Diseases of the Small Intestine and Colon

Question 1

What is the most common location for a large bowel obstruction?

Answer 1

Sigmoid colon

Question 2

What would be the expected findings on KUB in a patient with a mechanical obstruction?

Answer 2

Dilated loops of bowel with air fluid levels and little or no gas in the colon

Question 3

What is the most common cause of mechanical obstruction in a patient with history of abdominal surgery?

Answer 3

adhesions

Question 4

A patient undergoes a barium study of the colon and an “Apple core” lesion is found. What do you suspect?

Answer 4

colon cancer

Question 5

What is the most common type of colon cancer?

Answer 5

adenocarcinoma

Question 6

A 17 year old presents with abdominal pain, bloating, flatulence, and diarrhea after ingesting dairy. What is the test used to make the diagnosis?

Answer 6

Lactase breath hydrogen test

Question 7

what lab antibodies would likely be positive in a patient with Celiac sprue?

Answer 7

+anti-tissue transglutaminase
+antigliadin
+anti endomysial antibodies

Question 8

Celiac sprue is an abnormal immune response to what food product?

Answer 8

gluten

Question 9

What finding on abdominal X-ray is suggestive of acute mesenteric ischemia?

Answer 9

Thumb-printing of small bowel or right colon due to submucosal bleeding (Thumb printing may also be seen with toxic megacolon)

Question 10

What is the gold standard for diagnosis of mesenteric ischemia?

Answer 10

angiography

Question 11

A diabetic presents with abdominal pain that begins one hour after eating and resolves a few hours later. What is your suspected diagnosis?

Answer 11

Chronic mesenteric ischemia

Question 12

A 55 year old male presents with acute abdominal pain. He is in atrial fibrillation and has a relatively benign exam. What is your diagnosis?

Answer 12

mesenteric ischemia

Question 13

What antibodies will be found positive in Crohn’s disease?

Answer 13

+ anti-saccharomyces cerevisiae antibodies (ASCA)

Question 14

What antibodies will be found positive with ulcerative colitis?

Answer 14

+ anti-neutrophil cytoplasmic antibodies (pANCA)

Question 15

Patient presents with alternating diarrhea and then constipation. A complete workup and physical exam are normal. What do you suspect?

Answer 15

Irritable bowel syndrome

Question 16

What are the three major complications of ulcerative colitis?

Answer 16

Toxic megacolon
Primary Sclerosing Cholangitis
Colorectal cancer

Question 17

Crohn’s disease affects what part of the GI tract?

Answer 17

Mouth to anus

Question 18

Which type of diverticular problem generally is painless bleeding?

Answer 18

diverticulosis

Question 19

A patient having less than two bowel movements per week is defined as having what?

Answer 19

constipation

Question 20

Which type of laxative is first in the line of treatment after lifestyle changes and adequate fiber?

Answer 20

Osmotic Laxatives - These laxatives include milk of magnesia, magnesium citrate, sorbitol, polyethylene glycol, and lactulose

Question 21

What is the test of choice to diagnose appendicitis in an adult?

Answer 21

CT

Question 22

What is the test of choice to diagnose appendicitis in a child?

Answer 22

ultrasound

Question 23

What is Iliopsoas sign?

Answer 23

RLQ pain with R hip extension

Question 24

What is Obturator sign?

Answer 24

RLQ pain upon flexion and internal rotation of RLE

Question 25

What is Rovsing's sign?

Answer 25

RLQ pain upon palpation of LLQ

Question 26

What is McBurney's sign?

Answer 26

Pain upon palpation of the RLQ

Question 27

What tumor marker is elevated in pancreatic cancer?

Answer 27

CA 19-9

Question 28

What is the most common cause of painless rectal bleeding in pediatric population?

Answer 28

polyps

Question 29

What are the three borders of Hesselbach's triangle?

Answer 29

Medial border: rectus abdominus Superior border: inferior epigastric artery Lateral border: inguinal ligament

Question 30

What is intestinal pseudo-obstruction without evidence of mechanical cause called?

Answer 30

Ogilvie Syndrome

Question 31

List the 6 "rule of 2" characteristics of Meckel's diverticulum.

Answer 31

2% of population - 2 feet proximal to ileocecal valve - 2 inches long - 2 years old - 2:1 M:F ratio - 2 tissues: gastric & pancreatic

Question 32

Which disorder commonly has cobblestoning or skip lesions on imaging?

Answer 32

Crohn's

Question 33

What test is used to diagnose lactase deficiency?

Answer 33

Lactose breath hydrogen test

Question 34

What disorder is colon dilation air fluid levels and thumbprinting sign on imaging suggestive of?

Answer 34

Toxic megacolon (Thumbprinting may also occur with mesenteric ischemia)

Question 35

What is the Dx? Acute abdominal pain. KUB shows dilated loops of bowel with air fluid levels.

Answer 35

small bowel obstruction

Question 36

At what age should routine colonoscopy screening begin for men and women?

Answer 36

age 50

Question 37

Most common type of colon cancer?

Answer 37

adenocarcinoma

Question 38

What is the DX? 65-year-old male 3 months of recent weight loss poor appetite new constipation and anemia.

Answer 38

think colon cancer

Question 39

Celiac sprue intestinal biopsy findings?

Answer 39

villous atrophy

Question 40

Good test for malabsorption?

Answer 40

Fecal fat testing

Question 41

Intestinal angina?

Answer 41

chronic mesenteric ischemia

Question 42

What is the Dx? 60-year-old male smoker complains of recurrent dull abdominal cramps/pain within 1 hour of eating meals.

Answer 42

chronic mesenteric ischemia

Question 43

What is severe abdominal pain out of proportion to physical exam findings suggestive of?

Answer 43

acute mesenteric ischemia

Question 44

Acute thrombosis or embolism of the celiac or mesenteric arteries?

Answer 44

acute mesenteric ischemia

Question 45

Name the criteria used to diagnose Irritable bowel syndrome.

Answer 45

``` Rome criteria: Pain relieved with defecation Change in frequency and form Altered stool passage Passage of mucus ```

Question 46

Irritable bowel disease that may affect the entire GI tract from mouth to anus?

Answer 46

Crohn's

Question 47

What are the extraintestinal manifestations that can be seen in ulcerative colitis patients?

Answer 47

``` Pyoderma gangrenosum Arthritis Ankylosing spondylitis Erythema nodosum Uveitis ```

Question 48

Inflammatory bowel disease that only affects the large intestines?

Answer 48

Ulcerative colitis

Question 49

Inflammatory bowel disease that often presents with bloody diarrhea?

Answer 49

Ulcerative colitis

Question 50

What is the Dx? Newborn with double bubble sign on abdominal X-ray.

Answer 50

duodenal atresia

Question 51

List 3 antibiotic regimens which can be used for diverticulitis?

Answer 51

Quinolone with metronidazole Amoxicillin-clavulanate Trimethoprim-sulfamethoxazole

Question 52

Treatment for acute diverticulitis?

Answer 52

Initial: NPO/IV fluids antibiotics - May require surgery if perforation or abscess

Question 53

+anti-tissue transglutaminase +anti gliadin and +anti endomysial antibodies are suggestive of what disorder?

Answer 53

Celiac sprue

Question 54

What cardiac disorders are acute mesenteric ischemia associated with?

Answer 54

AFib, CHF, MI

Question 55

Sign seen with appendicitis with pain over the right lower quadrant one-third of the distance from the ASIS to the umbilicus?

Answer 55

McBurney's

Question 56

Medications to treat gastroparesis?

Answer 56

Metoclopramide | IV erythromycin

Question 57

A sausage shaped mass and currant jelly stool are consistent with what diagnosis?

Answer 57

intussusception

Question 58

A newborn with bilious vomiting and a non-distended abdomen is found to have a double bubble sign on KUB. What is your diagnosis?

Answer 58

duodenal atresia

Question 59

What exam finding would be possibly seen on radiologic work up for child with pyloric stenosis?

Answer 59

US for identification shows a Double-track - Follow up barium studies show String sign and Shoulder sign

Question 60

Use of what antibiotic is associated with increased risk of pyloric stenosis?

Answer 60

Clarithromycin (Note: erythromycin is also associated)

Question 61

A baby presents with vomiting and abdominal exam reveals an olive like mass in the RUQ. What do you suspect?

Answer 61

pyloric stenosis

Question 62

Both mesenteric ischemia and toxic megacolon may have a thumb printing sign on imaging. What differentiates the two on physical exam?

Answer 62

Mesenteric ischemia has a soft abdomen - Toxic megacolon as rigid abdomen