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3 GI 1/5
Step Up to Medicine, Chap 3, Colon
| Question | Answer |
|---|---|
| Can CEA be used for colorectal cancer screening? | No. Only useful for baseline and recurrence screening. |
| MC site of distant spread in colorectal cancer? | Liver |
| Which subset of IBD poses a greater risk for developing colorectal cancer? | UC |
| Recommended management of familial adenomatous polyposis? | Prophylactic colectomy (riks of CRC is 100% by 3rd or 4th decade of life) |
| Name that syndrome!: Polyps, osteomas, dental abnormalities, benign soft tissue tumors, desmoid tumors, sebaceous cysts | Gardner's syndrome (risk of CRC is 100% by 40yo) |
| Name that syndrome!: AR; polyps, cerebellar medulloblastoma or glio mutliforme | Turcot's syndrome |
| Name that syndrome!: single or multiple hamartomas scattered throughout GI tract; pigmented spots on lips, oral mucosa, face, genitalia, and palmar surfaces; possible intussuception or GI bleeds | Peutz-Jeghers |
| Which has higher malignant potential-- hamartomas or adenomas? | Adenomas (hamartomas have very low malignant potential) |
| MC presenting symptom of colon cancer? | Abdominal pain |
| MCC of large bowel obstructions in adults | CRC (colorectal cancer) |
| Which sided CRC is more likely to present with melena (dark stools)? | R sided |
| Which sided CRC is more likely to present with hematochezia (BRBPR)? | L sided |
| Triad of anemia, weakness, and RLQ mass points towards which diagnosis? | CRC |
| Signs of obstruction are more common in which sided CRC? | Left sided (smaller luminal diameter compared to right) |
| Which sided CRC is more likely to have changes in bowel habits? | L sided (more likely to see pencil stools and/or alternating diarrhea/constipation) |
| MC symptom of rectal cancer? | Hematochezia |
| In which type of cancer is radiation therapy NOT indicated: colon cancer or rectal cancer? | Colon cancer (radiation is used to treat rectal cancer, however) |
| When should CEA levels be checked? | Prior to surgery, and then every 3-6 mos. CEA <2-3 post-op= excellent prognosis. |
| What do very high CEA levels suggest? | Liver involvement |
| In addition to surgery, what adjuvant therapy is recommended for pts with Dukes' C colon cancer? | Post-op chemo (5-FU and leucovorin). Radiation therapy is NOT recommended for colon cancer. |
| What is the recommended management of juvenile polyps (generally seen in children <10yo)? | Removal (highly vascular and common) |
| MC type of adenomatous polyp? Risk of malignancy (small, med, great)? | Tubular (60-80%). Smallest risk of malignancy (tubulovillous=intermed, villous=greatest risk). |
| Which polyp morphology is more likely to be malignant? | Sessile (flat) is more likely to be malignant. Pedunculated (stalk) is more likely to be benign. |
| What is the treatment for most polyps? | Removal |
| Where are most polyps found? | Rectosigmoid region |
| What causes diverticulosis? | Increased intraluminal pressure |
| MC location for diverticula? | Sigmoid colon |
| Diagnostic test of choice for diverticulosis? | Barium enema (abdominal radiographs are usually normal) |
| Treatment for diverticulosis? | High fiber (bran) diet or psyllium to bulk stools |
| Diagnostic test of choice in diverticulitis? | CT scan (abd and pelvis) |
| Which tests are CONTRindicated in acute diverticulitis? | Barium enema and colonoscopy (risk of perforation) |
| Treatment for initial episode of diverticulitis? | IV abx, NPO, IV fluids. Surgery if symptoms persist x3-4d |
| Treatment of 2+ episodes of diverticulitis? | Surgery (resection of involved segment) once acute inflammation resolves |
| Which type of acute mesenteric ischemia more often occurs in acutely ill elderly pts? | Nonocclusive ischemia |
| Which type of acute mesenteric ischemia has the most sudden and painful onset? | Embolic |
| What is the classical presentation of acute mesenteric ischemia? | Sudden onset of severe abdominal pain disproportionate to physical findings |
| How is acute mesenteric ischemia diagnosed? | Mesenteric angiography (also order plain film abd to r/o other causes; look for thumb printing on barium enema) |
| Hypotension, tachypnea, lactic acidosis, fever, AMS, and shock. | Signs of intestinal infarction (check lactate level if mesenteric ischemia is suspected) |
| Why should vasopressors be avoided in mesenteric ischemia? | They worsen the ischemia. |
| LLQ pain, fever, and leukocytosis is suggestive of which diagnosis? | Diverticulitis |
| Tx of choice in acute mesenteric ischemia? | IV fluids and broad spectrum abx. Direct intra-arterial infusion of papverine (vasodilator) into superior mesenteric system relieves occlusion and vasospasm. Possibly surgery if peritonitis develops. |
| S/S and radiographic evidence of large bowel obstruction in an ill pt with recent h/o surgery or medical illness in absence of any mechanical obstruction | Ogilvie's syndrome |
| At which point should bowels be decompressed immediately due to risk of impending rupture? | Colonic distention or when colon diameter exceeds 10cm |
| MC 3 abx to cause C diff pseudomembranous colitis? | Clindamycin, ampicillin, and cephalosporins |
| Dx test of choice in C diff. | C diff toxins in stools (results take 24h) |
| Drug of choice in treating C diff colitis? Contraindications for its use? Alternative drug? | Metronidazole. Can't use in babies or pregnant pts. Oral vancomycin if pt is resistant to metro or can't tolerate it. |
| MC site for colonic volvulus? | Sigmoid colon (75% of cases). Cecal volvulus=25% of cases (caused by congenital lack of fixation; tends to occur in younger pts). |
| Diagnostic test of choice for colonic volvulus? | Plain abd films |
| Omega loop sign (bent-inner tube shape) on plain film indicates which type of volvulus? | Sigmoid |
| Coffee bean sign (large air-fluid level in RLQ) on plain film indicates which type of volvulus? | Cecal |
| Preferred diagnostic and therapeutic test for SIGMOID volvulus? | Sigmoidoscopy (NOT for cecal) |
| Which type of volvulus requires emergent surgery: sigmoid or cecal? | Cecal. Sigmoid is treated with nonoperative reduction (decompression w/sigmoidoscopy). |
| In which case of acute abdomen/colonic volvulus should you NOT perform a barium enema? | If strangulation is suspected |
Created by:
sarah3148
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