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GI block > GI goljan IBD, bowel polyps, colon cancer, acute appendicitis > Flashcards

GI goljan IBD, bowel polyps, colon cancer, acute appendicitis Flashcards

1
Q

MC inflammatory bowel disease?

A

ulcerative colitis

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2
Q

define ulcerative colitis

A

chronic relapsing ulcerinflammatory disease w/ ulcerations in continuity and limited to mucosa and submucosa of rectum and colon

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3
Q

Define Crohn’s disease

A

chronic noncaseating granulomatous, ulceroconstrictive disease

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4
Q

characteristics of Crohn’s diseae

A

transmural inflammation;

discontinous spread throughout GI tract

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5
Q

What is indeterminate colitis?

A

features of UC and crohn’s

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6
Q

Epidemiology of UC

A

whites > blacks;
no sex predilection;
early teen to 40y/o;
lower incidence if previous appendectomy

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7
Q

smoking relationship to UC

A

lower incidence in smokers and other nicotine users

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8
Q

extent of inflammation in UC

A

mucosal and submucosal

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9
Q

epidemiology of Crohn’s disease (CD)

A

whites > blacks;
jews > non-Jews;
no sex predilectation;
majority from age 10-35

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10
Q

smoking relationship to CD

A

smoking is risk factor

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11
Q

extent of inflammation for CD

A

transmural

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12
Q

location of UC

A

mainly rectum and extends CONTINUOUSLY INTO LEFT COLON;

does NOT involve other areas of GI tract

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13
Q

location of CD

A

ileum and colon (50%), terminal ileum alone (30%), colon alone (20%);
MAY involve other areas of GI tract (mouth to anus)

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14
Q

gross features of UC

A

inflammatory pseudopolyps;
areas of friable, bloody residual mucosa;
ulceration and hemorrhage

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15
Q

gross features of CD

A

thick bowel wall and narrow lumen (leads to obstruction);
apthous ulcers in bowel (early sign);
skip lesions, strictures, fistulas;
deep linear ulcers w/ cobblestone pattern;
Fat creeping around serosa

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16
Q

Micro features of UC

A

ulcers and crypt abscesses containing neutrophils;

dysplasia or cancer may be present

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17
Q

micro features of CD

A

noncaseating granulomas (60%);
lymphoid aggregates;
dysplasia or cancer less likely

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18
Q

clinical findings w/ UC

A

recurrent L sided abdominal cramping w/ bloody diarrhea and mucus;
fever, tenesmus, weight loss

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19
Q

ExtraGI findings of UC

A

primary sclerosing cholangitis (UC > CD), erythema nodosum, iritis/uveitis (CD > UC);
pyoderma gangrenosum;
HLA-B27+ arthritis

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20
Q

Lab and radiograph findings in UC

A

p-ANCA Abs > 45% cases;

“lead pipe” appearance in chronic disease

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21
Q

complications of UC

A 
toxic megacolon (hypotonic and distended bowel);
adenocarcinoma (greatest risks are pancolitis, early onset and duration of disease > 10yrs)
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22
Q

Tx of UC

A

sulfasalazine or mesalamine;
corticosteroids for severe disease;
nicotine patch;
immunosuppressants : azathiprine or cyclosporine;
surgery=> colectomy w/ ileostomy usually cures

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23
Q

How does sulfasalazine or mesalamine help in UC and CD by their mechanism of action?

A

5-ASA active metabolite;
O2 free radicical scavenger;
inhibits lipoxygenase pathway in arachidonic acid metabolism

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24
Q

clinical findings of CD

A

recurrent RLQ colicky pain (obstruction) w/ diarrhea;
bleeding occurs only w/ colon or anal involvement (fistulas or abscesses);
apthous ulcers in mouth

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25
extraGI findings in CD
``` erythema nodosum; sacroiliitis (HLA-B27 assoc); pyoderma gangrenosum; iritis (CD > UC); primary sclerosing cholangitis (UC > CD) ```
26
radiographical findings in CD
"string" sign in terminal ileum from luminal narrowing by inflammation and/or fistulas
27
complicaitons of CD
fistulas, obstruction, colon cancer (UC > CD); Ca+ oxalate renal calculi (increased reabsorption of oxalate through inflamed mucosa); malabsorption due to bile salt deficiency; macrocytic anemia due to vit B12 deficiency
28
Tx for CD
sulfasalazine or mesalamine (5-ASA; oral salicylate) corticosteroids for mod to severe disease; steroid analogues that target areas of GI tract; immunosuppressants: azathioprine or cyclosporine
29
What is used for Tx of complications of CD?
metronidazole for colonic fistulas; TNF-i for enterocutaneous fistulas; Surgery for obstruction, fistulas, toxic megacolon, refractory disease
30
What are the non-neoplastic or hamartomatous polyps?
hyperplastic polyp; Juvenile (retention) polyp; Peutz-Jeghers polyposis
31
Where is the most common adult non-neoplastic polyp located? How does it appear on histo?
hyperplastic polyp usually occurs in sigmoid colon; | Histo=> sawtooth appearance
32
Where is the most common polyp in children located? risks associated
Juvenile (retention) polyp is located in rectum and may prolapse out of rectum and bleed
33
How does a juvenile polyp present grossly?
solitary polyp w/ smooth surface w/ enlarged cystic spaces on cut section
34
Genetic associated w/ juvenile polyposis?
AD or nonhereditary
35
How will nonhereditary polyposis syndrome present and what is it called?
Cronkhite-Canada syndrome => polyps + ectodermal abnormalities of nails
36
A patient presents w/ mucosal melanin pigmentation of buccal mucosa and lips. where and how does this disease present?
Peutz-Jeghers polyposis that is AD; | hamartomatous polyps predominate in small bowel and less common in stomach and colon
37
What is the risk associated w/ PJP?
``` increased risk (>50%) for colorectal, breast, gynecologic cancers; this is true even if polyps are hamartomas ```
38
Neoplastic polyps are called what?
adenomas
39
Epidemiology of premalignant dysplastic colonic polyps
increase w/ age; | equal sex incidence
40
Where is the most common polyp found? How does it look grossly and micro?
tubular adenoma MC site is sigmoid colon; | stalked polyp w/ complex branching glands
41
How does a tubulovillous adenoma present?
usually stalked polyp; | adenomatous and villous change (similar to small bowel villi)
42
How common is a villous adenoma? MC location? and presentation on micro/gross? potential for malignancy?
villous adenoma (10% of polyps); rectosigmoid location; sessile polyp w/ primarily villous component; 30-40% risk for malignancy
43
What is different about villous adenomas compared to others? risks associated
secrete protein and K+ rich mucus => can produce hypoalbuminemia and hypokalemia
44
Risk factors for malignancy in adenomas
adenoma > 2cm (40% risk of malignancy); multiple polyps; polyps w/ increased villous component
45
Etiology of FAP
AD disease where ALL patients develop tubular adenomas and cancer; polyps begin developing bw 10-20y/o
46
pathogenesis of FAP
inactivation of adenomatous polyposis coli (APC) suppressor gene
47
clinical findings in FAP
malignant transformation usually bw 35-40y/o; | assoc w/ congenital hypertrophy of retinal pigment epithelium
48
What should be done if FAP is diagnosed?
prophylactic colectomy recommended
49
Differentiate 2 syndromes associated w/ FAP
Gardner's=> AD polyposis w/ benign osteomas and desmoid tumors Turcot's=> AR polyposis w/ malignant brain tumors such as astrocytoma and medulloblastoma
50
Epidemiology for colon cancer
3rd MC cancer related death in adults and in men and women; rates have been decreasing due to screening; typically elderly disease
51
How are rectal and colon cancers Dx?
rectal => 50% detected from DRE colon=> 50% detected by flexible sigmoidoscopy
52
risk factors for colon cancer
``` Age >50y/o; smoking; obesity, physical inactivity, heavy alcohol intake; hereditary polyposis syndromes; hereditary nonpolyposis colon cancer; family cancer syndrome; 1st degree relatives w/ colon cancer; IBD (UC > CD); diet (low fiber, increased sat fats, reduced veggies) ```
53
2 pathways for the carcinogenesis of colon cancer
Adenoma-carcinoma sequence (80% sporadic cases)=> sequential mutations of different genes (APC, RAS, p53) MSI sequence=> inactivation of DNA mismatch genes
54
MC locations for colon cancer
rectosigmoid (50%); ascending colon (15%); descending colon (15%); transverse colon and cecum (10%)
55
Screening tests for colon cancer in order of best tests
colonoscopy (gold standard) > fecal occult blood > barium enema
56
When should screening of colonoscopy be started?
age 50 w/ no risk factors and 3-5yrs if Hx of polyp removal; | age 40 if 1st degree relative has polyps or colorectal cancer
57
What is the basis for fecal occult blood test? how good is the test?
peroxidase activity of heme in Hb but myoglobin has peroxidase activity causing color change => not sensitive or specific for colon cancer
58
What accounts for the varying levels of sensitivity and specificity in fecal occult blood test?
false pos=> myoglobin in met, plant peroxidase (radish)
59
Colon cancer presents differently depending on site of tumor. Describe if it is Left sided cancer
tend to obstruct => smaller diameter than R colon & lesions will have annular ("napkin-ring") look; change in bowel habits w/ constipation & diarrhea w/ or w/o bleeding (bright red blood coating stool)
60
Colon cancer presents differently depending on site of tumor. Describe if it is right sided cancer
tend to bleed => may lead to Fe deficiency tumors are polypoid in appearance; Blood is mixed w/ stool
61
Sites of mets for colon cancer
liver (MC); lungs; bone; brain
62
6 ways of preventing colon cancer
ASA and other NSAIDs (decreases adenomas); annual fecal occult blood testing; estrogens and progestins; diet alterations (decrease fat intake, increase fiber, fruit and vegs); statin Tx (inhibit growth of cancer lines); cessation of smoking
63
Tx of colon cancer
surgery => CTX => targeted monoclonal Ab Tx
64
Px for colon cancer and what is used to detect recurrences?
5yr=> 65%; serum CEA detects recurrences
65
Epidemiology of acute appendicitis
10% of population; | MC abdominal surgical emergency
66
Pathogenesis of acute appendicitis in children
lymphoid hyperplasia secondary to viral infection (adenovirus, measles virus infection/immunization)
67
pathogenesis of acute appendicitis in adults
fecalith obstructs proximal lumen (increased intraluminal pressure causes mucosal injury and bacterial invasion); seeds (sunflower, persimmons); pinworm infection
68
What are the primary pathogens causing acute appendicitis?
E. coli (MC); | Bacteroides fragilis
69
Clinical findings of acute appendicitis IN SEQUENCE
initial colicky periumbilical pain (50%); fever; pain then N/V; cutaneous hyperesthesia at T12 level; pain shifts to RLQ in 12-18hrs; may have signs of lower UTI (increased freq, dysuria)
70
Why is colicky periumbilical pain associated w/ acute appendicitis?
irriration of unmyelinated afferent C fibers on visceral peritoneal surface => referred pain to midline
71
What is a key sign for ID'ing children w/ abdominal pain suspected of acute appendicitis?
fever
72
Why does pain shift to RLQ in 12-18hrs?
irritation of A-(S) fibers on parietal peritoneum that localizes pain to exact location
73
What are some clinical signs of acute appendicitis?
rebound tenderness at McBurney's point; Psoas sign; Rovsing's sign (LLQ pain referred to RLQ)
74
Lab findings in acute appendicitis?
``` neutrophilic leukocytosis w/ L shift; abnormal urinalysis (increased protein, hematuria, pyuria) ```
75
How will a rectocecal appendicitis present?
``` radiograph sows sentinal loop in RLQ; localized ileus (lack of motility) from subjacent appendicitis ```
76
Complications of acute appendicitis
periappendiceal abscess w/ or w/o perforation; pyelophlebitis; subphrenic abscess
77
Why does the most common complication of acute appendicitis occur?
periappendiceal abscess w/ or w/o perforation may develop subphrenic abscess due to Bacteroides fragilis
78
Describe pyelophlebitis complication of acute appendicitis
infection of portal vein w/ thrombosis danger; | radiograph shows gas in portal vein
79
Describe subphrenic abscess complication of acute appendicitis
persistent fever postop; diaphragm fixed on Right w/ R-sided pleural effusion; tenderness over lateral 7th or 8th ribs
80
How is subphrenic abscess Dx and Tx?
Dx=> ultrasound, CT, gallium scan; | Tx=> extraperitoneal drain and ABx
81
How is acute appendicitis diagnosed?
clinical exam; spiral CT RLQ after Gastrografin enema; plain CT w/ rectal contrast; Ultrasound
82
Tx for acute appendicitis
appendectomy; | cefoxitin (prophylactic in periop if perforation is suspected)
83
What disorders mimic appendicitis?
``` viral gastroenteritis; ruptured follicular cyst; ruptured ectopic pregnancy; mesenteric lymphadenitis; Meckel's diverticulitis ```

GI block (11 decks)

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