Health Maintenance & Screening Flashcards

(45 cards)

1
Q

Risk Factors for Colorectal CA

A
Age >50
Hx of adenomatous polyps
Personal Hx of IBD
Family Hx
African-American or Easter European Jew
Type 2 DM
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2
Q

Adenomatous Polyps (Adenomas)

A

Adenomas increase colon CA risk
Large or multiple polyps increase risk
Hyperplastic polyps do not increase risk

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3
Q

Personal Hx of IBD

A

Ulcerative colitis

Crohn’s disease

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4
Q

Why is a personal Hx of IBD important?

A

Chronic inflammation
Dysplasia
CA

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5
Q

Lifestyle Related Factors

A
Diet: high in red meat/processed meats, low fruits/veggies consumption
Physical inactivity
Obesity
Smoking
Heavy alcohol use
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6
Q

Family Hx of Adenomatous Polyps or Colorectal CA

A

1 in 5 have a family Hx of colorectal CA
First degree relative with colorectal CA doubles risk
Family members with adenomatous polyps also increase risk

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7
Q

Inherited Syndromes

A

Family Adenomatous Polyposis (FAP
Hereditary non-polyposis colon cancer (HNPCC)
Turcot syndrome: DNA mismatch repair
Peutz-Jeghers syndrome: dramatic looking polyps; increased risk of CA elsewhere

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8
Q

Type 2 DM

A

Increased risk of colorectal CA

Less favorable prognosis

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9
Q

Previous Treatment for Other CA

A

Testicular CA

Prostate CA

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10
Q

Colorectal CA Screening Tests

A
Flexible sigmoidoscopy
Colonoscopy
Double-contrast barium enema
Virtual colonoscopy
Fecal occult blood test (FOBT)
Fecal immunochemical test (iFOBT or FIT)
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11
Q

Pros of Fecal Immunochemical Test (iFOBT or FIT)

A

More accurate
Less false positives
No dietary restrictions
Uses antibodies to detect HB in stool

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12
Q

Flexible Sigmoidoscopy

A
Quick & safe
Sedation not used
Doesn't require specialist
Done every 5 years
View 1/3 of colon
Can miss polyps
Can't remove polyps
Colonoscopy of abnormal
Small risk of bleeding, infection, or bowel tear
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13
Q

Colonoscopy

A
Preferred method
View entire colon
Biopsy & remove polyps
Every 10 years
Can mis polyps
Full bowel prep needed
Sedation needed
Small risk of bleeding, bowel tears, or infection
Expensive
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14
Q

Double Contrast Barium Enema

A
Usually view entire colon
Relatively safe
Every 5 years
No sedation
Can miss sm. polyps
Full bowel prep
Some false positive results
Can't remove polyps during testing
Colonoscopy if abnormal
Replaced by virtual colonoscopy
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15
Q

Virtual Colonoscopy

A
Quick & safe
Usually view entire colon
Every 5 years
No sedation
Full bowel prep
Can miss sm. polyps
Some false positive test results
Colonoscopy if abnormal
Air enema given
CT scan of colon done times 2
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16
Q

Fecal Occult Blood Test (FOBT)

A
No risk to colon
No bowel prep
Done at home
Inexpensive
May produce false positive tests
Pre-test dietary restrictions
Yearly
3 stool samples
Patient drops off
Colonoscopy if abnormal
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17
Q

Restrictions Prior to FOBT

A

Avoid NSAIDs 7 days
Avoid vitamin C 3 days
Avoid red meats 3 days

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18
Q

Difference Between FIT & FOBT

A
No pre-test restrictions
More accurate
Less false positives
Uses antibodies to detect HB
1 day sample
Automated vs. manual system
Closed system
Better patient compliance
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19
Q

Guidelines for Colon CA Screening

A

Begin at age 50

Colonoscopy every 10 years

20
Q

Unable to Undergo Colonoscopy Then:

A

Flexible sigmoidoscopy every 5 years
Double contrast barium enema every 5 years
Virtual colonoscopy every 5 years

21
Q

If all imaging tests refused or contraindicated then:

A

FOBT yearly with 3 stool samples

FIT yearly

22
Q

Exceptions to Colon CA Screening Guidelines

A

African-Americans at age 45

High risk guidelines more aggresive

23
Q

High Risk Colon CA Screening Guidelines

A

1st degree family with colon CA need colonoscopy 10 years prior to relative’s age at diagnosis
IBD- colonoscopy every 1-2 years
Personal Hx of adenomatous polyps or colon CA- colonoscopy 1 year post resection then every 3-5 years
FAP- yearly flex sig beginning at age 10-12 years (positive genetic testing consider colectomy)
HNPCC- colonoscopy every 1-2 years beginning at age 20-25

24
Q

Prevention of Colon CA

A

Colonoscopy

Decrease the western diet/lifestyle

25
Risks Factors for Hepatocellular Carcinoma (HCC)
``` Hep B viral infection Chronic Hep C infection Hereditary hemochromatosis Cirrhosis Nonalcoholic fatty liver disease DM Chronic alcohol abuse Chronic tobacco abuse Alpha-1 antitrypsin deficiency ```
26
HCC Screening Needed for:
Patients with cirrhosis Chronic Hep B infection + Asian, African & African-Americans, family Hx of HCC Caucasians with chronic Hep B + active inflammation & high viral load for several years, men >40, women >50
27
Screenings Tests for HCC
Liver ultrasound (every 6 months)
28
Summary of HCC
Hep B infection highly associated with HCC | Screening guidelines complex
29
Risk Factors for Esophageal CA
``` Age >55 Men 3x more likely ETOH abuse Tobacco use Obesity Diet: high in processed meats, low in fruits/veggies ```
30
Medical Conditions Associate with Esophageal CA
``` HPV infection GERD Barrett's esophagus: GERD Achalasia: narrowing of distal esophagus Tylosis: esophageal papillomas Plummer-Vinson syndrome: esophageal webs ```
31
Screening for Esophageal CA
None for general population | Periodic endoscopies: Barrett's, achalasia, Plummer-Vinson syndrome
32
Dietary Fiber can be Beneficial for Treatment
Hemorrhoids Constipation Diarrhea Diverticulosis
33
2 Types of Fiber
Soluble | Insoluble
34
Soluble Fiber
Dissolve in water
35
Foods Containing Soluble Fiber
``` Oatmeal Oat cereal lentils Apples Oranges Pears Oat bran Strawberries Nuts Flaxseeds Beans Dried peas Blueberries Psyllium Cucumbers Celery Carrots ```
36
Insoluble Fiber
Nondigestible
37
Foods Containing Insoluble Fiber
``` Whole wheat Whole grains Wheat bran Corn bran Seeds Nuts Barley Couscous Brown rice Bulgur Zucchini Celery Broccoli Cabbage Onions Tomatoes Carrots Cucumbers Green beans Dark leafy veggies Raisins Grapes Fruit Root veggie skins ```
38
What can fiber help treat?
Diarrhea (bulking) | Constipation (easier to pass)
39
Chronic Constipation can Lead to:
Hemorrhoids Anal fissures Development of diverticulosis
40
Dietary Fiber Recommendations
Women: 25 g/day Men: 38 g/day
41
Diverticulosis
Starting at age 40 1/2 people btw 60-80 Almost everyone over 80
42
What can a high fiber diet help with?
Constipation Diverticular disease Diverticulitis
43
Risk Factors for GERD
Eating large meals before lying down Obesity Foods: citrus, tomato, chocolate, mint, garlic, onions, spicy or fatty foods Drinks: ETOH, carbonated drinks, coffee, tea Smoking Pregnancy Hiatal hernia
44
Medications that can worsen GERD
``` NSAIDs Beta-blockers CCB Bronchodilators Dopamine active drugs TCAs Some muscle relaxants ```
45
Dietary & Lifestyle Counseling to Reduce GERD Symptoms
``` Maintain healthy weight Avoid tight fitting clothes Avoid trigger foods Eat smaller meals Wait 3 hours after eating to lay down Elevate head of bed 6-9 inches Don't smoke or chew Decrease stress & anxiety ```