GASTROINTESTINAL DISORDERS IN PREGNANCY (AB)

Question 1

What are the diagnostic procedures for pregnant women with GI disorder symptoms?

Answer 1

Endoscopy,
non-invasive imaging techniques (ultrasound, MRI, limited use of CT),
laparoscopy.

Question 2

Why is endoscopy used in pregnant women?

Answer 2

It is useful for diagnosing and managing upper GI issues; can visualize the esophagus, stomach, duodenum, and colon.

Question 3

What is a risk associated with endoscopy during pregnancy?

Answer 3

A slightly increased risk of preterm birth, though this is likely due to the disease itself rather than the procedure.

Question 4

What imaging technique is ideal for evaluating the GI tract in pregnancy?

Answer 4

Abdominal sonography (ultrasound).

Question 5

Why is CT scan use limited during pregnancy?

Answer 5

Due to radiation exposure.

Question 6

What are the benefits of laparoscopy during pregnancy?

Answer 6

Minimally invasive, replaces traditional surgery for many abdominal disorders, and allows diagnosis and treatment.

Question 7

Why is enteral feeding preferred over parenteral nutrition?

Answer 7

It uses the entire GI tract and has fewer serious complications.

Question 8

What are some conditions treated with enteral or parenteral nutrition during pregnancy?

Answer 8

Achalasia, anorexia nervosa, appendiceal rupture, bowel obstructions, burns, cholecystitis, Crohn’s disease, diabetic gastropathy, esophageal injury, hyperemesis gravidarum, jejunoileal bypass, malignancies.

Question 9

What is hyperemesis gravidarum?

Answer 9

Severe, unrelenting nausea and vomiting in pregnancy, leading to weight loss, dehydration, ketosis, alkalosis, and hypokalemia.

Question 10

What is a severe complication of hyperemesis gravidarum?

Answer 10

Acute kidney injury, esophageal rupture (Boerhaave’s syndrome), Wernicke encephalopathy (thiamine deficiency), Mallory-Weiss tears, vitamin K deficiency, diaphragmatic rupture.

Question 11

What are the risk factors for hyperemesis gravidarum?

Answer 11

Increased hCG (multiple pregnancy, molar gestation), increased estrogen and progesterone, carrying a female fetus (1.5-fold increased risk).

Question 12

What vitamin deficiency is associated with Wernicke encephalopathy in hyperemesis gravidarum?

Answer 12

Thiamine deficiency.

Question 13

How is hyperemesis gravidarum managed?

Answer 13

Vitamin replacement, antiemetics (Diclegis, ondansetron, promethazine, metoclopramide), IV hydration, hospitalization if necessary, enteral or parenteral nutrition for intractable cases.

Question 14

What are the first-line antiemetics for nausea and vomiting in pregnancy?

Answer 14

Diclegis (doxylamine + pyridoxine), promethazine, prochlorperazine, ondansetron, metoclopramide.

Question 15

Why is total parenteral nutrition (TPN) given through a central venous catheter?

Answer 15

TPN is hyperosmolar and requires rapid dilution in a high-flow vascular system.

Question 16

What are the common complications of parenteral feeding?

Answer 16

Catheter sepsis, hyperalimentation complications, electrolyte imbalances.

Question 17

What are common medications for GERD in pregnancy?

Answer 17

Proton pump inhibitors (pantoprazole, lansoprazole, omeprazole), H2-receptor antagonists (famotidine, cimetidine, nizatidine).

Question 18

What dietary modification can help mild cases of hyperemesis gravidarum?

Answer 18

Ginger-flavored candies and small frequent meals.

Question 19

When should a pregnant patient with hyperemesis gravidarum be hospitalized?

Answer 19

If vomiting persists after outpatient treatment, leading to dehydration, electrolyte imbalance, or weight loss.

Question 20

What is the main symptom of gastroesophageal reflux disease (GERD)?

Answer 20

Heartburn (pyrosis), a burning sensation from the epigastric area towards the throat.

Question 21

What causes the retrosternal burning sensation in GERD?

Answer 21

Esophagitis caused by gastroesophageal reflux related to relaxation of the lower esophageal sphincter.

Question 22

What lifestyle modifications can help manage GERD?

Answer 22

Tobacco and alcohol abstinence, small meals, head-of-bed elevation, and avoidance of postprandial recumbency.

Question 23

What is the first-line therapy for GERD?

Answer 23

Oral antacids.

Question 24

What medications are used for severe GERD symptoms?

Answer 24

Sucralfate (Carafate) + proton-pump inhibitor or H2-receptor antagonist.

Question 25

What is the recommended dosage for sucralfate in GERD?

Answer 25

1-g sucralfate tablet taken orally 1 hour before meals and at bedtime for up to 8 weeks.

Question 26

Why should antacids not be taken within 30 minutes before or after sucralfate doses?

Answer 26

It can interfere with sucralfate’s protective action.

Question 27

When should endoscopy be considered in GERD?

Answer 27

If symptoms persist despite medical therapy.

Question 28

What are the possible complications of GERD?

Answer 28

Esophagitis, stricture, Barrett esophagus, and adenocarcinoma.

Question 29

What is a diaphragmatic hernia?

Answer 29

Herniation of abdominal contents through the foramen of Bochdalek or Morgagni.

Question 30

Which structure is involved in a diaphragmatic hernia?

Answer 30

The esophageal hiatus in the diaphragm.

Question 31

What is the maternal mortality rate of diaphragmatic hernia in pregnancy?

Answer 31

Approximately 45%, making it a surgical emergency.

Question 32

What is a rare cause of spontaneous diaphragmatic rupture in pregnancy?

Answer 32

Increased intra-abdominal pressure during vaginal delivery.

Question 33

What is achalasia?

Answer 33

A rare motility disorder in which the lower esophageal sphincter does not relax properly with swallowing.

Question 34

What causes achalasia?

Answer 34

Inflammatory destruction of the myenteric (Auerbach) plexus within the smooth muscle of the lower esophagus.

Question 35

What are the symptoms of achalasia?

Answer 35

Dysphagia, chest pain, and regurgitation.

Question 36

What radiographic finding is seen in achalasia?

Answer 36

Bird-beak or ace of spades narrowing at the distal esophagus on barium swallow.

Question 37

What test is confirmatory for achalasia?

Answer 37

Manometry.

Question 38

What is the surgical treatment for achalasia?

Answer 38

Myotomy (excision of smooth muscle of the lower esophagus).

Question 39

What medical treatments are used for achalasia?

Answer 39

Soft diet, anticholinergics, nitrates, calcium-channel antagonists, botulinum toxin A.

Question 40

What is peptic ulcer disease (PUD)?

Answer 40

Erosive ulcer disease involving the stomach and duodenum.

Question 41

What are the main causes of peptic ulcer disease?

Answer 41

H. pylori infection and NSAID use.

Question 42

Why is peptic ulcer disease uncommon in pregnancy?

Answer 42

Physiological changes in pregnancy include reduced gastric acid secretion, decreased motility, and increased mucus secretion.

Question 43

What is the first-line therapy for peptic ulcer disease?

Answer 43

H2-receptor blockers or proton-pump inhibitors.

Question 44

What is the role of sucralfate in peptic ulcer disease?

Answer 44

Provides a protective coating at the ulcer base and inhibits pepsin.

Question 45

What is the diagnostic approach for H. pylori in pregnancy?

Answer 45

Urea breath test, serological testing, or endoscopic biopsy.

Question 46

What is the treatment for H. pylori-positive ulcers?

Answer 46

Multidrug therapy with amoxicillin, clarithromycin, metronidazole, and a proton-pump inhibitor.

Question 47

What is the most common cause of upper GI bleeding in pregnancy?

Answer 47

Mallory-Weiss tears (small linear mucosal tears near the gastroesophageal junction).

Question 48

What is the initial management of upper GI bleeding?

Answer 48

Iced-saline irrigations, topical antacids, and IV H2-blockers or proton pump inhibitors.

Question 49

When is endoscopy indicated for upper GI bleeding?

Answer 49

If bleeding persists despite conservative management.

Question 50

What is Boerhaave syndrome?

Answer 50

Esophageal rupture due to greatly increased esophageal pressure, often secondary to forceful belching.

Question 51

How is diarrhea classified based on duration?

Answer 51

Acute (<2 weeks), Persistent (2-4 weeks), Chronic (>4 weeks).

Question 52

What is the most common cause of acute diarrhea?

Answer 52

Infectious agents, often foodborne pathogens.

Question 53

What are indications for evaluating acute diarrhea?

Answer 53

Profuse watery diarrhea with dehydration, grossly bloody stools, fever >38°C, duration >48 hours without improvement, recent antibiotic use, or immunocompromised status.

Question 54

What is the first-line treatment for mild acute diarrhea?

Answer 54

Oral rehydration therapy.

Question 55

When should a patient with diarrhea be hospitalized?

Answer 55

If moderate dehydration is present or if symptoms do not improve after 3-4 hours of observation.

Question 56

What is the most important risk factor for Clostridium difficile infection?

Answer 56

Antibiotic use, especially aminopenicillins, clindamycin, cephalosporins, and fluoroquinolones.

Question 57

What are other risk factors for Clostridium difficile infection?

Answer 57

Inflammatory bowel disease, immunosuppression, advanced age, and gastrointestinal surgery.

Question 58

What is the diagnostic test for Clostridium difficile?

Answer 58

Enzyme immunoassay for toxins in stool or DNA-based tests for toxin genes.

Question 59

What is the first-line treatment for Clostridium difficile infection?

Answer 59

Oral vancomycin or metronidazole.

Question 60

What is the mainstay of treatment for diarrhea in pregnancy?

Answer 60

IV hydration with normal saline or lactated Ringer’s with potassium supplementation.

Question 61

When is empirical antibiotic treatment recommended for diarrhea?

Answer 61

For moderately severe diarrhea with fecal leukocytes or gross blood.

Question 62

What antibiotics are used for Salmonella spp.?

Answer 62

Ciprofloxacin or trimethoprim-sulfamethoxazole.

Question 63

What antibiotic is used for Campylobacter spp.?

Answer 63

Azithromycin.

Question 64

What antibiotics are used for Clostridium difficile?

Answer 64

Oral metronidazole or vancomycin.

Question 65

What antibiotics are used for Giardia spp. and Entamoeba histolytica?

Answer 65

Metronidazole.

Question 66

When can loperamide be used for diarrhea?

Answer 66

For non-febrile, non-bloody diarrhea.

Question 67

What is the role of Bismuth subsalicylate (Pepto-Bismol) in diarrhea?

Answer 67

It may alleviate symptoms.

Question 68

What are the two main forms of Inflammatory Bowel Disease (IBD)?

Answer 68

Ulcerative colitis and Crohn's disease.

Question 69

What is the presumed cause of inflammation in IBD?

Answer 69

Dysregulated mucosal immune function in response to commensal microbiota, with or without an autoimmune component.

Question 70

What layer of the colon does ulcerative colitis affect?

Answer 70

The mucosal (superficial) layer.

Question 71

In what percentage of ulcerative colitis cases is the disease confined to the rectum and rectosigmoid?

Answer 71

0.4

Question 72

What are the major symptoms of ulcerative colitis?

Answer 72

Diarrhea, rectal bleeding, tenesmus, and abdominal cramps.

Question 73

What are two dangerous complications of ulcerative colitis?

Answer 73

Toxic megacolon and catastrophic hemorrhage.

Question 74

What extraintestinal manifestations are associated with ulcerative colitis?

Answer 74

Arthritis, uveitis, and erythema nodosum.

Question 75

What is the annual risk of colon cancer in ulcerative colitis?

Answer 75

1% per year.

Question 76

What is another name for Crohn’s disease?

Answer 76

Regional enteritis, Crohn ileitis, or granulomatous colitis.

Question 77

How does Crohn’s disease differ from ulcerative colitis in terms of bowel involvement?

Answer 77

Crohn’s disease affects the entire GI tract (mouth to anus) and involves deeper layers, often transmural.

Question 78

What are common symptoms of Crohn’s disease?

Answer 78

Right lower quadrant cramping abdominal pain, diarrhea, weight loss, low-grade fever, and obstructive symptoms.

Question 79

What are two common complications of Crohn’s disease?

Answer 79

Perianal fistulas and abscesses.

Question 80

Which form of IBD has a greater risk of gastrointestinal cancer?

Answer 80

Ulcerative colitis.

Question 81

What is the first-line drug for the treatment of ulcerative colitis?

Answer 81

5-Aminosalicylic acid (5-ASA) or mesalamine.

Question 82

Which drug inhibits prostaglandin synthesis in the colonic mucosa?

Answer 82

Sulfasalazine (Azulfidine).

Question 83

What class of drugs is used for moderate to severe ulcerative colitis unresponsive to 5-ASA?

Answer 83

Glucocorticoids (orally, parenterally, or by enema).

Question 84

What immunomodulating drugs are used for ulcerative colitis?

Answer 84

Azathioprine, 6-mercaptopurine, and cyclosporine.

Question 85

What are examples of TNF-alpha inhibitors used in IBD?

Answer 85

Infliximab (Remicade), Adalimumab (Humira), and Golimumab (Simponi).

Question 86

Why is folic acid supplementation recommended in ulcerative colitis treatment?

Answer 86

To counteract the antifolate effects of sulfasalazine and prevent neural tube defects.

Question 87

Does ulcerative colitis significantly alter pregnancy outcomes?

Answer 87

No, but disease activity at conception influences the course during pregnancy.

Question 88

How is intestinal obstruction diagnosed during pregnancy?

Answer 88

It is difficult to diagnose, but suspicion arises with a history of prior surgery, abdominal pain, and imaging.

Question 89

What is the most common cause of intestinal obstruction in pregnancy?

Answer 89

Compression of adhesions by the growing uterus.

Question 90

What is Ogilvie syndrome?

Answer 90

Acute colonic pseudo-obstruction causing massive abdominal distension.

Question 91

When does Ogilvie syndrome most commonly develop?

Answer 91

Postpartum, especially after cesarean delivery.

Question 92

What is the first-line treatment for Ogilvie syndrome?

Answer 92

Intravenous neostigmine (2 mg) for colonic decompression.

Question 93

What imaging modality is preferred for appendicitis diagnosis in pregnancy?

Answer 93

MRI (if available) due to high diagnostic accuracy and ability to rule out other conditions.

Question 94

What is the first-line surgical approach for appendicitis in early pregnancy?

Answer 94

Laparoscopy (in the first two trimesters).

Question 95

What antibiotic prophylaxis is given before appendectomy in pregnancy?

Answer 95

Second-generation cephalosporin or third-generation penicillin.

Question 96

How does appendicitis impact pregnancy outcomes?

Answer 96

Increases the risk of abortion or preterm labor, especially if peritonitis develops.