Clinical GI

Question 1

Appendicitis - Presentation

Answer 1

Early diffuse or dull periumbilical pain
Anorexia, nausea, vomiting
Tenderness in RLQ or pelvis
Low grade fever

Question 2

Appendicitis - Test Results

Answer 2

Leukocytosis

Psoas (retrocecal), obturator (pelvic) or Rovsing’s signs

Question 3

Appendicitis - Confirmation

Answer 3

Ultrasound

Question 4

Peptic Ulcer Disease - Presentation

Answer 4

Burning epigastric pain
Worse pain on empty stomach
Pain relieved by food, antacids, H2 blockers or PPIs

Question 5

Peptic Ulcer Disease - Precipitating Factors

Answer 5

NSAID disruption of mucosal protection by prostaglandins
H. pylori infection
Smoking, alcoholism, stress

Question 6

Peptic Ulcer Disease - Confirmation

Answer 6

Low hematocrit and Hb

Positive breath urea test

Question 7

Irritable Bowel Syndrome - Presentation

Answer 7

Onset before age 45
Nonspecific abdominal pain, gas, bloating
Intermittent constipation or diarrhea
Pain relieved after defecation
Exacerbated by stress
Normal physical exam

Question 8

Irritable Bowel Syndrome - Diagnosis

Answer 8

Rule out serious conditions (requires extensive work-up)

Often has psychosocial determinants

Question 9

Gallbladder Disease - Causes

Answer 9

Structural
Functional
Gallstones
Biliary sludge

Question 10

Gallbladder Disease - Acute Cholecystitis

Answer 10

Progressively worse biliary pain
Prior attacks resolve spontaneously
Usually obstructive jaundice

Question 11

Pancreatitis - Presentation

Answer 11

Looks acutely ill, anxious, in moderate distress

Diminished bowel sounds, soft, diffusely tender

Question 12

Pancreatitis - Lab Results

Answer 12

Elevated leukocytes, amylase, lipase (precipitating factor often obvious)

Question 13

Pancreatitis - Causes

Answer 13

Gallstone in distal bile duct
Alcohol-related
Hypertriglyceridemia
Trauma