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Clin Med 2 > Neoplasms and Anorectal Diseases > Flashcards

Neoplasms and Anorectal Diseases Flashcards

1
Q

Colorectal cancer is the ____ most frequently diagnosed cancer and the ____ leading cause of cancer death in the US.

A

4th

2nd

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2
Q

Esophageal Carcinoma epi

A

6th most common cause of cancer death
M > W

Subtypes:
Adenocarcinoma
SCC

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3
Q

What are the major risk factors of SCC of esophagus?

A

Smoking and EtOH

SCC risk decreases substantially after smoking cessation

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4
Q

What are risk factors of adenocarinoma of esophagus?

A

Obesity (high BMI)

GERD and Barrett’s esophagus

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5
Q

How do you dx esophageal carcinoma?

A

Direct tissue biopsy via upper endoscopy

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6
Q

How do you stage esophageal carcinoma?

A 
Upper endoscopy (length, bulky tumor) 
Endoscopic US (regional nodes) 
CT scan PET scan  (distal mets)
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7
Q

Therapies of esophageal carcinoma?

A

Low stage (Tis and T1) - endoscopic, chemo/surgery if needed

Higher stage (T2 and above) - chemo/XRT then surgery

Long term survival is poor

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8
Q

Gastric cancer is the ____ leading cause of cancer worldwide

A

3rd

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9
Q

When is gastric cancer typically diagnosed?

A

At a later stage

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10
Q

Risk factors of gastric cancer

A

H. Pylori
High salt intake
Smoking
Heavy EtOH use

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11
Q

How do you dx gastric cancer?

A

Direct tissue biopsy via upper endoscopy

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12
Q

How do you stage gastric cancer?

A 
Upper endoscopy (size, location) 
Endoscopic US (depth/nodes) 
CT scan PET scan (distal mets)
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13
Q

What is the treatment for gastric cancer?

A

Low stage (Tis and T1) - endoscopic therapy (EMR/ESD)

Higher stage (T2 and above) - chemo/XRT then surgery (morbid)

Long term survival is poor

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14
Q

Small bowel cancers

A

Rare
Less than 2% of GI cancers

Types:
Adenocarcinoma 
Carcinoids
Sarcomas 
Lymphomas 
GISTs

M> F

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15
Q

What are the risk factors of small bowel cancer?

A

FAP

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16
Q

Where in the small bowel is adenocarcinoma more common?

A

50% duodenum
30% jejunum
20% ileum

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17
Q

What is the treatment for small bowel adenocarcinoma?

A

Surgery + chemo

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18
Q

Colorectal cancer is the ____ leading cause of cancer death in the US

A

2nd

5% lifetime risk

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19
Q

What is the treatment for colon cancer?

A

Stage 1 and low risk stage 2 - surgical resection is curative (no chemo)

All other stages - surgical resection if possible + chemo

Rectal cancers respond well to radiation upfront followed by surgery

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20
Q

Pancreas cancer is the _____ leading cause of cancer related deaths

A

4th

Most pts present late stage with obstructive jaundice, abdominal pain, and weight loss

21
Q

How do pts with pancreas cancer present?

A

Late stage with obstructive jaundice, abdominal pain, and weight loss

22
Q

Anal fissure presentation

A

Anal pain
Anal itching
Outlet bleeding

23
Q

What is the medical treatment for anal fissure?

A 
High fiber diet (30-50 g) 
Warm baths 
Nitrates 
CCB 
Steroid creams
24
Q

What are the surgical treatments for anal fissures?

A 
BoTox injection 
Sphiceterotomy 
Anoplasty
Advancement flap 
Anal dilation
25
Q

Path behind anal fissure

A

Anal spasm MC

Traumatic stooling causing tear

26
Q

What positions can pts be in for anal examination?

A

Left lateral decubitus

Prone jack knife position

Be sure to ask the pt to bare down

27
Q

What is the path behind thrombosed external hemorrhoid?

A

NOT DONE HERE

28
Q

How do pts with thrombosed external hemorrhoids present?

A

Constant pain
Protrusion
Bleeding

29
Q

What are the PE of thrombosed external hemorrhoid?

A

Tender mass protrusion
Secondary findings
-skin necrosis
-prolapsed internal hemorrhoids

30
Q

What is the treatment of thrombosed external hemorrhoids?

A

Non-operative management
Excision
Evacuation

31
Q

What is the risk of death (in %) of pts with esophageal CA?

A

90% mortality

32
Q

What is the most common risk factor for Gastric Ca?

A

H. Pylori

33
Q

What is the % mortality of gastric cancer?

A

60%

34
Q

FAP risk factor for

A

Gastric Cancer
Small bowel cancers
Colon cancer

35
Q

Where in the stomach is gastric cancer most common?

A

Lesser curve

36
Q

What does a central ulceration of a mass on endsocpy or colonscopy indicate?

A

Having an ulcer in the middle is a sign of progression of the CA

37
Q

Fish mouth appearance

A

Pancreas cancer

38
Q

MC location of anal fissure

A

Posterior aspect

39
Q

What is the major difference between treatment of Stage 1 - 4 internal hemorrhoids?

A

Stage 1 and 2 you can do conservative treatment

Stage 3 and 4 need surgery

40
Q

Can you band external hemrrhoids?

A

No

41
Q

Which hemorrhoids can you do banding for?

A

Stage 1 and 2 internal hemorrhoids

42
Q

Who gets perianal abscess?

A

Infected anal crypt gland
Infected fissure
Crohns
Post surgical

43
Q

How to pts with perianal abscess present?

A 
Constant pain 
Pressure 
Subacute onset 
Fever
Malaise
44
Q

What are the PE to perianal abscess?

A 
Erythema 
Induration 
Swelling
Drainage
Sometimes minimal
45
Q

How do you dx perianal abscess?

A

Exam under anesthesia
CT
US
Evaluation for IBD, diverticulitis

Watch closely - untreated perianal abscess could lead to necrotizing soft tissue infection

46
Q

What is the treatment for perianal abscess?

A 
I and D 
ABX if:
-immunocompromised
-DM
-extensive cellulitis
Seton placement
47
Q

What is the treatment for pilonidal cyst?

A

I and D

48
Q

What causes proctalgia fugax?

A

Smooth muscle spasm secondary to stool withholding in adults

Tx. Antispasmodics, BoTox injection

49
Q

How do nitrates work in anal fissure treatment?

A

increase blood flow to the area to aid in healing

Clin Med 2 (13 decks)

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