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BOARDS > SESAP - Alimentary - Large Intestine > Flashcards

SESAP - Alimentary - Large Intestine Flashcards

1
Q

LGIB

First step?

A

NG tube placement for aspiration along with resuscitation.

Bile back - likely not UGI.

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2
Q

LGIB
Best study?
Bleeding rates on Nuc scintography?
Bleeding rates on Mesenteric angiography?

A

Colonoscopy. Early colonoscopy = lower hosp stay, more cost effective, highest yeirlg.

Nuc scintography: 0.04 mL/min (only 66% accuracy)

Mesenteric angiography: 0.5 mL/min

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3
Q

CRC Screening
FOBT?
Home v. Office?
What is the method?

A

Home based testing is > greater sensitivity than in-office DRE

stool smear from 3 different BM on guiac card, to test for peroxidase rxn.

False positive w/ Vitamin C ingestion

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4
Q

CRC Screening
FIT?
What is it?

A

Fecal immunochemical test

Specific for Hg (no peroxidase reactions)
ONLY blood in colon (does not react with Heme from UGI sources)

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5
Q

CRC Screening
MSDT?
What is it?

A

Multi-targer stool DNA test.

requires collection of an entire BM.

Looks at DNA abnormalities asspciated with FIT.

WHEN COMBINED WITH FIT, increased SENSITIVITY, decreased specificity compared to FIT alone.

May have a higher FP rate though…

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6
Q

CRC Screening
Colonoscopy?
Preps?
Time for withdrawal?

A
  1. STANDARD for diagnostic and therapeutic reasons.
  2. Split preps - 1/2 evening before, 1/2 day off are equivalent to just a single prep the day before
  3. Withdrawal time of AT LEAST 6 minutes
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7
Q 
CRC Screening?
Average Risk
When to start?
What to perform?
What about a flexible sigmoidoscopy?
A
  1. 50 years
  2. Colonoscopy every 10 years
    AND
    FOBT or FIT annually.
  3. Yes. FSIG every 3-5 years or every 10 years with annual FIT
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8
Q

Flexible sigmoidoscopy?

Can they be used for screening?

A

Yes. Average sigmoidoscope is 60 cm long. Miss 1/3 of proximal ademonas.
If abnormal, must get full colonoscopy.

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9
Q 
CRC Screening?
Family Hx of CRC of adenomatous polyp 
OR two family members with the above
When to start?
What to perform?
How often?
A
  1. 10 years before age of patient or 40 years of age.
    If family member dx <60 years = get c-scope every 5 years
    if family member > 60 years = get c-scope at 50
  2. Every 5 year interval (if > 60 years then just 50 every 10)
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10
Q 
CRC Screening?
FAP
When to start?
What to perform?
How often?
A
  1. Age at 10-12 years
  2. Sigmoidoscopy
  3. every year
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11
Q 
CRC Screening?
HNPCC
When to start?
What to perform?
How often?
A
  1. Age 20-25 years
  2. colonoscopy
  3. every 1-2 years
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12
Q

CRC Screening?
Personal Hx: small <5 mm, OR 1-2 tubular adenomas
When is the next colonoscopy?

A
  1. Repeat 5 years
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13
Q

CRC Screening?
Personal Hx: >1 cm, > 3 tubular adenomas
When is the next colonoscopy?

A
  1. Repeat 3 years
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14
Q

CRC Screening?

What are other personal colonoscopic findings that warrant repeat c-scope in 3 years?

A
  1. 10 mm/1 cm size
  2. HG dysplasia
  3. villous/sessile polyp
  4. > 3 adenomas
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15
Q

Diverticulitis
elective sigmoidectomy?
When to do it?

A

No longer age based or number of attacks.

INDIVIDUAL and based on severity of attacks.

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16
Q

Diverticulitis?

When a patient has pandiverticulitis, what do you do?

A
  1. If you need to operate, still do a sigmoid colectomy electively. <10% recurrent risk
17
Q 
Crohn's 
Common medications and impact on surgery?
Corticosteroids?
5-ASA
Thiopurines
Anti-TNF
A
  1. Steroids 4 weeks before surgery = INC risk for abdominal cx
  2. Does not need to be stopped. No specific peri-operatice cx.
  3. Thiopurines within 6 weeks of sx = increased risks of sepsis
  4. Anti-TNF blocker = no peri-operative risks.
18
Q 
Perforated appendicitis with IAA? 
Immediate management?
Recommendations after hospitalization regarding:
1. interval appendectomy?
2. colonoscopy?
3. malignancy rates?
A

Percutaneous drainage and antibiotics. Failure rate = 13-20% for all-comers (phlegmon/abscess); < 5% in just abscess

Risk of recurrence is 8%, Complication risk for interval appy is 2-23%. routine interval appy NOT INDICATED.

If no Appy, malignancy rate - appendiceal is 2%
inc risk in 1. > 40 years (15%) , 2. inflammatory mass (10-30%). 3. other malignancies (10%)
–> COLONOSCOPY if > 40 years

19
Q 
POEM
what is it?
What is used for?
Basics of procedure?
Outcomes?
A
  1. Per-oral endoscopic myotomy
  2. For achalasia
  3. forward viewing scope, make a longitudinal mucosal incision, submucosal tunnel, divide circular layer NOT longitudinal.
  4. Equivalent to Heller myotomy
20
Q

Heller Myotomy

How to do it?

A

laparoscopic. ports like a fundo.
Longitudinal myotomy 6 cm on esophagus and 2 cm onto gastric cardia past the inferior pulmonary vein
Watch the muscle separate 1-2 cm.
Then a fundoplication - partial. Traditionally a Dor.

BOARDS (17 decks)

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