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GI > Health Maintenance & Screening > Flashcards

Health Maintenance & Screening Flashcards

1
Q

Risk Factors for Colorectal CA

A 
Age >50
Hx of adenomatous polyps
Personal Hx of IBD
Family Hx
African-American or Easter European Jew
Type 2 DM
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2
Q

Adenomatous Polyps (Adenomas)

A

Adenomas increase colon CA risk
Large or multiple polyps increase risk
Hyperplastic polyps do not increase risk

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3
Q

Personal Hx of IBD

A

Ulcerative colitis

Crohn’s disease

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4
Q

Why is a personal Hx of IBD important?

A

Chronic inflammation
Dysplasia
CA

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5
Q

Lifestyle Related Factors

A 
Diet: high in red meat/processed meats, low fruits/veggies consumption
Physical inactivity
Obesity
Smoking
Heavy alcohol use
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6
Q

Family Hx of Adenomatous Polyps or Colorectal CA

A

1 in 5 have a family Hx of colorectal CA
First degree relative with colorectal CA doubles risk
Family members with adenomatous polyps also increase risk

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7
Q

Inherited Syndromes

A

Family Adenomatous Polyposis (FAP
Hereditary non-polyposis colon cancer (HNPCC)
Turcot syndrome: DNA mismatch repair
Peutz-Jeghers syndrome: dramatic looking polyps; increased risk of CA elsewhere

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8
Q

Type 2 DM

A

Increased risk of colorectal CA

Less favorable prognosis

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9
Q

Previous Treatment for Other CA

A

Testicular CA

Prostate CA

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10
Q

Colorectal CA Screening Tests

A 
Flexible sigmoidoscopy
Colonoscopy
Double-contrast barium enema
Virtual colonoscopy
Fecal occult blood test (FOBT)
Fecal immunochemical test (iFOBT or FIT)
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11
Q

Pros of Fecal Immunochemical Test (iFOBT or FIT)

A

More accurate
Less false positives
No dietary restrictions
Uses antibodies to detect HB in stool

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12
Q

Flexible Sigmoidoscopy

A 
Quick & safe
Sedation not used
Doesn't require specialist
Done every 5 years
View 1/3 of colon
Can miss polyps
Can't remove polyps
Colonoscopy of abnormal
Small risk of bleeding, infection, or bowel tear
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13
Q

Colonoscopy

A 
Preferred method
View entire colon
Biopsy & remove polyps
Every 10 years
Can mis polyps
Full bowel prep needed
Sedation needed
Small risk of bleeding, bowel tears, or infection
Expensive
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14
Q

Double Contrast Barium Enema

A 
Usually view entire colon
Relatively safe
Every 5 years
No sedation
Can miss sm. polyps
Full bowel prep
Some false positive results
Can't remove polyps during testing
Colonoscopy if abnormal
Replaced by virtual colonoscopy
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15
Q

Virtual Colonoscopy

A 
Quick & safe
Usually view entire colon
Every 5 years
No sedation
Full bowel prep
Can miss sm. polyps
Some false positive test results
Colonoscopy if abnormal
Air enema given
CT scan of colon done times 2
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16
Q

Fecal Occult Blood Test (FOBT)

A 
No risk to colon
No bowel prep
Done at home
Inexpensive
May produce false positive tests
Pre-test dietary restrictions
Yearly
3 stool samples
Patient drops off
Colonoscopy if abnormal
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17
Q

Restrictions Prior to FOBT

A

Avoid NSAIDs 7 days
Avoid vitamin C 3 days
Avoid red meats 3 days

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18
Q

Difference Between FIT & FOBT

A 
No pre-test restrictions
More accurate
Less false positives
Uses antibodies to detect HB
1 day sample
Automated vs. manual system
Closed system
Better patient compliance
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19
Q

Guidelines for Colon CA Screening

A

Begin at age 50

Colonoscopy every 10 years

20
Q

Unable to Undergo Colonoscopy Then:

A

Flexible sigmoidoscopy every 5 years
Double contrast barium enema every 5 years
Virtual colonoscopy every 5 years

21
Q

If all imaging tests refused or contraindicated then:

A

FOBT yearly with 3 stool samples

FIT yearly

22
Q

Exceptions to Colon CA Screening Guidelines

A

African-Americans at age 45

High risk guidelines more aggresive

23
Q

High Risk Colon CA Screening Guidelines

A

1st degree family with colon CA need colonoscopy 10 years prior to relative’s age at diagnosis
IBD- colonoscopy every 1-2 years
Personal Hx of adenomatous polyps or colon CA- colonoscopy 1 year post resection then every 3-5 years
FAP- yearly flex sig beginning at age 10-12 years (positive genetic testing consider colectomy)
HNPCC- colonoscopy every 1-2 years beginning at age 20-25

24
Q

Prevention of Colon CA

A

Colonoscopy

Decrease the western diet/lifestyle

25
Q

Risks Factors for Hepatocellular Carcinoma (HCC)

A 
Hep B viral infection
Chronic Hep C infection
Hereditary hemochromatosis
Cirrhosis
Nonalcoholic fatty liver disease
DM
Chronic alcohol abuse
Chronic tobacco abuse
Alpha-1 antitrypsin deficiency
26
Q

HCC Screening Needed for:

A

Patients with cirrhosis
Chronic Hep B infection + Asian, African & African-Americans, family Hx of HCC
Caucasians with chronic Hep B + active inflammation & high viral load for several years, men >40, women >50

27
Q

Screenings Tests for HCC

A

Liver ultrasound (every 6 months)

28
Q

Summary of HCC

A

Hep B infection highly associated with HCC

Screening guidelines complex

29
Q

Risk Factors for Esophageal CA

A 
Age >55
Men 3x more likely
ETOH abuse
Tobacco use
Obesity
Diet: high in processed meats, low in fruits/veggies
30
Q

Medical Conditions Associate with Esophageal CA

A 
HPV infection
GERD
Barrett's esophagus: GERD
Achalasia: narrowing of distal esophagus
Tylosis: esophageal papillomas
Plummer-Vinson syndrome: esophageal webs
31
Q

Screening for Esophageal CA

A

None for general population

Periodic endoscopies: Barrett’s, achalasia, Plummer-Vinson syndrome

32
Q

Dietary Fiber can be Beneficial for Treatment

A

Hemorrhoids
Constipation
Diarrhea
Diverticulosis

33
Q

2 Types of Fiber

A

Soluble

Insoluble

34
Q

Soluble Fiber

A

Dissolve in water

35
Q

Foods Containing Soluble Fiber

A 
Oatmeal
Oat cereal
lentils
Apples
Oranges
Pears
Oat bran
Strawberries
Nuts
Flaxseeds
Beans
Dried peas
Blueberries
Psyllium
Cucumbers
Celery
Carrots
36
Q

Insoluble Fiber

A

Nondigestible

37
Q

Foods Containing Insoluble Fiber

A 
Whole wheat
Whole grains
Wheat bran
Corn bran
Seeds
Nuts
Barley
Couscous
Brown rice
Bulgur
Zucchini
Celery
Broccoli
Cabbage
Onions
Tomatoes
Carrots
Cucumbers
Green beans
Dark leafy veggies
Raisins
Grapes
Fruit
Root veggie skins
38
Q

What can fiber help treat?

A

Diarrhea (bulking)

Constipation (easier to pass)

39
Q

Chronic Constipation can Lead to:

A

Hemorrhoids
Anal fissures
Development of diverticulosis

40
Q

Dietary Fiber Recommendations

A

Women: 25 g/day
Men: 38 g/day

41
Q

Diverticulosis

A

Starting at age 40
1/2 people btw 60-80
Almost everyone over 80

42
Q

What can a high fiber diet help with?

A

Constipation
Diverticular disease
Diverticulitis

43
Q

Risk Factors for GERD

A

Eating large meals before lying down
Obesity
Foods: citrus, tomato, chocolate, mint, garlic, onions, spicy or fatty foods
Drinks: ETOH, carbonated drinks, coffee, tea
Smoking
Pregnancy
Hiatal hernia

44
Q

Medications that can worsen GERD

A 
NSAIDs
Beta-blockers
CCB
Bronchodilators
Dopamine active drugs
TCAs
Some muscle relaxants
45
Q

Dietary & Lifestyle Counseling to Reduce GERD Symptoms

A 
Maintain healthy weight
Avoid tight fitting clothes
Avoid trigger foods
Eat smaller meals
Wait 3 hours after eating to lay down
Elevate head of bed 6-9 inches
Don't smoke or chew
Decrease stress & anxiety

GI (20 decks)

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