Term
| when do you screen for colon cancer? |
|
Definition
| if one family member has colon cancer, begin at age 40; or 10 years before age of onset of family member |
|
|
Term
| What is the positive predictive value of FOBT? |
|
Definition
|
|
Term
| What percent of colorectal tumors are palpable by DRE? |
|
Definition
|
|
Term
| What percent of colorectal cancers are reachable by flex sig? |
|
Definition
|
|
Term
| What is the use of getting a CEA? |
|
Definition
| recurrence surveillance; prognostic significance= pts with preop CEA >5 ng/mL have a worse prognosis |
|
|
Term
| How do you clinically stage colorectal cancer? |
|
Definition
| CT chest abdomen and pelvis |
|
|
Term
| What percent of people with colorectal cancer have mets at time of diagnosis? |
|
Definition
|
|
Term
| What is the increased risk of colorectal cancer with inflammatory bowel disease? |
|
Definition
| incidence of cancer is 5-10% at 20 yrs with crohn's disease; 12-20% at 20 years with UC |
|
|
Term
| What are some colonic polyposis syndromes? |
|
Definition
| familial adenomatous polyposis, gardner's syndrome, turcot's syndrome, peutz jeghers, familial juvenile polyposis coli, hereditary nonpolyposis CRC |
|
|
Term
| What is the inheritance pattern of FAP? |
|
Definition
|
|
Term
| What part of the GI tract is involved in FAP? |
|
Definition
| hunderds of adenomatous polyps in the colon; the colon is always involved and the duodenum is involved in 90% of cases; polyps may also form in the stomach, jejunum and ileum |
|
|
Term
| What is teh risk of colorectal ca in pts with FAP? |
|
Definition
| 100% by third or fourth decade of life |
|
|
Term
| What are the characteristics of Gardner's syndrome? |
|
Definition
| polyps pluse osteomas, dental abnormalities, benign soft tissue tumors, desmoid tumors, sebaceous cysts; risk of CRC is 100% by approx age 40 |
|
|
Term
| What is the inheritance pattern of Turcot's? |
|
Definition
|
|
Term
| What are the manifestations of Turcot's syndrome? |
|
Definition
| polyps plus cerebellar medulloblastomas or glioblastoma multiforme |
|
|
Term
| What are the phenotypic manifestations of Peutz jeghers? |
|
Definition
| single or multiple hamartomas that may be scattered through entire GI tract: in small bowel (78%), colon (60%), stomach (30%); pigmented spots around lips, oral mucosa, face, genitalia and palmar surfaces |
|
|
Term
| Is there increased risk of malignancy with Peutz Jeghers? |
|
Definition
| hamartomas have very low malignant potential; slight increased incidence in various carcinomas (stomach, ovary, breast , cervix, testicle, lung) |
|
|
Term
| complication of the hamartomas of peutz jeghers? |
|
Definition
| intussusception of GI bleeding may occur |
|
|
Term
| What is familial juvenile polyposis coli? |
|
Definition
| rare disease; presents in childhood; only small risk of CRC; more than 10 and up to hundreds of juvenile colon polyps |
|
|
Term
| What are the two types of hereditary nonpolyposis CRC? |
|
Definition
| lynch syndrome I and lynch syndrome II |
|
|
Term
| What is lynch syndrome I? |
|
Definition
| a type of hereditary nonpolyposis CRC with site specific CRC; early onset CRC; absence of antecedent multiple polyposis |
|
|
Term
| What is lynch syndrome II? |
|
Definition
| hereditary nonpolyposis CRC that is a cancer family syndrome; all features of lynch I plus increased number and early occurrence of other cancers (e.g. female genital tract, skin, stomach, pancreas, brain, breast, biliary tract) |
|
|
Term
| What is the most common presenting symptom of colon cancer? |
|
Definition
|
|
Term
| What is the most common cause of large bowel obstruction in adults? |
|
Definition
|
|
Term
| What is the prognosis of colon cancer vs rectal cancer? |
|
Definition
| higher recurrence rate and a lower 5 yr survival rate than colon cancer |
|
|
Term
| Is radiation used to treat CRC? |
|
Definition
| used to treat rectal cancer but not colon cancer |
|
|
Term
| What is the most common symptom in pts with symptomatic colonic polyps? |
|
Definition
|
|
Term
| Symptoms of right sided CRC tumors= |
|
Definition
| obstruction is unusual because of th elarger luminal diamter; commonly there is occult blood in stool, iron def anemia, and melena; change in bowel habits is uncommon |
|
|
Term
| Symptoms of left sided CRC tumors= |
|
Definition
| signs fo obstruction more common; change in bowel habits more common; alternating constipation and diarrhea; narrowing of stools ("pencil stools"); hematochezia |
|
|
Term
| What percent of all CRC are rectal cancers? |
|
Definition
|
|
Term
| What are teh symptoms of rectal cancer? |
|
Definition
| hematochezia, tenesmus, rectal mass |
|
|
Term
| How do you followup colorectal cancer after surgical cure +/- adjuvant? |
|
Definition
| stool guaiac test; annual CT scan of abdomen/pelvis and CXR for up to 5 years; colonoscopy at 1 yr and then every 3 years; CEA levels are checked periodically (every 3 to 6 months) |
|
|
Term
| When do most recurrences of CRC occur? |
|
Definition
| 90% within three years of surgery |
|
|
Term
| What is the use of checking CEA levels? |
|
Definition
| after surgery a rise in CEA is a sensitive marker of recurrence; often second look operations are based on high CEA levels post resection; very high elevations of CEA suggest liver involvement |
|
|
Term
| What are juvenile polyps? |
|
Definition
| typically in children younger than 10 yrs; a type of nonneoplastic colonic polyp that are highly vascular and common so they should be removed |
|
|
Term
| What is the most common type of adenomatous polyps? |
|
Definition
|
|
Term
| Most common location of diverticuli? |
|
Definition
|
|
Term
| What percent of diverticuli become symptomatic? |
|
Definition
|
|
Term
| What are some complications of diverticulosis? |
|
Definition
| painless rectal bleeding and diverticulitis |
|
|
Term
| What percent of diverticulitis recurs? |
|
Definition
| 30% of pts treated medically have another episode of diverticulitis, usually within the first 5 years |
|
|
Term
| What percent of colovesical fistulas secondary to diverticulitis close spontaneously? |
|
Definition
|
|
Term
| Test of choice to diagnose diverticulitis? |
|
Definition
| CT scan of abdomen and pelvis with oral and IV contrast |
|
|
Term
| How do you treat diverticulitis? |
|
Definition
| uncomplicated can be managed with IV antibiotics, bowel rest, IV fluids; mild cases can be treated as outpt; if symptoms persist after 3-4 days then surgery may be necesary |
|
|
Term
| People with bleeding arteriovenous malformations are likely to have... |
|
Definition
|
|
Term
| Which is more common, acute or chronic mesenteric ischemia? |
|
Definition
|
|
Term
| What percent of pts have massive hemorrhage with angiodysplasia? |
|
Definition
|
|
Term
| In what percent of pts does bleeding from angiodysplasia of the colon stop spontaneously? |
|
Definition
|
|
Term
| What is the most common vessel to be affected by acute mesenteric ischemia? |
|
Definition
| superior mesenteric vessels |
|
|
Term
| What are the four types of acute mesenteric ischemia? |
|
Definition
| arterial embolism (50%), arterial thrombosis (25%), nonocclusive mesenteric ischemia (20%), venous thrombosis (<10%) |
|
|
Term
| What is nonocclusive meseenteric ischemia? |
|
Definition
| splanchnic vasoconstriction secondary to low cardiac output; typically seen in critically ill elderly patients |
|
|
Term
| What are some predisposing factors to venous thrombosis causing acute mesenteric ishcmia? |
|
Definition
| infection, hypercoagulable states, oral contraceptives, portal HTN, malignancy, pancreatitis |
|
|
Term
| What is the overall mortality rate for acute mesenteric ischemia? |
|
Definition
|
|
Term
| How do you diagnose acute mesenteric ischemia? |
|
Definition
| mesenteric angiography is the definitive test; thumbprinting on barium enema d/t thickened edematous mucosal folds |
|
|
Term
| How do you treat acute mesenteric ischemia? |
|
Definition
| IV fluids; abx; intraarterial infusion of papaverine or thrombolytics or embolectomy; heparin for venous thrombosis |
|
|
Term
| How do you confirm the diagnosis of chronic mesenteric ischemia? |
|
Definition
|
|
Term
| How do you treat chronic mesenteric ischemia? |
|
Definition
| surgical revascularization; pain is relived in 90% |
|
|
Term
| What is Ogilvie's syndrome? |
|
Definition
| an unusual problem in which signs, symptoms, and radiographic evidence of large bowel obstruction are present but there is no mechanical obstruction |
|
|
Term
| What are some causes of ogilvie's syndrome? |
|
Definition
| recent surgery or trauma, serious medical illnesses (sepsis, malignancy), and medications (narcotics, psychotropic drugs, anticholinergics) |
|
|
Term
| At what colonic wall distension is there a serious risk of perforation and you should decompress imediately? |
|
Definition
|
|
Term
| What is another name for pseudomembranous colitis? |
|
Definition
| antibiotic associated colitis |
|
|
Term
| What are teh most frequently implicated abx in pseudomembranous colitis? |
|
Definition
| clindamycin, ampicillin, and cephalosporins |
|
|
Term
| When is the timing of pseudomembranous colitis in association with abx administration? |
|
Definition
| usually begin during the first week of antibiotic therapy; however, up to six weeks may elapse after stopping antibiotics before clinical findings become apparent |
|
|
Term
| What are the complications of severe pseudomembranous colitis that may require surgery? |
|
Definition
| toxic megacolon, colonic perforation, anasarca, electrolyte disturbances |
|
|
Term
| What is teh most RAPID test to diagnose cdiff? |
|
Definition
|
|
Term
| T/F Leukocytosis is common with cdiff infection. |
|
Definition
|
|
Term
| What pts can you not use metronidazole? |
|
Definition
| infants or pregnant women |
|
|
Term
| What percent of pts with cdiff get recurrent disease? |
|
Definition
| 15-35% recur 2 to 8 weeks after stopping the antibiotic |
|
|
Term
| What can you use to help treat diarrheal symptoms of cdiff other than antibiotics? |
|
Definition
|
|
Term
| sigmoid volvulus vs cecal volvulus |
|
Definition
sigmoid= 75%, chronic illness, age, institutionalization, and CNS disease; "omega loop" sign, sigmoidoscopy is diagnostic and tehrapeutic
cecal= 25%, congenital lack of fixation often right colon and tends to occur in younger patients; "coffee bean sign", emergent surgery |
|
|
Term
|
Definition
|
|
Term
| How successful is sigmoidoscopy in treating sigmoid volvulus? |
|
Definition
| nonoperative reduction is succesful in >70% of cases but the recurrence rate is high so elective sigmoid colon resection is recommended |
|
|
Term
| What is the gold standard for diagnosis of cirrhosis? |
|
Definition
|
|
Term
| What percent of heavy drinkers get alcoholic cirrhosis? |
|
Definition
|
|
Term
| How do you chronically manage ascites? |
|
Definition
| diuretics and salt restriction |
|
|
Term
| What percent of the upperGI varices assoc with cirrhosis are esophageal? |
|
Definition
| 90% esophageal; 10% gastric |
|
|
Term
| How do you treat variceal bleed? |
|
Definition
| hemodynamic stabilization, IV antibiotics, IV octreotide (or vasopressin) x 3-5 days; emergent upper GI endoscopy, long term beta blocker therapy |
|
|
Term
| What is teh most common complication of cirrhosis? |
|
Definition
|
|
Term
| T/F you can have cirrhosis with ascites without having portal HTN. |
|
Definition
|
|
Term
| Abdominal ultrasound can detect as little as ___ of fluid in pts with ascites. |
|
Definition
|
|
Term
| What do you use to balloon tamponade esophageal varices? |
|
Definition
| Sengstaken-Blakemore tube |
|
|
Term
|
Definition
| cirrhosis, portal HTN, CHF, chronic renal disease, massive fluid overlaod, tuberculous peritonitis, malignancy, hypoalbuminemia, peripheral vasodilation secondary to endotoxin-induced release of nitrous oxide, which leads to increased renin secretion; impaired liver inactivation of aldosterone |
|
|
Term
| What are teh indications for therapeutic paracentesis? |
|
Definition
| tense ascites, shortness of breath, or early satiety is present |
|
|
Term
| What precipitates hepatic encephalopathy? |
|
Definition
| alkalosis, hypokalemia, sedating drugs, GI bleeding, systemic infection, and hypovolemia |
|
|
Term
| Describe teh long term monitoring that should be done for cirrhotic patients? |
|
Definition
| order periodic lab values every 3 to 4 months (CBC, CMP and coagulation tests); perform an endoscopy to determine the presence of esophageal varices |
|
|
Term
| What is the MOA of lactulose in treating hepatic encephalopathy? |
|
Definition
| metabolism of lactulose by bacteria in colon favors formation of NH4+, which is poorly absorbed from teh GI tract, thereby promoting excretion of ammonia |
|
|
Term
| Pts with hepatic encephalopathy should limit their protein intake to.... |
|
Definition
|
|
Term
| Name the complications of liver failure? |
|
Definition
| ascites, coagulopathy, portal HTN, hypoalbuminemia, hyperammonemia, hepatic encephalopathy, hepatorenal syndrome, hypoglycemia, hyperbilirubinemia, hyperestrinism, hepatocellular carcinoma |
|
|
Term
| What are the clinical features of hepatorenal syndrome? |
|
Definition
| azotemia, oliguria, hyponatremia, hypotension, low urine sodium (<10mEq/L) |
|
|
Term
| What percent of pts hospitalized for ascites get SBP? |
|
Definition
|
|
Term
| What is the mortality rate of spontaneous bacterial peritonitis? |
|
Definition
|
|
Term
| What is teh recurrence rate of SBP? |
|
Definition
|
|
Term
| What are teh organims of SBP? |
|
Definition
| ecoli (most common), klebsiella, strep pneumo |
|
|
Term
|
Definition
|
|
Term
|
Definition
| abx; clinical improvement should be seen in 1 to 2 days; repeat paracentesis in 2 to 3 days to show decresae in ascitic fluid PMNs (<250) |
|
|
Term
| What lab values are abnormal with cirrhotic coagulopathy? |
|
Definition
| PT is prolonged; PTT may be prolonged with severe disease |
|
|
Term
| What percent of pts with cirrhosis get HCC? |
|
Definition
|
|
Term
| How long does a pt have to be alcohol free to get a liver transplant? |
|
Definition
|
|
Term
| What is the inheritance pattern of Wilson's disease? |
|
Definition
|
|
Term
| What is the pathophys of wilson's disease? |
|
Definition
| normally excess copper is excreted by the liver, but the livers of patients with wilson's disease can not do so because there is usually a deficiency of ceruloplasmin, a copper binding portein that is necessary for copper excretion |
|
|
Term
| What organs are affected by copper accumulation in wilson's disease? |
|
Definition
| kidney (aminoaciduria, nephrocalcinosis), cornea (Kayser-Fleischer rings), brain (extrapyramidal signs= parkinsonism, chorea, drooling, incoordination; psychiatric disturbances), liver (acute hepatitis, cirrhosis, fulminant hepatic failure) |
|
|
Term
| How do you diagnose wilson's disease? |
|
Definition
| decreased serum ceruloplasmin levels although ranges within normal do not exclude the diagnosis; liver biopsy will show elevated copper concentration |
|
|
Term
| What is the treatment for wilson's disease? |
|
Definition
| D-penicillamine, zinc (prevents uptake of dietary copper, give alone or in conjunction with chelating agents) |
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