GI health maintenance Flashcards
1
Q
RFs for colorectal cancer?
A
- age over 50
- hx of adenomatous polyps
- personal hx of IBD
- family hx
- african-american or Eastern European jews
- Type 2 DM (less favorable prognosis)
2
Q
Why is it so impt to get colonoscopy at 50?
A
- 9/10 people dx with colorectal cancer are at least 50
3
Q
Why are adenomatous polyps (adenomas) concerning?
A
- ***adenomas increase colon cancer risk
- large in size or mult polyps increase risk
- ***hyperplastic polyps don’t increase risk
4
Q
Why is personal hx of IBD impt?
A
- uclerative colitis
- crohn’s
- chronic inflammation may lead to dysplasia and eventually cancer
5
Q
What are lifestyle related factors related to increased risk of colon cancer?
A
diet: high in red meat (beef, pork, lamb) and processed meats - low fruit and veggie consumption - physical inactivity - obesity - smoking - heavy alcohol use
6
Q
Importance of family hx of adenomatous polyps or colorectal cancer?
A
- 1/5 people with colorectal cancer have family members who were also affected
- first degree relative with colorectal cancer doubles risk
- even higher if that person is 45 or younger at dx
- family members with adenomatous polyps also increases risk
7
Q
What are the inherited syndromes that put pts at higher risk for colorectal cancer?
A
- familial adenomatous polyposis (FAP) - 1% of all colorectal cancers
- hereditary non-polyposis colon cancer (HNPCC): 2-4% of all colorectal cancers
- Turcot syndrome
- peutz-jeghers syndrome: dramatically large polyps that are benign but pt at risk for other malignancies throughout the body
8
Q
Previous tx for what other cancers put you at risk for colorectal cancer?
A
- testicular cancer
- prostrate cancer
9
Q
What are the screening tests for colorectal cancer?
A
- flexible sigmoidoscopy
- colonoscopy
- double-contrast barium enema
- virtual colonoscopy
- FOBT, stool guaiac test: guaiac detects heme in stool
iFOBT or FIT:
-more accurate measurement
-less false positives - no need to avoid meat and vitamin C
- uses abs to detect HB in stool
10
Q
Flexible sigmoidoscopy use? How often? Cons? Risks?
A
- fairly quick and safe
- sedation usually not used
- doesn’t reqr a specialist to perform
- done q 5 yrs
- views only about 1/3 of colon
- can miss polyps
- can’t remove all polyps
- will need a colonoscopy if abnormal
- small risk of bleeding, infection or bowel tear
11
Q
When is use of colonoscopy preferred? Risks, cons?
A
- preferred method for screening
- can usually view the entire colon
- can bx and remove polyps
- done q 10 yrs
- can miss small polyps
- full bowel prep needed
- sedation is needed
- small risk of bleeding, bowel tears or infection
- expensive
12
Q
When is double contrast barium enema used? Pros, cons?
A
- can usually view the entire colon
- relatively safe
- done q 5 years
- no sedation needed
- can miss small polyps
- full bowel prep needed
- some false positive test results
- can’t remove polyps during testing
- colonoscopy will be needed if abnormal
- test has largely been replaced by virtual colonoscopy
- contrast is with barium and air
- only detect 1/2 of large (over 1 cm) polyps
- use has declined with increasing use of endoscopic and CT procedures
- procedural expertise in double-contrast barium studies may be declining:
- no one really knows how to do these anymore
13
Q
Virtual colonoscopy - pros and cons?
A
- fairly quick and safe
- can usually view entire colon
- done q 5 yrs
- no sedation needed
- full bowel prep needed
- cna miss small polyps
- some false positive test results
- colonoscopy will be needed if abnormal
- AKA CT colonography, air enema is given and CT scan of colon is done 2x (supin and one in prone position)
14
Q
Pros and cons to FOBT?
A
- no direct risk to colon
- no bowel prep needed
- sampling done at home
- inexpensive
- may produce false positive test results
- may have pre-test dietary restrictions
- should be done yearly
- need 3 diff stool samples
- pt drops off or mails in (26% compliance rate)
- colonoscopy will be done if abnormal
- avoid NSAIDs for 7 days prior to testing: can cause false positives
- avoid vitamin C in excess of 250 mg daily (supplements and food) for 3 days prior to testing - false positives
- avoid red meats for 3 days prior to testing: false positives
15
Q
Diff b/t FOBT and FIT (IFOBT) test?
A
- no pre-test dietary or med restrictions
- more accurate measurement
- less false positives
- no need to avoid meat and vitamin C
- use abs to detect HB in stool
- only need one day’s sample
- automated vs manual system
- closed system, less risk of exposure
- better pt compliance: 96%
