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Gastrointestinal & Hepatobiliary Systems > Conditions of the Abdomen > Flashcards

Conditions of the Abdomen Flashcards

1
Q

What are common causes of LLQ pain?

A

IBD
Diverticulitis
Ovarian cyst, tumor
PID
IBS
Colon Cancer

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2
Q

What are the common causes of RLQ pain?

A

Appendicitis
Ileo-cecal valve problems ie: Crohn’s Disease
PID
Ectopic Pregnancy
Ovarian cyst or tumor

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3
Q

What are the common causes of RUQ pain?

A

Hepatitis
Cholecystitis
Gastritis
Nephrolithiasis

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4
Q

What are the common causes of LUQ pain?

A

Splenomegaly
Gastritis
Pancreatitis
Nephrolithiasis

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5
Q

What are common cause of epigastric pain?

A

GERD
PUD
Hiatal Hernia
Esophagitis
Gastritis
Pancreatitis

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6
Q

What are the two (2) types of esophageal cancer and what are the risk factors for each one?

A

Squamous Cell Carcinoma: Smoking, Spirits, Seeds (Betel Nut, Tobacco) , Scalding (hot liquids), HPV infection
Adenocarcinoma: Barrett’s Esophagus, Smoking, Obesity due to increased reflux, GERD

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7
Q

What are the signs and symptoms of esophageal cancer?

A

Progressive dysphagia (solids to liquids), chest pain, hemoptysis, cough, weight loss, hoarseness

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8
Q

How is esophageal cancer diagnosed?

A

Barium Swallow, Endoscopy, biopsy, cytological studies

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9
Q

What factors lead to the development of colon cancer?

A

Low fiber, high fat diet
Prolonged transit time
Low intestinal flora
High nitrosamines in the diet
Cigarette Smoking
Obesity
Physical Inactivity
Age >50 years; first degree relatives with colon cancer

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10
Q

What are the symptoms of colon cancer?

A

1) Asymptomatic for years
2) Right sided: anemia, weakness, DOE, palpitations, lethargy, abdominal pain without obstructive symptoms
3) Left sided: Change in bowel habits
4) Bowel obstruction during initial phases
5) Unexplained watery diarrhea as it progresses
6) If severe or metastatic you will get systemic sxs: weight loss, anorexia, fatigue

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11
Q

How is colon cancer diagnosed?

A

Fecal Occult Blood Test: Not sensitive or specific
Sigmoidoscopy
Colonoscopy (best)
Carcinoembryonic Antigen (CEA)

*Direct imaging, colonoscopy or flexible sigmoidoscopy with biopsy

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12
Q

What tumor marker is used to monitor recurrence or progression of colon cancer?

A

Carcinoembryonic Antigen (CEA): Tumor Marker in colon cancer; 5 ng/ml have worse prognosis

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13
Q

What primary cancer sites metastasize to the liver?

A

Lung, Breast, Colon, Pancreas, Esophagus, Kidney, Stomach and skin

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14
Q

What viral infection is strongly related to hepatic carcinoma?

A

Chronic Liver Inflammation: Chronic Hepatitis B (oncogenic) and C

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15
Q

What are the signs and symptoms of hepatic carcinoma?

A

1) 33% Asymptomatic
2) Nonspecific: weight loss, anorexia, fever, anemia, nausea
3) RUQ or epigastric pain
4) Liver hard, tender and enlarged
5) Splenomegaly
6) Jaundice
7) Ascites

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16
Q

What lab changes would you expect from hepatic carcinoma?

A

1) Increased alpha-fetoprotein
2) Increased Bilirubin
3) Increase Alkaline phosphatase & GGT
4) Elevated ALT and AST
5) Elevated LDH

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17
Q

How is liver carcinoma diagnosed?

A

Liver Biopsy

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18
Q

What are the risk factors for developing pancreatic cancer?

A

Increase Age: mean age is 60
Obesity and physical inactivity
Diabetes mellitus
Chronic pancreatitis
Cigarette smoking
Diet high in saturated fats and processed meats

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19
Q

What are the signs and symptoms of pancreatic cancer?

A

1) Epigastric pain, persistent, dull pain that may radiate to the back
2) Anorexia, N/V
3) Anxiety/Depression
4) Jaundice
5) Onset DM > 55 years old
6) Weight loss
7) Loose stools

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20
Q

What is the prognosis for pancreatic cancer?

A

5 year survival rate < 5%

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21
Q

What imaging study would you order if you suspect pancreatic cancer?

A

CT scan with contrast

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22
Q

What’s in the DDx for pancreatic cancer?

A

1) Acute cholangitis
2) Chronic pancreatitis
3) Hepatitis
4) Cirrhosis
5) Liver Malignancy

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23
Q

What antigen is associated with pancreatic cancer?

A

CA -19-9

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24
Q

What might contribute to gallbladder cancer?

A

1) Primary sclerosing cholangitis
2) Hx of gallstones
4) Occupational carcinogen exposure
5) Chronic infection
6) Smoking Tobacco

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25
Q

What organism may be associated with gastric carcinoma?

A

H.pylori

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26
Q

What are the predisposing factors for developing gastric cancer?

A

1) Achlorhydria
2) Increase nitrate ingestion and salt composition
3) Hx of gastric ulcers
4) Chronic gastritis
5) Pernicious anemia cause achlorhydria and chronic atrophic gastritis

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27
Q

What age group is more likely to develop gastric cancer?

A

Men > 50 year old, special affiliation with blood type A

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28
Q

What are the signs and symptoms of gastric cancer?

A

1) Early stage is non-specific
2) Epigastric pain
3) N/V
4) Anorexia, early satiety
5) Dysphagia
6) Weight Loss
7) Change in bowel habits
8) Jaundice

  • Ulcer that fails to heal
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29
Q

What is seen on PE with gastric cancer?

A

1) Palpable mass in advanced disease
2) Hepatomegaly
3) Abdominal Tenderness
4) Weight Loss
5) LAO: Supraclavicular or axillary
6) Ascites

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30
Q

How is gastric cancer diagnosed?

A

Esophagogastro-duodenoscopy and biopsy

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31
Q

What is acute pancreatitis?

A

Alcohol abuse and gallstones are the most common causes

Acute inflammation associated with pancreatic edema, swelling, autodigestion, necrosis and hemorrhage

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32
Q

What are the risk factors for developing acute pancreatitis?

A

Alcoholism 30%
Cholelithiasis with pancreatic duct blockage 30-75%
Hypertriglyceridemia with serum >1000 mg/dL
Medication side effect

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33
Q

What are some of the medications that can lead to acute pancreatitis?

A

1) Aminosalicylates
2) Sulfonamides
3) Valproic Acid
4) Tetracycline
5) GLP-1 agonists

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34
Q

What are the signs and symptoms of acute pancreatitis?

A

Fever, nausea, vomiting
Severe, knife-like pain in the mid-epigastric area; may radiate to back
Tender, rigid abdomen
Hypovolemic shock
Jaundice caused by compression/obstruction of bile duct
Hypoxemia: pancreatic phospholipase circulates destory surfactant in the lungs –> ARDS
Cullen’s Sign (periumbilical hemorrhage)
Grey- Turners sign (Flank hemorrhage)
Disseminated intravascular coagulation
Tetant Coma

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35
Q

What labs are elevated in acute pancreatitis?

A

Serum amylase/lipase is increased 3x the upper limit
Increased ALT and AST
GGT may also be elevated

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36
Q

What are the risk factors of chronic pancreatitis?

A

Alcohol Abuse > 150 g daily for at least 5 years
Cigarrette smoking
Recurrent episodes of acute pancreatitis

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37
Q

What are the signs and symptoms of chronic pancreatitis?

A

1) Epigastric or diffuse abdominal pain
2) May radiate through to the back
3) Insulin dependent diabetes mellitus
4) Weight loss and loss of appetite
5) Nausea/ Vomiting
6) Steatorrhea

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38
Q

Which pancreatic enzyme rises first and which one stays elevated the longest?

A

Amylase will typically rise and return to normal first

Lipase is elevated several days after onset

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39
Q

How is chronic pancreatitis diagnosed?

A

Pancreatic calcification seen on abdominal x-ray is considered pathognomonic for chronic pancreatitis

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40
Q

What causes peritonitis?

A

Acute inflammation of the visceral and parietal peritoneum

Secondary to other ill:
Appendicitis
Pelvic Inflammatory Disease
Ruptured Ectopic Pregnancy
Perforated Peptic Ulcer
Cholecystitis
Diverticulitis
Ascites
Trauma

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41
Q

What are the signs and symptoms of peritonitis?

A

Sudden onset of acute abdominal pain, tenderness, rigidity
Nausea, vomiting, *high fever, dyspnea
Abdominal distention; absent bowel sounds (Hypoactive)

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42
Q

How is peritonitis diagnosed?

A

Abdominal Films: Free air in peritoneal cavity or CT contrast

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43
Q

What predisposes to Barrett’s esophagus?

A

Chronic exposure to stomach acid

Male
>50 years of age
Caucasian
Smokers
Overweight w/ Hx of GERD

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44
Q

What type of cancer does chronic GERD cause?

A

Esophageal adenocarcinoma

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45
Q

What is eosinophilic esophagitis?

A

Prominence of eosinophils from esophagus biopsy due to chronic immune/antigen-mediated disease causing chronic esophageal inflammation

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46
Q

What are the common signs and symptoms of eosinophilic esophagitis?

A

GERD-like symptoms (Heartburn)
Dysphagia when eating solids: history dates back to childhood
ER presentation: ER with food bolus impaction
N/V

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47
Q

What should be evaluated in patient with eosinophilic esophagitis?

A

Food Allergies

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48
Q

What are the most common types of food allergies in patients with eosinophilic esophagitis?

A

Dairy, wheat, soy, egg, nuts, and fish

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49
Q

What are the 3 main types of esophageal motility disorders?

A

1) Diffuse (distal) esophageal spasm (DES)
2) Hypertensive peristalis (NutcracKer esophagus)
3) Hypertension lower esophageal sphincter (LES)

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50
Q

What are the common signs/symptoms of esophageal motility disorders?

A

1) Dysphagia for solids and liquids
2) Difficulty swallowing several seconds after initiating the swallow
3) Sensation of food getting stuck in esophagus
4) Occasionally retrosternal chest pain
5) Some patient experience GERD

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51
Q

How are esophageal motility disorders diagnosed?

A

1) Upper Endoscopy and biopsy to rule out structural disorders
3) Esophageal manometry

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52
Q

What are some underlying conditions that can result in esophageal motility disorders?

A

1) Scleroderma
2) Diabetes Mellitus

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53
Q

What is the main pharmacologic treatment for esophageal motility disorders?

A

Calcium Channel Blockers: Diltiazen and nifedipine

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54
Q

What are the common signs and symptoms of GERD?

A

1) Burning retrosternal chest pain- worse after meals
2) Aggravated by lying down
3) Acid regurgitation
4) Dry cough
5) Belching

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55
Q

What are the main pharmacologic treatments of GERD?

A

Proton Pump Inhibitor are most effective therapy
-Esomeprazole (Nexium)
-Ranitidine (Zantac)

Antiacids or H2 blockers

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56
Q

What lifestyle modifications are indicated for patients with GERD?

A

Avoidance of individual food intolerances:
Avoid alcohol, coffee and other acidic foods, do not eat 3 hours before lying down

Food substances that Aggravate GERD Symptoms:
Alcohol
Caffeine
Tobacco
Fatty/Fried Foods
Chocolate
Peppermint
Spicy Foods
Citrus fruit juices

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57
Q

What herbs can be used to soothe GERD?

A

Demulcent Herbs:
Aloe Vera
Glycyrrhiza glabra
Ulmus Fulva

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58
Q

What is the etiology for peptic ulcer disease?

A

PUD is most often caused by H. Pylori (90%)
NASIDs use (7% of duodenal ulcers, 35% for gastric ulcers)
Physiologic stress-induced
Strong association with smoking, alcohol abuse or cocaine use

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59
Q

What are the 2 types of peptic ulcers?

A

Gastric or Duodenal Ulcers

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60
Q

What are the general symptoms of peptic ulcers?

A

Nagging, gnawing, or burning epigastric or retrosternal pain, weight loss, N/V, halitosis

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61
Q

What are symptoms of gastric ulcers?

A

-Epigastric pain worse by eating, starts shortly after eating
-Nausea is frequent
-Bleeding is frequent
-Pain is not alleviated by food

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62
Q

What are the symptoms of duodenal ulcers?

A

-Pain relived with eating, starts several hours after eating
-Substernal heatburn
-Pain awakens them at night
-Pain is relieved by food but returns several hours later

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63
Q

How are peptic ulcers diagnosed?

A

Endoscopy

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64
Q

What are the complications of peptic ulcer disease?

A

Bleeding
Duodenal Perforation
Obstruction

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65
Q

Where are gastric ulcers most commonly located?

A

Gastric ulcers are more common along the lesser curvature of the stomach

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66
Q

Which herbs are indicated for treating ulcers?

A

Aloe Vera
Glycyrrhiza glabra
Ulmus Fulva

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67
Q

Ulcers may be a side effect of the use of what drugs?

A

NSAIDs: ibuprofen, aspirin, naproxen

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68
Q

What amino acid is indicated for ulcers?

A

Glutamine

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69
Q

What causes gastritis?

A

Helicobacter pylori infection
Drugs: Aspirin/NSIADs
Alcohol
Physiological-Stress related mucosal changes

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70
Q

What are the signs and symptoms of gastritis?

A

Epigastric pain: burning, gnawing
Dyspepsia, N/V
Bloating, belching
Loss of appetite
Erosive: Bleeding, Melena, Iron Deficiency

71
Q

How is gastritis diagnosed?

A

Biopsy during endoscopy showing red, inflamed and irritated mucosa

72
Q

What causes cirrhosis of the liver?

A

Alcoholic liver disease (85%)
NASH
Biliary cirrhosis or sclerosing cholangitis
Chronic viral hepatitis (B, B+D, C; but never A or E)
Autoimmune diseases
Metabolic Diseases
-Hemochromatosis
-Wilson’s Disease (rare)

73
Q

What are the signs and symptoms of cirrhosis?

A

1) Well compensated people may not have any symptoms
2) Systemic: weight loss, fever, weakness, anorexia
3) Palmar erythema
4) Caput Medusea: Dilated abdominal veins radiating out from umbilicus
5) Hepatomegaly
6) Spider telangiectasias
7) Hepatic Encephalopathy
8) Coagulopathy

Pruritis (20-70%)
Painful Hepatosplenomegaly
Jaundice (60%)- Late finding
Inflammatory Arthropathy

74
Q

What values on a liver function test will be affected by cirrhosis of the liver?

A

AST/ALT >1 in alcoholic cirrhosis
Elevated Bilirubin
Decreased Albumin
BUN will be increased in renal involvement

75
Q

What factors contribute to the anemia seen in liver cirrhosis?

A

1) Acute and chronic GI blood loss
2) Folate Deficiency
3) Direct Toxicity due to alcohol
4) Hypersplenism
5) Bone Marrow Suppression ( aplastic anemia)
6) Anemia or chronic disease (Inflammation)

76
Q

What herbs are indicated for cirrhosis?

A

Curcuma longa
Silybum Marianum
Cynara Scolymus
Leptandra Virginia
Taraxacum officinalis root
Ceanothus virginicus

77
Q

What is the accumulation of excess fluid in the peritoneum called?

A

Ascites

78
Q

What are the major causes of ascites?

A

-Portal hypertension: Cirrhosis, CHF
-Hypoalbuminemia
-Malignancy
-Peritoneal Disease

79
Q

What diuretic medication is used to help treat ascites?

A

Furosemide

80
Q

What are the causes of jaundice?

A

Prehepatic: (unconjugated) Hemolytic anemia, Gilbert’s Syndrome

Hepatic causes: (conjugated) Hepatitis, alcohol-induced, NASH, hemochromatosis

Posthepatic: Obstructive jaundice, gallstones, pancreatitis

81
Q

What effect does obstructive jaundice have on urobilinogen?

A

It will be normal. No bile may be excreted so no urobilinogen may be reabsorbed

82
Q

In which cause of jaundice will you NOT see a rise in unconjugated bilirubin?

A

Gilbert’s Syndrome: Liver doesn’t properly process bilirubin

83
Q

What are the different causes of hepatitis?

A

Viral, autoimmune, Alcohol, NASH, medication, toxins

Hepatitis A: Fecal-oral
Hepatitis B: Parenteral, oral, sexual, vertical (pregnancy) transmission
Hepatitis C: Parenteral or sexual transmission

84
Q

What are the signs and symptoms of acute hepatitis?

A

Prodrome: Flu-like symptoms with malaise, fatigue, anorexia, N/V, myalgia, HA and mild fever, Smokers may be disgusted by smell of cigarettes

Icteric phase: Jaundice, abdominal pain, hepatomegaly and/or dark urine

85
Q

What would you see on labs with hepatitis?

A

Elevated enzymes
ALT > AST
AST: ALT < 1 with viral hepatitis
AST: ALT >2 with alcoholic hepatitis
Hyperbilirubinemia
Bilirubinuria
Slight elevated alkaline phosphate

86
Q

What’s the incubation period for HAV?

A

2 to 6 weeks (WB) ; 4- 6 weeks

87
Q

What is the incubation period for HBV?

A

1 to 6 months

88
Q

What’s the incubation period for HCV?

A

2 weeks to 6 months

89
Q

How is hepatitis A dignosed?

A

(+) Anti-HAV IgM indicates active infection; Anti-HAV IgG indicated recovery or vaccination

90
Q

How is acute hepatitis B diagnosed?

A

(+) HBsAg , (+) HBeAg, followed by (+) HBcAg IgM

91
Q

What antigen is associated with high infectivity of HBV?

A

HBe antigen

92
Q

What antigen is a sign of HBV infection?

A

HB core antibody

93
Q

What are complications of hepatitis?

A

Chronic B,C, or B/D hepatitis

94
Q

What color stool will you often see in patients with hepatitis?

A

Tan/gray color

95
Q

What would be the following tell you about hepatitis B? HBsAg(-), HBcAB (+), HBsAB(IgG)(+)

A

Immune due to previous infection

96
Q

What would the following tell you about hepatitis B? HBsAg (-), HBcAB (-), HBsAB (IgG) (+)

A

Immune due to vaccination

97
Q

What would the following tell you about hepatitis B? HBsAg (-), HBcAB (-), HBsAB (IgG) (-)

A

Suceptible to infection

98
Q

What would the following tell you about hepatitis B? HBsAg (+), HBeAg(+), HBcAB (+), HBsAB (IgG) (-), HBeAB (-)

A

Chronic Hepatitis B

99
Q

What would the following tell you about hepatitis B? HBsAg (+), HBeAg (+), HBcAB (+), HBsAB (IgG) (-), HBeAB (-)

A

Acute Hepatitis B

100
Q

The presence of HBV serological marker indicates convalescence and recovery?

A

HBeAb(IgG)

101
Q

What is the schedule of pediatric HBV vaccination?

A

3 doses: Birth, 1-2 months, 6 months

102
Q

How is HAV and HEV transmitted?

A

Fecal-oral

103
Q

How is HCV and HBV transmitted?

A

Blood and Bodily Fluids

104
Q

How is HDV transmitted?

A

Blood and body fluids concomitant with hepatitis B

105
Q

What herbs are indicated for hepatitis?

A

Curcuma longa
Silybum Marianum
Taraxacum officinalis root
Leptnadra virginica
Glycrrhiza glabra
Silybum marianum
Arctium Lappa
Cynara scolymus

106
Q

What are the predisposing factors for the development of non-alcoholic steatohepatitis (NASH)?

A

Obesity, DM, Hyperlipidemia

107
Q

What is the best treatment for NASH?

A

Weight loss, Tx of DM and hyperlipidemia

108
Q

What is the term for a stone on the common dile duct?

A

Choledocholithiasis

109
Q

What are the predisposing factors for cholelithiaisis?

A

Fair, fat, female, forty, fertile
Obesity
Rapid Weight Loss
Use of OCP’s or estrogen replacement therapy
Hypertriglyceridemia

110
Q

What are the symptoms of cholelithiasis?

A

1) Usually asymptomatic or may present with signs of biliary colic
2) Pain getting progressively worse over 1-5 hours and then remitting
3) N/V is common
4) Intermittent episodes
5) May be aggravated by fatty foods

111
Q

What diagnostic imaging techniques are used to help diagnose cholelithiasis?

A

Abdominal ultrasound; biliary tree

112
Q

What herbs are indicate for cholelithiasis?

A

Chionanthis virginicus
Collinsonia Canadensis
Curcuma Longa
Mentha piperita
Silybum Marianum
Chelidonium majus- caution
Gentiana lutea- caution

113
Q

What is the major cause of cholecystitis?

A

Gallstone obstructing cystic duct

114
Q

What are the signs and symptoms of cholecystitis?

A

Biliary colic
Vomiting
Severe constant epigastric RUQ pain longer than 6 hours , anorexia, nausea, low grade fever
Murphy sign
Jaundice
Palpable gall bladder
Aggravated by Fatty Foods

115
Q

What is seen on labs with cholecystitis?

A

Neutrophilic leukocytosis, left shift ( due to bacterial invasion of gallbladder wall)
Increased WBC
Increase Bilirubin ( indicates stone in bile duct)
Elevates ALT/AST
Elevate ALk phos

116
Q

How is cholecystitis diagnosed?

A

Ultrasound (98% sensitive), CT or HIDA scan

117
Q

What nutrient can be helpful in preventing gallstone formation?

A

Lecithin

118
Q

What are the symptoms of appendicitis?

A

-Persistent, steady, diffuse abdominal pain
-Radiates to RLQ
-Followed by nausea and vomiting
-Mild Fever
-Anorexia

119
Q

What would you find on PE with appendicitis?

A

Low grade fever
Rebound tenderness at McBurney’s point
Rosvig’s sign: Pain in RLQ upon palpation of LLQ
Guarding: voluntary and involuntary
Positive Psoas and obturator’s signs

120
Q

What is a possible complication of appendicitis?

A

Perforation leading to peritonitis

121
Q

If appendicitis is suspected, what diagnostic workup is ordered?

A

CBC with differential, Abdominal CT

Neutrophilic leukocytosis with left shift
Higher leukocyte count with perforation
B-hCG r/o ectopic pregnancy
Abnormal urinalysis: increased protein, hematuria, pyuria

122
Q

What causes celiac disease?

A

Inappropriate immune response to gliadin, a component of gluten found in grains (barely, kamut, oat, rye, spelt, wheat)

T cell and IgA mediated response against gluten

Damage to intestinal mucosa via immune response to gliadin

123
Q

What elements on a chemistry screen and CBC will be affected by celiac disease?

A

Decreased Hct, Hgb, MCV, hypoalbuminemia, electrolyte imbalances

124
Q

How does celiac disease affect the instestines?

A

Flattened jejunal mucosa resulting in defective absorption of fat, protein and carbohydrates, iron, water and fat soluble vitamins.

125
Q

What are some of the gluten-containing foods?

A

Wheat, rye, triticale, barely, spelt, kamut. Oats may be tolerated by some but must be cautious for cross contamination

126
Q

What are the classic symptoms of celiac disease?

A

Diarrhea (foul, bulky, greasy) , bloating, gas, steatorrhea
Weight loss; anemia
Vitamin/Mineral Deficiency

127
Q

How is celiac disease diagnosed?

A

Positive gliadin IgA, IgG (older test, not used much anymore)

Small bowel biopsy, Fecal Fat > 7%, Malabsorption, Bloodwork

128
Q

Whats in the DDx for celiac disease?

A

Crohn’s Disease
Ulcerative Colitis
Giardiasis
Lactose Intolerance
Irritable Bowel Disease

129
Q

What are the clinical findings of fecal impaction?

A

Rectal pain, tenesmus, repeated attempts to defecate, abdominal cramps, serous fluid may flow around mass, palpable lump on digital exam

130
Q

What is an outpouching of the colonic mucosa called?

A

Diverticulosis

131
Q

What can predispose to diverticulosis?

A

Low-fiber diet
Constipation

132
Q

What are the common signs and symptoms of diverticulosis?

A

-Usually asymptomatic
-Episodic LLQ abdominal pain, bloating flatulence, constipation, diarrhea
-Normal temperature
-Poorly localized LLQ tenderness
Palpable inflammatory mass

133
Q

How is diverticulosis diagnosed?

A

Sigmoidoscopy

134
Q

Would a sigmoidoscopy be performed during an acute attack of diverticulitis?

A

No, its contraindicated

135
Q

What dietary advice would you give someone in the acute phase of diverticulosis?

A

High Fiber diet to prevent constipation
Bowel Rest
Liquid Diet
Hydration

136
Q

Would you approve colon hydrotherpy in a patient with diverticulosis?

A

Yes

137
Q

What is seen on colonoscopy with ulcerative colitis (UC)?

A

Pseudopolyps and ulceration in the colon, limited to the mucosa

UC: inflammation from rectum to cecum of large intestine

138
Q

What are the local GI symptoms of UC?

A

Recurrent left-sided abdominal cramping with *bloody diarrhea and *mucus
Pre-defecatory urgency
Fever, tenesmus, weight loss, fatigue

139
Q

What are some of the extra-intestinal symptoms of UC?

A

General: weight loss, fever, nutrient deficiencies
Ankylosing spondylitis: migratory arthritis
Skin: Erythema nodosum
Primary sclerosing cholangitis
Ocular: episcleritis, uveitis, iritis, conjunctivitis

140
Q

What is seen on barium enema with UC?

A

“Lead pipe sign” on X-ray

141
Q

What lab antibody test is more specific for ulcerative colitis over chron’s disease?

A

P-ANCA

142
Q

Is colon hydrotherapy indicated for inactive UC?

A

Yes, but not while active

143
Q

What are the signs and symptoms of Chron’s disease?

A

Chronic intermittent diarrhea, usually not bloody
Abdominal pain on right side
Anorexia
RLQ mass or fullness
Systemic: Fever, fatigue, lethargy, weight loss
Apthous ulcers in mouth

144
Q

What is seen on colonoscopy in Chron’s Disease?

A

Cobblestone appearance
Skip lesions
Spares the rectum
Narrowing/Strictures
Perianal involvement

145
Q

Where does the Crohn’s disease most often occur ?

A

Most common location: Ileum and ascending colon

146
Q

What is the gold standard method of diagnosing Crohn’s Disease?

A

Biopsy of small ileun
Endoscopy with biopsy to visualize and diagnose; Barium studies, CT of ABD show cobblestone appearance

147
Q

What amino acid is indicated for both Crohn’s and UC?

A

Glutamine

148
Q

What does an elevated C-reactive protein indicate?

A

Can be used to r/o diagnosis and monitor tx response

1) Inflammatory Disease (non-specific)
2)Autoimmune Disease
3) Inflammatory Bowel Disease
4) PID

149
Q

What is the main complication that arises from inguinal and umbilical hernias?

A

Incarceration and strangulation

150
Q

What are the cause of adynamic ileus?

A

Recent abdominal surgery is main cause
Peritoneal infections
Drug side effect: especially opiates

151
Q

What is seen on x-ray with adynamic ileus?

A

Copious gas dilation of the small intestine and colon

152
Q

What are the signs and symptoms of adynamic ileus?

A

Abdominal distention
Mild Abdominal pain
N/V possible
Anorexia

153
Q

What condition usually occurs with Meckel’s diverticulum?

A

Gastrointestinal Bleeding

Meckel’s Diverticulum vestigial remnant of the omphalomesenteric (vitellointestinal duct)

Mnemonic: 2 inches long, 2 feet from ileocecal valve, 2% of population, 2% symptomatic

154
Q

What constitutes an external hemorrhoid?

A

Below the dentate line, inferior hemorrhoidal veins, systemic circulation

155
Q

What constitutes an internal hemorrhoid?

A

Above the dentate line, superior hemorrhoidal veins, portal circulation

156
Q

What are the most common food intolerance’s?

A

Gluten
Dairy (casein)
Soy
Corn
Eggs
Nuts

157
Q

Gastric acid assists in the absorption of which nutrients?

A

Calcium, iron, and vitamin B12

158
Q

What are common symptoms of intestinal dysbiosis?

A

Bloating
Flatulence
Abdominal Discomfort
Diarrhea
Vitamin Deficiencies

159
Q

What are the signs and symptoms of irritable bowel syndrome?

A

Constipation alternating with diarrhea, usually one will predominate
Urgency at stool
Exacerbated by stress
Increase Mucus
Gas and bloating
Abdominal tenderness usually localized to LLQ

160
Q

What is seen on colonoscopy with IBS?

A

Colonoscopy is normal

161
Q

How is IBS diagnosed?

A

Diagnosed by exclusion; Rome III Criteria for Diagnosing
12 weeks in 12 months of ABD pain, you have 2 out of 3:
-relieved with defecation
-frequency stool
-change in appearance

162
Q

What is the DDx for IBS?

A

1) Food allergy or intolerance (celiac disease, gluten intolerance, lactase intolerance)
2) Crohn’s disease or ulcerative colitis
3) Diverticulitis
4) Gastroenteritis: viral, bacterial, fungal, parasitic
5) Small bowel intestinal overgrowth
6) Colorectal malignancy
7) Gardia

163
Q

What specific diet could be prescribed for IBS?

A

Low sugar, avoidance of dairy and gluten, consider SIBO diets

164
Q

What dietary advice would you give someone in the acute phase of IBS?

A

Avoid common food allergens

165
Q

What amino acids are indicated for IBS?

A

Gutamine

166
Q

What are the most common causes for bacterial gastroenteritis?

A

Salmonella, Shigella, E.coli and Campylobacter

167
Q

How is bacterial gastroenteritis transmitted?

A

Fecal-oral route, food and water borne

168
Q

What are the common symptoms of bacterial gastroenteritis?

A

Acute Diarrhea, usually contain blood or pus
2) Cramping abdominal pain
3) Fever

169
Q

What is the usual presentation for viral gastroenteritis?

A

Short prodrome followed by mild fever and vomiting, followed by 1-4 days of non-bloody watery diarrhea

170
Q

What is the incubation period for giardia?

A

1-3 weeks

171
Q

What are the symptoms of gardiasis?

A

Gradual onset of nausea, epigastric pain, abdominal cramps, bloating and flatus
Frequent explosive, non-bloody, watery stools

172
Q

What drug is used to treat giardiasis?

A

Metronidazole

173
Q

What is the most important consideration in a patient with acute infectious diarrhea?

A

Dehydration

Gastrointestinal & Hepatobiliary Systems (1 decks)

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