Gastrointestinal

Question 1

Ulcerative colitis

Answer 1

Eti: autoimmune inflammation: colon only
Cigarettes can help symptoms, flare with quitting.
Sx: Halmark: bloody diarrhea, LLQ pain, cramps, urgency, tenesmus, abd pain, sweats/fever
- Begins at the rectum and spreads proximally
Dx: Flex sig
Tx: 5-ASA, corticosteroids for flares
Complications: Toxic megacolon

Question 2

Crohns disease

Answer 2

Eti: autoimmmune disorder of mouth to anus, mostly small bowel and colon.
Risk: strongly associated with smoking
- ileitis or ileocolitis → pts w/ malaise, weight loss, and loss of energy, may be diarrhea (often nonbloody and intermittent)
- RLQ pain or periumbilical
Dx: clinically based, supported with endoscope, pathology, radiologic
Signs: endoscope (stellate and skip lesions)
- Barium: string sign
Tx: 5-ASA, corticosteroid for flares
Complication: bowel obstruction, internal fistuals

Question 3

Inflammatory diarrhea: essentials of Dx?

Answer 3

Blood or pus
Fever
-LLQ cramps, urgency, tenesmus
-Diarrhea usually in small volumes
Workup: Stool culture, check for C.diff and O&P if indicated

Question 4

Treatment of inflammatory and non-inflammatory diarrhea

Answer 4

Inflammatory:
-Diet: bowel rest, give tea, “flat” carbonated beverages, and soft, easily digested foods (eg, soups, crackers, bananas, applesauce, rice, toast)
-IV fluids if more severe
-Bismuth-sulfate (pepto)
-Empiric antibiotics are usually NOT indicated
** if severe fever, tenesmus, bloody stools, immunocompromise, or significant dehydration→ fluoroquinolones
NO ANTIDIARRHEALS
Non-inflammatory: rehydration, can use antidiarrheals

Question 5

Diverticulosis

Answer 5

Eti: Bulging pouches of intestinal wall, typically 40 plus yo. (Ehlers-Danlos, marfans, scleroderma)
-Most pts are asymptomatic
+/- nonspecific complaints: chronic constipation, abdominal pain, or fluctuating bowel habits
PE: can have mild LLQ pain
Management: diet high in fiber

Question 6

Diveriticulitis

Answer 6

Eti: Inflamed or infected diverticula
Sx:
- Fever, mild-moderate aching abdominal pain & mass, usually in LLQ
- Constipation or loose stools, N/V

• Free perforation = more pain, peritoneal signs
• PE: low-grade fever, LLQ tenderness, palpable
  Dx: Guiac positive, CBC: leukocytosis, CT if sx lasting longer than 2-4 days

Comp: Fistula or stricture

Question 7

Hepatitis A

Answer 7

Fecal oral transmission,
Sx: abrupt onset of nausea, vomiting, anorexia, fever, malaise, and abdominal pain
- follow by dark urine and sometimes pale stools
- Then jaundice and pruritis
Physical signs: fever, jaundice, scleral icterus, hepatomegaly, abdominal pain

Question 8

Hepatitis B

Answer 8

Sx: serum sickness in early stages: (type III hypersensitivity reaction -> fever, malaise, cutaneous eruptions (urticarial or serpiginous), arthralgias, GI issues, HA, etc)
Dx:
(+) HBsAg = current infection
(+) anti-HBs = past infection, vaccine, immunity
(+) anti-HBc = previous exposure

Question 9

Hepatitis C

Answer 9

50% of cases= IV drug use
Blood borne
Sx: initial illness is mild, usually asymptomatic +/- jaundice
Who to screen: babyboomers 1945-1965

Question 10

Causes of upper GI bleeds

Answer 10

Peptic ulcer disease >50%
Esophogeal varices from portal hypertension 10-20%
Mallory-weiss tears
Sx: Hematemesis, bright red blood or “coffee ground” appearence
Melena in most cases, can be hematochezia if massive bleed

Question 11

Causes of lower GI bleeds

Answer 11

greater than 50 yo:
- diverticulosis (50% of all cases), angiectasias, malignancy, or ischemia

less than 50 yo:
-infectious colitis, anorectal disease, and IBD
Sx: hematochezia

Question 12

Acute pancreatitis

Answer 12

Eti: 2/3 due to chronic EtoH and gall stones
Sx: acute pancreatitis have acute onset of persistent, abrupt severe epigastric abdominal pain, radiates to the back. Exacerbated by walking or lying supine, better with leaning forward
- N/V, sweating
PE: epigastric pain, decreased bowel sounds, tachycardia, cullens sign (periumbilical), gray turners sign (flank ecchymosis)
Labs:
Leukocytosis
Lipase and amylase 3x normal (lipase is specific and amylase is sensitive)
ALT 3x normal, suggests gallstone pancreatitis
Hypertriglyceridemia, Hypocalcemia

Question 13

Chronic pancreatitis

Answer 13

progressive inflammatory disease of the pancreas, characterized by irreversible morphologic changes and gradual fibrotic replacement of the gland.
Sx: pain is dull or boring in quality and worsens after eating. The pain is located in the epigastric area and often radiates to the back.