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3 GI 1/5

Step Up to Medicine, Chap 3, Colon

QuestionAnswer
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