cancer history genetic and colonscopic screening

Meet Bethesda screening

222
Q

Genetics HNPCC

A

AD

DNA base pair mismatches MLH1 MSH2

223
Q

When suspect HNPCC

A

Tumor tissue histology staining for mismatch repair proteins or testing for microsatellite instability

Confirmed by genetic testing

224
Q

Treat HNPCC

A

Subtotal colectomy with ileocecal anastomoses followed by anual surveillance

Screen for endometrial and ovarian cancer beginning at 30-55, pelvic exam, transvaginal US, endometrial sampling

*prophylactic hysterectomy and oophorectomy is recommended to women at 40 or once finished child bearin

Upper endoscopy for gastric cancer screen

Relatives screened

225
Q

Gardners syndrome

A

Adenomatous colon polyps
95% develop colorectal polyps
Osteopath of mandible skull and long bones

Supernumerary teeth, epidermis and sebaceous teeth, thyroid and adrenal tumors

AD

226
Q

Turncoats syndrome

A

Adenomatous colon polyps

Brain tumors

CRC 100% over 40

AD

227
Q

Peutz jeghers

A

Hamartomatous polyps throughout GI lead to bleeding, intiussusception or obstruction

Mucocutaneous pigmented msucles on lips, buccal mucosa and skin

228
Q

Familial juvenile polyposis

A

Several juvenile hamartomatous polyps located most commonly in colon

Increased risk of adenocarcinoma

229
Q

PTEN multiple hamartoma syndrome (cowden disease)

A

Hamartomatous polyps and lipomas throughout GI tract trichilemommomas and cerebellar lesions

Increased rate of malignancy is demonstrated in the thyroid , breast, and urogenital tract

230
Q

Genetics peutz jeghers

A

AD

STK11

231
Q

Familial juvenile polyposis genetics

A

AD

Genetic defects 18q and 10q MADH2 and BMPR1A

Clin Medicine (28 decks)

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