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60 Cards in this Set
- Front
- Back
diagnostic test for ppl w + fobt
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COLONOSCOPY
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most common site of distant spread in crc
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liver
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what type of polyps are considered to have malignant potential
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adenomatous polyps (villous > tubular)
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features of familial polyposis syndrome
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autosomal dominant
hundreds of adenomatous polyps in colon colon always involved, duodenum usually (90%) involved |
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tx for familial polyposis syndrome
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prophylactic colectomy
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clinical features of gardner's syndrome
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autosomal recessive
polyps + osteomas, dental abnormalities, benign soft tissue tumors, desmoid tumors, sebaceous cysts 100% risk of colon ca |
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clinical features of turcot's syndrome
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autosomal recessive
polyps + cerebellar medulloblastoma or gbm |
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peutz-jeghers
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single or multiple hamartomas scattered through gi tract (mostly in small bowel and colon)
pigmented spots around lips and oral mucosa, genitalia, palmar surfaces low malignnat potential |
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complications of peutz-jeghers
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intussusception or bleeding
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familial juvenile polyposis coli
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rare, small risk for crc
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hereditary nonpolyposis crc
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no adenomatous polyps
lynch syndrome 1 and 2 early onset crc and other cancers |
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#1 cause of colon obx in adults
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crc
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most life threatening presentation of crc
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colonic perforation
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presentation of a right sided colon tumor
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obx not commonly seen (lumen is wider on right)
change in bowel habits is rare MELENA is most common type of bleed |
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presentation of left sided colon tumor
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smaller lumen diameter, so can present with obx, alternating constipation and diarrhea
narrowing of stools HEMATOCHEZIA |
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which side of colon is melena more common in?
hematochezia? |
right
left |
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most common presentation of rectal cancer
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hematochezia
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when should cea levels be obtaiened in crc
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before surgery
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use of radiation tx in crc
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used in rectal ca but not in colon ca
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frequency of colonoscopies in pts with h/o crc
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colonoscopy at 1 yr, then q3y
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in addition to colonoscopy, what other f/u is required in pts with crc
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ct scan of abdomen adn pelvic
cxr do these for up to 5 yrs check cea q 3-6 months |
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recurrence rate of crc
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90% w/i 3 yrs of surgery
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what types of polyps are associated with uc
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pseudopolyps
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pathogenesis of diverticuli
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outpouching at area of weakness in colon wall, which is at the site of a bv penetration --> bleeding
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risk factors for diverticulosis
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constipation increases intralumenal pressure
family hx |
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#1 location of diverticuli
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sigmoid colon
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test of choice for diverticulosis
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bariu enema
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tx of diverticulosis
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high fiber food to increase stool bulk psyllium
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complications of diverticulosis
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painless rectal bleeding
diverticulitis |
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complications of diverticulitis
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bowel obx
fistula abscess |
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how to manage bleeding in diverticulosis
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usually stops on its own - no tx for these pts
if it continues, then colonoscopy should be performed to locate site of bleeding, if persistent or recurrent, surgery may be needed |
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dx of diverticulitis
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ct abdomen and pelvis
abdominal xr to r/o other causes, ileus, obx, and perforation |
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tx of diverticulitis for first episode
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npo
abx surgery may be necessary if persists x 3-4 days |
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examples of angiodysplasia of the colon
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avm
vascular ectasia |
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dx of angiodysplasia of the colon
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colonoscopy
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tx of angiodysplasia of the colon
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colonoscopic coagulation
if bleeding persists, right hemicolectomy (cecum is most common location) |
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types of acute mesenteric ischemia
which is most common |
arterial embolism *
venous thrombosis (rarest) arterial thrombosis nonoclusive mesenteric ischemia |
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random association with angiodysplasia of the colon
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aortic stenosis
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clinical history of pt with mesenteric arterial thrombosis
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pts with h/o atherosclerotic dz at other sites
acute occlusion occurs over preexisting atherosclerotic dz (acute event can be a decrease in CO or plaque rupture) collateral circulation has usually developed SX are gradual and less severe than embolic causes |
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clinical history of a pt with nonocclusive mesenteric ischemia
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splanchnic vasoconstriction secondary to low CO
typically seen in elderly |
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overall mortality of all causes of acute mesenteric ischemia
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60%
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presentation of pt with venous thrombosis as a cause for mesenteric ischemia
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sx may be present for several days or weeks with gradual worsening
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clinical feature of acute mesenteric ischemia
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severe abdominal pain disproportionate to physical findings
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complications of acute mesenteric ischemia
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peritonitis
sepsis shock |
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dx of acute mesenteric ischemia
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mesenteric angiography
plain film of abdomen to r/o other causes |
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tx of acute mesenteric ischemia
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ivf
broad spectrum abx papaverine (vasodilator) into sma during arteriograph to relieve occlusion and vasospasm direct infusion of thromboloytics in pts with emoblism heparin for venous thrombosis |
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signs of intestinal infarction
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hypotension, tachycardia, tachypnea, lactic acidosis, fever, change in ms, shock
CHECK LACTATE LEVEL |
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causes of chronic mesenteric ischemia
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atherosclerotic occlusive dz of celial artery and sma, ima
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sx of chronic mesenteric ischemia
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abdominal angina (postprandially)
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tx of chronic mesenteric ischemia
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surgical revasularization
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tx of ogilvie's syndrome
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decompression with gentle enemas or ng suction
if not, colonoscopic decompression surgical decompression is last resort |
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complication of pseudomembranous colitis
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toxic megacolon with risk of perf
amasarca electrolyte disturbances |
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tx of pseudomembranous colitis
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metronidazole
(oral vanco if metronidazole is contraindicated - infants and pregnancy) |
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most common cause of ugi bleeding
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pud (duodenal ulcer, gastric ulcer, gastritis)
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pertinent history in a pt with aorticoenteric fistula
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distant h/o aortic graft surgery, in a pt with a small gi bleed, involving the duodenum
massive, fatal hemorrhage occurs hours to weeks later |
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tx of aortoenteric fistula
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endoscopy or surgery
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where is the bleeding from? test to order?
hematemesis |
ugi
endoscopy |
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where is the bleeding from? test to order?
hematochezia |
lgi
first r/o hemorrhoids colonoscopy |
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where is the bleeding from? test to order?
melena |
ugi or right side fo colon
do endoscopy first, if negative, do colonoscopy |
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where is the bleeding from? test to order?
occult blood |
lgi
colonoscopy upper endoscopy if colonoscopy is - |