Gastroenterology

Question 1

How can you improve O&P sensitivity?

Answer 1

Loosen the bowels - herbs, water, magnesium

Question 2

Which Ig rises with infxn and reduces with remission and is often specific to mucus membranes?

Answer 2

IgA

H. pylori often

Question 3

Name the referred pain pattern: 5th left rib to mid lumbar region, midline to left lateral border: dorsal and ventral epigastric areas

Answer 3

Stomach

Question 4

Name the referred pain pattern: same position as stomach on right half of body. Dorsal and ventral. Right scapula.

Answer 4

Liver

Question 5

Name the referred pain pattern: Murphy’s point, RUQ, right scapula

Answer 5

GB

Question 6

Name the referred pain pattern: McBurney’s point, RLQ, Right dorsal flank, celiac area

Answer 6

Appendix

Question 7

Name the referred pain pattern: Celiac, local area of lg intestine

Answer 7

Colon, Sm intestine

Question 8

Name the referred pain pattern: suprapubic area, sacral area

Answer 8

Rectum

Question 9

Name the referred pain pattern: Costovertebral area, bilateral dorsal flanks, R and L dorsal iliac crests

Answer 9

Kidneys

Question 10

Name the referred pain pattern: left inferior iliac crest, left inguinal area, left labia/testicle

Answer 10

Ureter

Question 11

T/F: Initial abd pain is often remote to the organ.

Answer 11

T

Question 12

DDX Central/Celiac pain

Answer 12

Acute/early appy, acute small bowel obs, gastritis, pancreatitis, intestinal colic

Question 13

DDX RUQ pain

Answer 13

Pleuritic pain, acute appy, cholecystitis, leaking duodenal ulcer, subphrenic abscess (hx of laparoscopic procedure)

Question 14

DDX LUQ pain

Answer 14

Subphrenic abscess, perforated gastric ulcer, jejunal diverticulitis, splenic pain

Question 15

DDX RLQ pain

Answer 15

Crohns, Appy, Mesenteric adenitis, leaking duodenal ulcers

less common: cholecystitis, biliary peritonitis, acute pancreatitis, inflamed Meckel’s diverticulum

Question 16

DDX LLQ pain

Answer 16

Diverticulitis, peritonitis, pericolitis

Question 17

DDX left inguinal/iliac pain

Answer 17

Back: ureteric pain, kidney pain

Question 18

Term: motility disorder of the esophagus secondary to loss of neurons from mesenteric plexus. LES fails to relax with swallowing.

Answer 18

Achalasia

Question 19

T/F: Gastric ulcer is better w/ eating. Duodenal ulcers are worse w/ food.

Answer 19

F - Gastric worse w/ food. Duodenal better w/ eating

Question 20

What should you consider when a pt presents with recurrent ulcer-like symptoms that do no respond to treatment?

Answer 20

CA - do endoscopy

Question 21

Two of the MC etiology for pancreatitis?

Answer 21

Alcohol, gallstones

Question 22

Lab tests to run with pancreatitis.

Answer 22

Amylase and lipase.

Question 23

If tot bili is elevated, MUST check direct and indirect. If indirect is elevates, what is the cause? Direct?

Answer 23

Indirect/Unconjugated - Gilbert’s syndrome, poor glucuronidation, or excessive lysis

Direct - hepatocellular dz, biliary obs

Question 24

What is the only DNA virus of the Hepatitis family?

Answer 24

Hep B

Question 25

Lab findings in cirrhosis.

Answer 25

Decreased serum albumin and prolonged PT

Question 26

MC gastric cancer.

Answer 26

Adenocarcinoma

Question 27

Which imaging is more sensitive in pancreatic cancer? What symptom occurs in 25-50% of patients w/ pancreatic CA?

Answer 27

CT Hyperglycemia

Question 28

Which two genetic conditions run in families and highly inc the risk of colon CA esp before the age of 40?

Answer 28

Familial polyposis and Lynch syndrome

Question 29

When do you start screening colonoscopies? What does screening include?

Answer 29

50-75 Colonoscopy, sigmoidoscopy, and fecal occult blood.

Question 30

``` Name the etiologic agent (bacteria/virus/ameoba): Inc time: 4-12 hr Diarrhea: Watery, profuse Emesis: Pronounced Abd pain: Mild Fever: Absent ```

Answer 30

Staph aureus, Clostridium perfringens

Question 31

``` Name the etiologic agent (bacteria/virus/ameoba): Inc time: 8-72 hr Diarrhea: Watery, profuse Emesis: Moderate Abd pain: Mild Fever: Absent ```

Answer 31

Vibrio cholera, enterotoxigenic E. coli

Question 32

``` Name the etiologic agent (bacteria/virus/ameoba): Inc time: 2-7 d Diarrhea: variable, watery Emesis: mild Abd pain: moderate Fever: variable ```

Answer 32

E. coli, giardia

Question 33

``` Name the etiologic agent (bacteria/virus/ameoba): Inc time: 1-3 d Diarrhea: variable, often bloody Emesis: mild Abd pain: severe Fever: mild ```

Answer 33

Hemorrhagic e. choli, clostridium difficile

Question 34

``` Name the etiologic agent (bacteria/virus/ameoba): Inc time: 1-4 d Diarrhea: often bloody Emesis: milde Abd pain: severe Fever: moderate to high ```

Answer 34

Salmonella, campylobacter, Shigella, enteroinvasive E. coli, entamoeba histolytica

Question 35

Which is the enterohemorrhagic strain of E. coli?

Answer 35

O157:H7 Hemolytic-uremic syndrome can cause death via renal failure due to toxins produced.

Question 36

T/F: Cryptosporidiosis can be found in municipal water sources while Giardia is acquired by feces in water.

Answer 36

T

Question 37

Crohns or UC: "skip" lesions/irregular that are transmural

Answer 37

Crohn's

Question 38

Crohns or UC: lead pip on barium xray

Answer 38

UC

Question 39

Crohns or UC: can be complicated by hemorrhage or toxic megacolon

Answer 39

UC

Question 40

Crohns or UC: can be complicated by fistula, abscess, or obstruction

Answer 40

Crohn's

Question 41

Crohns or UC: string sign on barium xray

Answer 41

Crohn's - due to strictures

Question 42

Crohns or UC: proximally contiguous from the colon only affecting the submucosa and mucosa

Answer 42

UC

Question 43

What are some extraintestinal manifestation of IBD?

Answer 43

Erythema nodosum, pyoderma gangrenosum, arthritis, AS, uveitis, fatty liver, primary sclerosing cholangitis

Question 44

What skin condition is associated with celiac's dz?

Answer 44

Dermatitis herpetiformis

Question 45

What vitamin/mineral deficiencies often coincide with celiac sprue?

Answer 45

Vit B12, folate, iron

Question 46

What lab tests are performed to assess for celiac dz?

Answer 46

Serum IgA antiendomysial and tissue transglutaminase Anti-gliadin (less specific can indicate intolerance) Intestinal biopsy is gold standard

Question 47

What are two visible signs of pancreatitis?

Answer 47

Cullen's sign - periumbilical hemorrhage visible as bruise | Grey-Turner sign - flank hemorrhage - producing visible bruise

Question 48

T/F: Must biopsy gastric ulcers for CA.

Answer 48

T

Question 49

What is the tumor marker for hepatocellular carcinoma?

Answer 49

alpha - fetoprotein

Question 50

What ratio of AST to ALT indicates alcoholic cirrhosis?

Answer 50

AST>ALT, greater than one

Question 51

What ratio of AST to ALT indicates viral hepatitis?

Answer 51

ALT>AST

Question 52

Which Hepatitis B antibody persists > 6mo if the infxn becomes chronic?

Answer 52

Hepatitis B Surface Antigen (HBsAg)

Question 53

What two liver markers are elevated in hepatocellular carcinoma?

Answer 53

ALT and GGT

Question 54

What tumor marker is elevated in gallbladder adenocarcinoma?

Answer 54

CA19-9

Question 55

For which GI infxn would you run a stoll culture and sensitivity?

Answer 55

Shigella, Salmonella, Campylobacter, and E. Coli

Question 56

What gene is a marker for Celiac's Dz?

Answer 56

HLA-DQ2

Question 57

What imaging is best used in acute diverticulitis?

Answer 57

CT scan

Question 58

T/F: Smoking increase the risk of UC and decreases risk for Crohn's.

Answer 58

F. Smoking inc risk for Crohn's and lowers risk for UC.

Question 59

What is the tumor marker for colon CA?

Answer 59

CEA