PANCE Blueprint GI and Nutrition (9%)

Polyps

Patient will present with →  rectal bleeding, cramps and abdominal pain. Obstruction may occur with a large lesion

Colonic polyps are common; the incidence ranges from 7% to 50% (depending on the diagnostic method used).

The main concern is malignant transformation, which occurs at different rates depending on the size and type of polyp.

"In patients with polyps, aspirin and COX-2 inhibitors may help prevent formation of new polyps."
  • Most common cause of painless rectal bleeding in the pediatric population
  • Adenomatous polyps are common in the distal colon and rectum
  • Distal colon are commonly benign if seen in the proximal colon they are more likely to be cancerous
  • The larger the colonic polyp, the greater the risk of malignant transformation
  • Villous adenomas have a 30-70% risk of malignant transformation
  • The greater the number of concomitant colonic polyps, the greater the risk of malignant transformation

Familial adenomatous polyposis (FAP) -  is characterized by the development of hundreds to thousands of colonic adenomatous polyps.

  • Colorectal polyps develop by mean age of 15 years and cancer at 40 years.
  • First-degree relatives of patients with FAP should undergo genetic screening after age 10 years.
  • The family should undergo yearly sigmoidoscopy beginning at 12 years of age. 

Colonoscopy is the recommended diagnostic and therapeutic procedure.

  • Diagnosis is by colonoscopy and biopsy
  • Once identified follow-up colonoscopy in 3-5 years

Polyps should be removed completely with a snare or electrosurgical biopsy forceps during total colonoscopy

  • Complete excision is particularly important for large villous adenomas, which have a high potential for cancer
  • If colonoscopic removal is unsuccessful, laparotomy should be done
Tubular adenoma in the descending colon - endoscopic polypectomy

Tubular adenoma in the descending colon - endoscopic polypectomy

Question 1
Familial adenomatous polyposis (FAP) is clinically defined by
A
the presence of more than 100 colorectal adenomas.
B
the presence of more than 10 colorectal adenomas.
Hint:
See A for explanation
C
the presence of more than 1000 colorectal adenomas.
Hint:
See A for explanation
D
the presence of more than 1 colorectal adenomas.
Hint:
See A for explanation
Question 1 Explanation: 
FAP is clinically defined by the presence of more than 100 colorectal adenomas.
Question 2
After identification and excision of an adenomatous polyp via routine colonoscopy, a follow up colonoscopy should be scheduled in
A
follow-up colonoscopy in 1-2 years.
B
follow-up colonoscopy in 3-5 years.
C
follow-up colonoscopy in 5-7 years.
D
follow-up colonoscopy in 10 years
Question 2 Explanation: 
Once identified follow-up colonoscopy is in 3-5 years
Question 3
Which of the following may help prevent formation of new polyps in patients with polyps or colon cancer
A
Aspirin
Hint:
See E for explanation
B
Cox-2 inhibitors
Hint:
See E for explanation
C
Propranolol
Hint:
See E for explanation
D
Metformin
Hint:
See E for explanation
E
both a and b
Question 3 Explanation: 
Aspirin and COX-2 inhibitors may help prevent formation of new polyps in patients with polyps or colon cancer
Question 4
Family members of those with familial polyposis syndrome should be evaluated
A
every 1-2 years beginning at age 19-21
Hint:
See B for explanation
B
every 1-2 years beginning at age 10-12 years old
C
once at age 10 then every 10 years afterwards
Hint:
See B for explanation
D
at first signs of symptoms
Hint:
See B for explanation
Question 4 Explanation: 
Family members of those with familial polyposis syndrome should be evaluated every 1-2 years beginning at age 10-12 years of age
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