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Surgery EOR > GI / Nutritional Part 2 (Colorectal cancer - Gastric carcinoma) > Flashcards

GI / Nutritional Part 2 (Colorectal cancer - Gastric carcinoma) Flashcards

1
Q

What is the MCC of LBO in adults?

A

Colorectal cancer (CRC)

also the MCC of occult bleed

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2
Q

MCC of CRC?

colorectal cancer

A

adenomatous polyps

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3
Q

What are the 4 different stages of polyps concerning malignancy likelihood/development?

A
  1. Hyperplastic
  2. Tubular
  3. Tubulovillous
  4. Villous

From least likely to most likely to be cancerous (HTTV)

Villous are villains

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4
Q

What size of a colorectal polyp is concerning?

A

1 cm or greater

less than this = unlikely to be malignant

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5
Q

RF of CRC (non-genetic)

A

age > 50 yo
IBD
Obesity, smoking, ETOH

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6
Q

What type of IBD is MC for CRC?

A

UC

> Crohn’s

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7
Q

What are the genetic predospitions to CRC? (4)

A

1) Familial Adenomatous Polyposis (FAP)
2) Turcot Syndrome
3) Lynch Syndrome (Hereditary Nonpolyposis CRC)
4) Puetz-Jebher’s Syndrome

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8
Q

Familial Adenomatous Polyposis (FAP) is a genetic mutation of the _ gene

A

APC

adenomatous polyposis coli (APC) gene

tumor supressor gene

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9
Q

What are the characteristics of Familial Adenomatous Polyposis (FAP) and the resulting treatment?

A

adenomas of colon at childhood

almost all will develop colon cancer by age 45yrs; prophylactic colectomy best for survival

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10
Q

What are the characteristics of Turcot syndrome and how does it differ from FAP?

A

FAP-like syndrome + CNS tumors (medulloblastoma, glial tumors)

FAP on steroids

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11
Q

Inheritance pattern of Lynch Syndrome and genes affected?

Hereditary Nonpolyposis CRC

A

Autosomal dominant

LADS (lynch autosomal dominant syndrome)

loss of function in DNA mismatch repair genes (MLH1, MSH2/6, PMS3)

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12
Q

What are the age differences of Lynch Syndrome vs FAP?

A

1) Lynch occurs at a mean age of late 40s
2) FAP = childhood adenomas

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13
Q

Difference between type I and type II Lynch syndrome

A

1)type I: esp. seen on right side
2)type II: ↑ risk of extra-colonic cancers (esp. endometrial)

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14
Q

Inheritance pattern of Puetz-Jegher’s Syndrome and associated characteristics

A

Autosomal dominant (like lynch syndrome)

hamartomatous polyps, mucocutaneous hyperpigmentation (lips, oral mucosa, hands) – risk of breast/pancreatic cance

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15
Q

In general what are the common clinical manifestations of the 4 CRCs?

A
  1. Iron deficiency anemia
  2. rectal bleeding
  3. abd pain
  4. change in bowel movements

advanced disease: ascites, abdominal masses, hepatomegaly

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16
Q

Clinical manifestations of right sided (proximal) CRC

A

Just general CRC symptoms

chronic occult bleeding

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17
Q

Clinical manifestations of left sided (distal) CRC

A

bowel obstruction; present later & cause changes in stool diameter – may develop Streptococcus bovis endocarditis

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18
Q

What are the characteristics of LOW risk CRC? (3)

hint, one is the size

A

*pedunculated
*tubular
*<1cm

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19
Q

What are the characteristics of HIGH risk CRC? (3)

A

*sessile (flat)
*villous (finger-like projections)
*>1cm

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20
Q

1st line diagnosis of CRC

A

Colonscopy + bx

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21
Q

If you were to do a barium enema for CRC, what is classic finding?

A

apple core lesion

constriction of lumen

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22
Q

Tumor marker for monitoring CRC

A

CEA

Carcinoembryonic antigen

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23
Q

Screening age for CRC and 3 screening options

assuming no RF

A

45 yo

1) q 10 years for colonoscopy
2) q 1 year fecal occult blood testing alone
3) flexible sigmoidoscopy q5yrs + fecal occult blood testing q3yrs

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24
Q

Screening frequency for CRC with the following level of RF
1) low
2) high
3) mega

A

1) low risk: q5-10yrs
1-2 polyps, <1cm, tubular, low grade
2) high risk: q1-3yrs
≥3 polyps, ≥1cm, sessile/villous, high grade
3) mega risk: q2-6mo
≥10 polyps

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25
Q

You have Lynch Syndrome (or a FH?), what is the screening protocol?

A

colonoscopy q1-2yrs beginning at 20-25yrs

remember, cancer typically appears in 40s

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26
Q

You have FAP (or a FH?), what is the screening protocol?

A

flexible sigmoidoscopy annually beginning 10-12yrs

appears in childhood

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27
Q

Overall management of non-metastatic CRC

A

surgical resection followed by post-op chemo

radical vs endoscopic
chemo to destroy residual cells and prevent METS

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28
Q

Mangement of METS CRC?

A

Palliative chemo :(

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29
Q

What chemo is used for CRC?

A

FOLFOX
FOLFIRI
VGEF inhibitor (bevacizumab)

folinic acid and leucovorin Ca2+ is used in FOLFOX and FOLFIRI (along with other chemo agents)

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30
Q

MCC of gastroenteritis?

A

Viruses

rotavirus and norovirus

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31
Q

Length of subacute diarrhea

A

2-4 weeks

above this = chronic (4+ weeks)
below this = acute (< 2 weeks)

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32
Q

MCC of foodborne disease outbreak

A

Norovirus

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33
Q

Common locations to get norovirus?

A

Cruise ships and daycare

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34
Q

Overall, if you want to use diagnostics for viral gastroenteritis, what might you use?

A

PCR

also antigen tests and stool analysis

it seems

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35
Q

All viral gastroenteritis have supportive treatment as management, but this virus has a prevention

A

Rotavirus

VACCINATE YOUR KIDDOS

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36
Q

Which causitive organism for gastroenteritis holds a risk of Guillain-Barre? hemolytic uremic syndrome (HUS)?

A

GB = Campylobacter jejuni
HUS = E. coli, Shiga-toxin-producing (STEC)

only sometimes!

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37
Q

How might you get Campylobacter jejuni infection?

for bacterial gastroenteritis

A

Think dairy/ animal exposure

at camp drinking milk

poultry, unpasteurized milk, untreated water, new pets, dairy farms

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38
Q

Treatment of Campylobacter jejuni

A

Supportive typically

azithromycin x3d or erythromycin x5d can shorten duration when given early in illness

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39
Q

Symptoms of E. coli, Shiga-toxin-producing (STEC) and what should be monitored

A

hemorrhagic colitis w/ bloody diarrhea

monitor: CBC/BUN/Cr for HUS

40
Q

Treatment of E. coli, Shiga-toxin-producing (STEC)

A

Supportive

abx not recommended d/t HUS risk!!!

41
Q

Dx and treatment of C diff

A

DX: two-step:
1) enzyme immunoassay for glutamine
2) dehydrogenase w/ confirmatory toxin testing by NAAT or toxin immunoassay

Metro for mild
Vanc for severe
Fidaxomicin for continuous relapse

42
Q

What is the causitive agent for traveler’s diarrhea? Symptoms?

A

E coli

s/s = watery diarrhea + abd cramps

43
Q

Treatment of E coli induced gastroenteritis

Traveler’s diarrhea

A

azithromycin or cipro x3d may ↓ duration

44
Q

Complications of non-typhoid salmonella?

A

Spread of infection systemically

salmonella = systemic

bacteremia, osteomyelitis, brain abscess, meningitis

45
Q

Tx of non-typhoid salmonella

A

Rocephin + azithromycin OR amoxicillin OR bactrim

ONLY in patients with high risk of systemic disease: 3mo, chronic GI dz, HIV/immunocompromised

46
Q

What are the hosts for salmonella typhi and the presentation?

A

Humans

sys symptoms + bloody diarrhea, then HSM & rose spots by wk2

humans are the only natural hosts!

47
Q

Treatment of salmonella typhi

A

Rocephin OR Azithromycin

+/- steroids in kiddos with enteric fever

monotherapy unlike non-typhoid salmonella?

48
Q

Common outbreak location of shigella and s/s

A

Daycare

s/s vary - watery or bloody diarrhea w/ systemic symptoms

49
Q

Treatment of shigella

A

rocephin OR azithromycin OR FQ

50
Q

What is the causative agent of gastroenteritis that leads to this characteristic finding - “rice water diarrhea”?

A

Vibrio cholerae

51
Q

Apart from rice water diarrhea, what are the symptoms of Vibrio cholerae and why does this make sense?

A

LOTS of watery diarrhea with no pain, but electrolyte abnormalities

from losing soooo much liquid

52
Q

Treatment of Vibrio cholerae

A

Rocephin OR Azithromycin OR Cipro OR Tetracycline

very similar to shigella

53
Q

What bacterial enteritis is often cause by exposure to any of the following:

SWINE; pork, milk, well water, chitterlings, tofu

A

Yersinia enterocolitica

uncommon in US

54
Q

What is Yersinia enterocolitica often mistaken for?

A

Appendicitis

very similar s/s - but bloody diarrhea is seen!

55
Q

Treatment of Yersinia enterocolitica

A

parenteral 3rd gen ceph, Bactrim, aminoglycosides, FQs, tetracycline, doxy, chloramphenicol – only for neonates/IC

56
Q

What are the two common causes of parasitic gastroenteritis?

A

Giardia lamblia
Entamoeba histolytica

57
Q

What is Giardia lamblia aka and what exposures often lead to it?

A

backpacker’s diarrhea

daycare, camping trips, contaminated water

58
Q

s/s of Giardia lamblia

A

acute – watery diarrhea, foul-smell, flatulence, anorexia; can lead to FTT

59
Q

treatment of Giardia lamblia

A

tinidazole x1, metronidazole x5-10d, nitazoxanide x3d

remember, parasitic

60
Q

What are the s/s of Entamoeba histolytica caused by? How does this present?

A

intestinal amebiasis

gradual onset bloody diarrhea, lower abd. pain, tenesmus, wt loss; complications: toxic megacolon, fulm. colitis

61
Q

Dx and treatment of Entamoeba histolytica and why this makes sense

A

Stool O&P
metronidazole then paramomycin

remember, fungal

62
Q

What antidiarrheal is indicated in patients with inflammatory diarrhea?

A

Bismuths

antimicrobial properties; salicylate: anti-secretory & anti-inflammatory properties

63
Q

Apart from pepto, what is another bismuth?

A

Kaopectate

pectate kinda sounds like pepto

64
Q

SE of bismuths and CI

A

dark colored stools, darkening of tongue

CI in kiddos d/t Reye’s syndrome (because salicylate)

65
Q

What two antidiarrheals bind to gut opioid receptors, thereby decreasing peristalsis? Which one increases anal sphincter tone as well?

A

Diphenoxylate and loperamide

loperamide also increases anal tone

should not be used in inflammatory diarrhea as a result!

66
Q

Indications for Diphenoxylate and loperamide

A

non-invasive diarrhea

watery/non-bacterial?

67
Q

Why use anticholinergics for diarrhea and what are they?

A

Decreases gut secretions (can’t poop)

inhibits Ach-related GI motility

Phenobarbital, Hyoscyamine, Atropine, Scopolamine

68
Q

MOA of zofran and suffix of generic names?

A

blocks serotonin receptors

-setron meds (sim to serotonin)

69
Q

SE of -setron (anti-emetic anti-cholinergic) meds

A

neuro: HA, fatigue, sedation
cardiac: QT prolongation, arrhythmias
GI: bloating, diarrhea, constipation

70
Q

What are the dopamine blockers used as anti-emetics? (3)

A

Prochlorperazine
Promethazine
Metoclopramide

blocks CNS dopamine receptors; mild antihistaminic/antimuscarinic

71
Q

SE of dopamine blockers used as anti-emetics?

A

QT prolongation, anticholinergic, drowsiness

also EPS: rigidity, bradykinesia, tremor, akathisia, parkinsonism: rigidity, tremor

72
Q

Treatment of dystonic reactions (dyskenesia) from EPS 2ndary to dopamine blockers

A

IV diphenhydramine

Benadryl

73
Q

MCC of ACUTE lower GI bleed

A

diverticulosis

chronic = CRC, remember :)

74
Q

Diverticulosis is outpouchings due to herniation of the mucosa into the wall of the colon along natural openings at the () of the colon

A

vasa recta

75
Q

Most common location vs site of bleeding for diverticulosis

A

Location = Left colon
Bleeding site = Right colon

76
Q

MC location of diverticulitis

A

sigmoid colon

remember, this is at the LLQ, which is why you feel pain there!

77
Q

Dx of diverticulosis vs diverticulitis

A

diverticulosis = incidental colonscopy
diverticulitis = CT w/ IV contrast after characteristic symptoms

78
Q

Treatment of diverticulitis

A

Metro + cipro OR levaquin for uncomplicated

with a clear liquid diet

Surgery: refractory to medical therapy, frequent recurrences, perforation, strictures

79
Q

MCC of Esophageal Neoplasms in US vs worldwide

A

US = adenocarcinoma
WW = squamous cell

80
Q

MC location of esophageal adenocarcinoma VS squamous cell

A

adenocarcinoma = distal esophagus, esophagogastric junction
squamous cell= mid to upper third of the esophagus

81
Q

which esophageal neoplasm can be a complication of barret’s esophagus?

A

adenocarcinoma

82
Q

What are the characteristic findings of an esophageal neoplasm?

A

*progressive dysphagia – solid food dysphagia progressing to include fluids
*odynophagia
*weight loss

think esophageal problems

83
Q

Dx of esophageal neoplasms

A

Upper endoscopy w/ bx

84
Q

Management of esophageal neoplasms

A

Resection + chemo OR
radiation + chemo (5-FU)

palliative stenting (advanced)

85
Q

Management of Barrett’s

A

endoscopic eval q3-5yrs

watchful waiting and observing the esopahgus

86
Q

What esophageal disease can lead to Plummer-Vinson Syndrome and what is it? Why is it a concern?

A

Esophageal Strictures

*dysphagia + webs + iron deficiency anemia
*may be associated w/ atrophic glossitis

*increased risk for esophageal SCC

87
Q

MC location of esophageal webs vs Shatzki Rings?

Esophageal Strictures

A

Esophageal Web = mid-upper esophagus
Shatzki Ring = lower esophagus (at the squamocolumnar junction)

Rings fall down d/t gravity

Webs can attach high in the sky

88
Q

Risks of Esophageal Strictures

A

hiatal hernia

d/t compromised anatomy?

89
Q

MC symptom of Esophageal Strictures

be specific

A

Dysphagia (esp. to solids)

90
Q

Diagnosis and treatment of Esophageal Strictures

A

Barium esophagram (swallow)

Symptomatic: dilation

91
Q

MC gastric carcinoma and biggest RF

A

Adenocarcinoma

H. pylori biggest risk factor

92
Q

MC symptoms associated with gastric carcinoma

A

weight loss & persistent abdominal pain

early satiety also seen

think what would happen if your stomach was having issues

93
Q

What are the palpable LNs sometimes associated with gastric carcinoma

A

*supraclavicular lymph nodes (Virchow’s node)
*umbilical LN (Sister Mary Joseph’s node)
*left axillary LN (Irish sign)
*palpable nodule on rectal exam (Blumer’s shelf)

94
Q

Diagnostic of choice for gastric carcinoma and what imaging is used for METS

A

Upper endoscopy w/ bx standard

Abdominal/pelvic CT (METS)
CXR sometimes

95
Q

What are the lab findings characteristic of gastric carcinoma? (2)

A

1) microcytic/hypochromic anemia
2) + guaiac

iron deficiency anemia?

96
Q

Treatment of early local disease gastric carcinoma

A

endoscopic resection

other therapies depending on location and course of disease (gastrectomy, chemo, radiation)

Surgery EOR (17 decks)

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