GI 8 Flashcards
In the general population Colon Cancer screening starts at 50 yo with a colonoscopy and then every 10 years. (or Sigmoid q 5 years + hemoccult q 3 years OR Sigmoid Q10 years + yearly hem occult.)
What makes a patient “High Risk” for colon CA, thereby changing screening recommendations?
- First degree relative with COLON CA < 60 yo
- First degree relative with polyps < 60 yo
- 2 or more first degree with CA or polyps at any age.
For HIGH RISK patients, what is the colon screening recommendations?
Start 40 YO or 10 years before age of CA in relative (whichever comes first)
Q3 years colonoscopy.
Lactose intolerance is a clinical dx…but if you had to what test can you do to diagnose?
Lactose breath hydrogen test.
The treatment of rectal prolapse depends on wether it is a partial thickness/mucosal or full thickness (concentric rings in anal mass) prolapse…
What is the management of each?
Partial thickness:
- digital reduction
- increased fluids and fiber
- Pelvic floor exercise
- (if incontinence present) - surgery
Full Thickness:
- Surgery
Diverticular bleed occurs due to arterial erosion from colonic outputting. It presents as self-limiting painless hematochezia…
How do you DX?
How do you TRX if bleed continues and is BRISK?
What is the TRX if recurrent bleeding occurs?
DX = Colonoscopy
TRX of ACTIVE bleed is Angiogram embolization OR Endoscopic embolization.
Recurrent bleed–> may need colonic resection
What do you do if you find an incidental CYST on the pancreas?
Endoscopic US guided Aspiration of FLUID to r/o Cancer.
you did a colon cancer screen with colonoscopy and found something….What is the interval for follow up with colonoscopy for the following:
- Small rectal hyperplastic polyp?
- 1-2 small (<1 cm) tubular adenoma?
- > 3 Adenomas
- Adenoma 1-2 cm
- high grade dysplasia
- villous.
- > 2 cm
- Sessile (flat)
- Adenocarcinoma on history
- In situ
- 10 years
- 5 years
- 3 years
- 2-6 months
A patient swallows a foreign body…normally you can follow with serial X rays to see if it passes on its own.
What 4 high risk objects do you want to retrieve with Endoscopy right away?
- Battery
- Magnet
- Button
- Sharp object.
Hirschsprung disease is caused by lack of neuronal innervation to the rectosigmoid colon.
What are the classic symptoms?
What is the initial test to order?
What it the next text to order?
What provided definitive dx?
Delayed Meconium + abd distention + abd obstruction.
Initial test = XRAY –> dilated loops and absent rectal free air (obstructive pattern)
Next = contrast enema –> shows transition between narrow sigmoid and dilated desc colon.
Definitive dx = Rectal BX showing no Ganglion cells.
A patient with IBD flair looks TOXIC…what should you rule out?
TOXIC MEGACOLON w XRAY
IF patient has signs of cholecystitis (RUQ pain, fever, leukocytosis, + murphy, LFT ok) BUT negative imaging(no stone, no wall thickening, no sonographic murphy)…
What test do you order next?
HIDA (Cholecintigraphy)
What is the first best study to get in a patient who is > 50 yo, with iron def anemia, with + hem occult?
Colonoscopy,
Get EGD next if Colonoscopy is negative.
A Child swallow a coin… you get an XRAY and confirm that there is a coin in Upper GI tract…in what 3 scenarios do you want to do Endoscopy to retrieve it?
1) Symptomatic
2) Time of ingestion unknown
3) > 24 hour after ingestion
A patient is brought in and diagnosed with diverticulitis…they are placed on PO abx but they do not improve after 2-3 days…What is the next step in management?
Abdominal CT to evaluate complications of Diverticulitis (abscess, obstruction, perforation)
Celiacs is associated with what malignancy?
How does it present?
Enteropathy associated T-Cell LYMPHOMA
ABD pain + “B symptoms” fever, fatigue, weight loss…Later progressing to GI bleed, obstruction and even perforation.
