Diseases of the Gastrointestinal System

Question 1

What is Turcot syndrome?

Answer 1

colon polyps plus cerebellar medulloblastoma or glioblastoma multiforme

Question 2

What is Gardner syndrome?

Answer 2

Variant of FAP; Colon polyps plus osteomas, dental abnormalities, sebaceous cysts, benign soft tissue tumors, and desmoid tumors

Question 3

What part of the colon has the largest diameter?

Answer 3

Cecum

Question 4

What are the common findings of right-sided colon cancer?

Answer 4

occult blood in stool, iron deficiency anemia, melena

Question 5

What the the signs of left-sided colon cancer?

Answer 5

Change in bowel habits - constipation/diarrhea; hematochezia

Question 6

What are the symptoms of rectal cancer?

Answer 6

Hematochezia (most common), tenses, rectal mass

Question 7

After resection of CRC, how often are CT scans of the abdomen/pelvis performed? CXR?

Answer 7

CT and CXR performed annually for 5 years

Question 8

What lab is used for surveillance of CRC?

Answer 8

CEA levels

Question 9

What is the most common location of diverticulosis?

Answer 9

sigmoid colon

Question 10

What is the diagnostic test of choice for diverticulosis?

Answer 10

barium enema; AXR are usually normal and not diagnostic

Question 11

How is diverticulitis diagnosed?

Answer 11

CT abdomen/pelvis with oral and IV contrast; barium enema and colonoscopy are contraindicated

Question 12

How is uncomplicated diverticulitis managed?

Answer 12

IV antibiotics, bowel rest, IV fluids

Question 13

How is acute mesenteric ischemia diagnosed?

Answer 13

Mesenteric angiography is definitive diagnostic test

Question 14

What is Ogilvie syndrome?

Answer 14

signs, symptoms, and radiographic evidence of large bowel obstruction are present, but there is no mechanical obstruction

Question 15

What are the causes of Ogilvie syndrome?

Answer 15

recent surgery or trauma, drugs (narcotics, psychogenic, anticholinergic), and serious medical illnesses (malignancy and sepsis).

Question 16

What is the treatment for C. difficile?

Answer 16

Metronidazole first-line; oral vanco if cannot tolerate metronidazole; **cholestyramine used as adjuvant to improve diarrhea

Question 17

What lab value should be checked in acute mesenteric ischemia is suspected?

Answer 17

Lactate level

Question 18

What is the most common site of colonic volvulus?

Answer 18

Sigmoid colon

Question 19

Cecal volvulus is seen in what age group usually? Why?

Answer 19

Younger patients; due to congenital lack of fixation of the right colon

Question 20

What imaging is used in diagnosing colonic volvulus?

Answer 20

Abdominal plain film - “omega loop sign” seen with sigmoid volvulus; dilated cecum and small bowel in cecum volvulus

Question 21

What is the treatment for cecum and sigmoid volvulus?

Answer 21

Cecum - emergent surgery; Sigmoid - sigmoidoscopy decompression but recurrence is high so sigmoid colon resection is recommended

Question 22

What are the most common etiologic agents in spontaneous bacterial peritonitis?

Answer 22

E. coli (most common), Klebsiella, S pneumo

Question 23

How is spontaneous bacterial peritonitis diagnosed?

Answer 23

Paracentesis and examination of fluid for WBCs and PMNs (WBCs >500, PMNs >250), gram stain with culture, and sensitivities

Question 24

What is the inheritance pattern of Wilson’s disease? What is the mutated gene?

Answer 24

AR; gene mutation is ATP7B

Question 25

Patient presents with elevated LFTs and decreased ceruloplasmin, what is likely to be significantly elevated on liver biopsy?

Answer 25

Copper; patient has Wilson's disease

Question 26

What is the treatment for Wilson's disease?

Answer 26

d-penicillamine (removes/detoxifies copper) and zinc (prevents uptake); liver transplant if unresponsive

Question 27

What is the inheritance pattern of hemochromatosis?

Answer 27

AR

Question 28

What is the treatment for hemochromatosis?

Answer 28

Repeated phlebotomies

Question 29

What is the treatment for hepatic adenomas?

Answer 29

Stop OCPs (or steroids), if tumor >5 cm and does not regress with d/c of OCPs, resect. Need to resect due to risk of rupture.

Question 30

What is the most common type of benign liver tumor?

Answer 30

Cavernous hemangiomas

Question 31

How is cavernous hemangiomas of the liver diagnosed?

Answer 31

CT with IV contrast or US; biopsy contraindicated due to risk of rupture/bleeding

Question 32

What is the most common type of HCC?

Answer 32

nonfibrolamellar HCC

Question 33

What type of HCC is associated with HBV and HCV?

Answer 33

Nonfibrolamellar HCC

Question 34

What percentage of cirrhotic patients develop HCC?

Answer 34

10%

Question 35

What chemical carcinogens are known risk factors for HCC?

Answer 35

Aflatoxin, vinyl chloride, thorotrast

Question 36

What imaging modalities are helpful in HCC?

Answer 36

US, CT (chest, abdomen, pelvis) and MRI or MRA if surgery is an option

Question 37

How is HCC diagnosed?

Answer 37

Liver biopsy

Question 38

What lab tests are ordered in HCC?

Answer 38

LFTs, Hep B and C, coags

Question 39

What is hemobilia?

Answer 39

blood draining into the duodenum via the common bile duct - source can be biliary tree, liver, or ampullary region

Question 40

What are the clinical features of hemobilia?

Answer 40

GI bleeding (melena, hematemesis), jaundice, RUQ pain

Question 41

How is hemobilia diagnosed?

Answer 41

arteriogram; Upper GI endoscopy shows blood coming out of ampulla of Vater

Question 42

What are the causes of hemobilia?

Answer 42

trauma (most common), papillary thyroid carcinoma, surgery, tumors, infection