ICU Supportive Care study guide previews.

years before earliest dx in relative; or age 40. ¹ African Americans may consider starting at 45 if not earlier. CRC is the 3rd most common cancer and 2nd leading cause of cancer death in the U.S. Early-stage detection vastly improves 5-year survival (>90% for localized disease). Most CRCs develop from benign adenomatous polyps over 5-10 years. Colonoscopy every 10 years balances procedure risks (perforation ~0.1%, bleeding ~0.3%) against cancer prevention benefits.

Adenomas includes tubular, tubulovillous, villous; size >1 cm or villous features = higher malignant potential. Serrated Lesions includes sessile serrated adenomas/polyps (SSA/P) in right colon; account for ~15-30% of CRC via serrated pathway. Endoscopic Submucosal Dissection (ESD): selected larger or flat lesions. -2 small (<10 mm) tubular adenomas: 7-10 years. -10 adenomas, or any ≥10 mm, or with high-grade dysplasia/villous: 3 years. Bowel Prep includes split-dose polyethylene glycol (PEG) or sodium picosulfate; clear liquids the day before.

Critical illness creates a hypermetabolic, inflammatory, catabolic state. Nutrition support is not just “calories.” It is organ support. If the gut works, enteral nutrition is usually preferred. Advancing enteral nutrition toward estimated caloric and protein goals. Simple rule include Use the gut when you can and Use PN when the gut cannot be used or EN is inadequate for too long.

Stress ulcer prophylaxis (SUP) is used in critically ill patients to prevent clinically important upper gastrointestinal bleeding (UGIB) from stress-related mucosal injury (SRMI). SUP should be reserved for critically ill patients with meaningful bleeding risk factors. These changes can produce diffuse superficial gastric erosions, most often in the stomach. Mucosal injury is common, but clinically important bleeding is relatively uncommon, which is why prophylaxis should be targeted rather than routine.

The key idea is include Use SUP in critically ill patients with meaningful bleeding risk and Use either a PPI or H2RA. Stop prophylaxis early once the risk period ends. The 2024 SCCM/ASHP guideline moved away from the old rigid “major/minor risk factor counting” approach and instead emphasizes whether the patient has a net meaningful risk of clinically important bleeding. Additional factors that may increase risk depending on context.