Gastrointestinal and Nutrition

Question 1

dumping syndrome symptoms and timing

Answer 1

15-30 minutes post-meal

N/D/abd cramps
Vasomotor (palpitaitons, diaphoresis, hypotension)
Dizziness/confusion, fatigue, diaphoresis

Question 2

dumping syndrome pathogenesis

Answer 2

rapid emptying of hypertonic gastric contents into duodenum due to loss of normal action of PYLORIC SPHINCTER POST-GASTRECTOMY

Question 3

treatment of dumping syndrome

Answer 3

diet modification - frequent, smaller meals, avoid simple sugar, increase fiber and protein, fluids between meals

Question 4

Blunt abdominal trauma and 24-36hrs later, epigastric pain and vomiting. Esp in children

Answer 4

Duodenal Hematoma - obstruction due to blood b/w submucosal and muscular layers of duodenum

Question 5

Mgmt of duodenal hematoma

Answer 5

NG tube decompression.

Surgery and drainage if nonoperative management fails

Question 6

RUQ pain, intraperitoneal free fluid, hemodynamic stability, abnormal blood counts

MCC of this is right eight or ninth rib fracture (seat belt sign)

Answer 6

liver LAC - one of MC complications of BAT

Question 7

BAT and days to weeks later develop N/V/wt loss, palpable abdominal mass.

Answer 7

pancreatic pseudocyst (or prior pancreatitis)

Question 8

1mo old with N/V/poor feeding.

Answer 8

pyloric stenosis

Question 9

Fever, RUQP, N/V. CREPITUS in abdominal wall adjacent to gallbladder.

Unconjucgated hyperBr, mildly elevated aminotransferases.

Dx and MCC

Answer 9

A form of acute cholecystitis - emphysematous cholecystitis due to infection with gas-forming bacteria (clostridium or E coli)

will see air fluid levels in GB, gas in GB wall

Question 10

Three risk factors for emphysematous cholecystitis

Answer 10

DM, vascular compromise, immunosuppression

Question 11

Following a vascular procedure (i.e. AAA repair), a 65yo M presents with mild pain and abdominal tenderness, hematochazia, diarrhea, and metabolic (lactic) acidosis).

CT scan: THICKENED BOWEL WALL, double halo sign, pneumatosis coli

Colonoscopy: mucosal pallor, cyanosis, petechia, hemorrhage

Answer 11

ischemic colitis

Question 12

Opacity in right upper lobe. Foamy sputum with BRB. Wheezing on right side.

Dx and initial management

Answer 12

tuberculosis

respiratory isolation

Question 13

TB patient is in respiratory isolation and needs to be intubated. Fresh blood fills the endotracheal tube. Best next step in management

Answer 13

bronchoscopy

Question 14

define “massive” hemoptysis, which requires immediate treatment of bleeding

Answer 14

> 600 mL/24h OR >100ml/h

Question 15

Gilbert syndrome has increased what kind of Br? Clinical findings

Answer 15

increased unconjugated Br

decreased UDP-glucuronosyltransferase

mild jaundice provoked by stress.

Question 16

discuss the evaluation of blunt genitourinary trauma in a hemodynamically stable patient with hematuria

Answer 16

UA

contrast CT of abdomen and pelvis

Question 17

discuss evaluation of hemodynamically unstable patient with evidence of renal trauma

Answer 17

Intravenous pyelography prior to surgical evaluation

Question 18

define acute mesenteric ischemia

Answer 18

Rapid onset of often severe periumbilical pain out of proportion with physical exa, Hematochezia is a late complication.

Urge to defecate.

Question 19

three lab findings in acute mesenteric ischemia

Answer 19

leukocytosis
elevated amylase and phosphate
METABOLIC ACIDOSIS (elevated LACTATE)

Question 20

nausea, vomiting, epigastric pain radiating to back

Answer 20

acute pancreatitis

Question 21

Recurrent, episodic pain in RUQ or epigastric region, corresponding elevations in aminotransferases and alkaline phosphatase. Opioids (morphine) can worsen/precipitate symptoms.

What is this and what is seen upon visualization of the common bile duct?

Answer 21

sphincter of oddi dysfunction

CBD is dilated in the absence of stones.

Question 22

gold standard for dx of sphincter of oddi dysfunction

Answer 22

sphincter of oddi manometry

Question 23

treatment of anal fissures

Answer 23

fiber, fluids, sitz bath, stool softeners, topical anesthetics and vasodilators (nitroglycerin and nifedipine)

Question 24

recommendation for diverticulitis with abscess formation (i.e “5cm ring enhancing perisigmoid fluid collection”)

Answer 24

CT guided percutaneous drainage

Question 25

Subacute fever, abdominal/flank pain radiating to groin. Anorexia and weight loss. Abdominal pain with hip extension.

May be associated iwth appendicitis.

Answer 25

This is a psoas abscess

Abdominal pain with hip extension is the PSOAS SIGN

Question 26

stehoscope placed over upper abdomen and patient’s hips rocked back and forth. retained gastric material >3h postprandial will generate splash sound and indicates presence of hollow viscus filled with fluids/gas

what is this called and what does it indicate?

Answer 26

called abdominal succussion splash

indicates gastric outlet obstructin

Question 27

BAT followed by left sided abdominal pain with radiation to shoulder, fever, vomiting.

Answer 27

splenic INFARCT (but LAC is more common)

Question 28

patient presents with appendicitis for >5d after onset of symptoms. high incidence of what? manage how?

Answer 28

perforation with abscess formation

manage with IV hydration ,antibiotics, bowel rest, and interval appendectomy

Question 29

Dx: fever, severe abdominal pain, tachycardia, peritonitis (guarding, rigidity, reduced bowel sounds, rebound tenderness) presenting after a penetrating abdominal wound.

Answer 29

perforated viscus

Question 30

the two MC locations of ischemic colitis

Answer 30

splenic flexure and rectosigmoid flexure

Question 31

child with:

midline abdominal defect covered by peritoneum. multiple abdominal organs contained. umbilical cord and APEX of defect

Answer 31

omphalocele

Question 32

child with:
defect to right of cord insertion not covered by membrane or skin. contains bowel. umbilical cord inserts next to defect

Answer 32

gastroschisis

Question 33

child with:

defect at linea alba covered by skin. sometimes contains bowel . umbilical cord inserts at apex of defect

Answer 33

umbilical hernia

Question 34

ALT>__ is 95% PPV for gallstone pancreatitis.

Answer 34

150

Question 35

NExt best step: gallstone pancreatitis with cholangitis, visible CBD dilation/obstruction, increasing liver enzymes.

Answer 35

ERCP

Question 36

epigastric pain/tenderness and weight loss in setting of nonspecific systemic symptoms and significant SMOKING history.

increased alkphos and direct Br

Answer 36

pancreatic adenocarcinoma.