GI #4

Question 1

MCC of acute pancreatitis

Answer 1

Gallstones and alcohol abuse

Question 2

Symptoms of pancreatitis

Answer 2

• Epigastric pain: constant, boring and radiates to the back
• Exacerbated if supine, relieved with leaning forward
• N/V, fever
• Epigastric tenderness
• Cullen’s Sign (periumbilical ecchymosis)
• Grey Turner Sign (flank ecchymosis)

Question 3

Labs for acute pancreatitis

Answer 3

• Increased amylase and lipase (initial)
• ALT elevated is highly suggestive of gallstone
• Hypocalcemia

Question 4

Diagnostics for acute pancreatitis

Answer 4

• Abdominal CT (imaging of choice)

- Abdominal radiograph: Sentinel loop, localized ileus of segment of small bowel

Question 5

Treatment for acute pancreatitis

Answer 5

• Supportive: NPO, high IV fluid resuscitation, Analgesia

- ABX not routinely used

Question 6

Symptoms of Pancreatic Carcinoma

Answer 6

• Painless jaundice
• Courvosier’s Sign: palpable, nontender gallbladder
• Pruritus
• Dark urine
• Weight loss

Question 7

Diagnostic for Pancreatic Carcinoma

Answer 7

CT scan (initial)
-If negative endoscopic US with biopsy

Question 8

70% of pancreatic carcinoma are found where

Answer 8

In head of Pancreas

-Adenocarcinoma MC

Question 9

Tumor marker for pancreatic carcinoma

Answer 9

CA 19-9

Question 10

Treatment for Pancreatic Carcinoma

Answer 10

Whipple Procedure. Post op Chemo or Radiotherapy

Question 11

Diagnostic for volvulus

Answer 11

Abdominal CT: bird beak appearance at site of volvulus

Question 12

Treatment for Volvulus

Answer 12

• Endoscopic decompression (proctosigmoidoscopy)

- Decompression followed by elective surgery due to high rate of recurrence

Question 13

MC etiology of small bowel obstruction

Answer 13

Post-surgical adhesions

Question 14

4 hallmark symptoms of small bowel obstruction (CAVO)

Answer 14

Crampy abdominal pain
Abdominal distention
Vomiting
Obstipation (no flatus)

Question 15

Abdominal radiographs for a small bowel obstruction show

Answer 15

Multiple air-fluid levels in a step ladder appearance, dilated bowel loops

Question 16

A CT scan for a small bowel obstruction is better because it shows

Answer 16

Transition zone from dilated loops of bowel with contrast to an area of no contrast

Question 17

Treatment for small bowel obstruction

Answer 17

• NPO, IVF

- Bowel decompression

Question 18

Symptoms of Intussusception

Answer 18

Vomiting + Abdominal pain + Passage of blood per rectum (currant jelly stools)

-Sausage shaped mass in RUQ and emptiness in RLQ (Dance’s Sign)

Question 19

Diagnostics for intussusception

Answer 19

• US (initial)

- Air or contrast enema (both diagnostic and therapeutic)

Question 20

Treatment for intussusception

Answer 20

• Fluid and electrolyte replacement
• Pneumatic or hydrostatic decompression
• Admit for observation

Question 21

Pathophysiology of Hirschsprung Disease

Answer 21

-Congenital megacolon due to absence of ganglion cells, leading to a functional obstruction

Question 22

Definitive diagnostic for Hirschsprung Disease

Answer 22

-Rectal biopsy

Question 23

Symptoms of Hirschsprung Disease

Answer 23

• Meconium Ileus
• Bilious vomiting
• Abdominal distention
• Failure to thrive

Question 24

Three factors of pathophysiology of IBS

Answer 24

• Abnormal motility: chemical imbalance in intestine
• Visceral hypersensitivity: lowered pain threshold to abdominal distention
• Psychosocial interactions: altered CNS processing

Question 25

Diagnostic imaging of choice for appendicitis

Answer 25

CT scan

Question 26

What labs are positive in primary biliary cirrhosis?

Answer 26

• Increased alkaline phosphatase and GGT

- Antimitochondrial antibody

Question 27

What diagnostic is the gold standard to diagnose primary biliary cirrhosis?

Answer 27

Liver biopsy

Question 28

What exactly is primary biliary cirrhosis?

Answer 28

-Idiopathic autoimmune disorder of intrahepatic small bile ducts that leads to decreased bile salt excretion, Cirrhosis, and end stage liver disease in women 30-60 years old

Question 29

Long-term use of PPI should be supplemented with what vitamin?

Answer 29

B12