GI 4

Question 0

Acute mesenteric ischemia Ssxs

Answer 0

Severe ab pain that doesn’t match with PE findings
(sudden= arterial, gradual =venous)

*suspect if >50 yrs with risk factors and sudden, severe pain.

Imaging: mesenteric angiography, ab CT

Question 1

Acute mesenteric ischemia etiology

Answer 1

1) low CO: CHF or shock or drugs

2) occlusive diseases: thrombosis or embolism (CAD, atrial fibrillation, hypercoaguability, portal HTN)

Question 2

Potential complications from ab surgery

Answer 2

Intestinal obstruction (birds beak, volvulus)
Ileus (temporary arrest of peristalsis)

Question 3

What can cause a true intestinal perforation/peritonitis/an emergency?

Answer 3

Duodenal ulcer, acute appendicitis, obstruction, toxic megacolon

Question 4

Work up for gastroenteritis

Answer 4

If N/V, borborygmus, diarrhea, distended abdomen…do:

Hemoccult, fecal WBCs, O&P, culture, CBC, CMP

Question 5

Viral gastroenteritis organisms

Answer 5

Rotavirus, norovirus, astrovirus, enteric adenovirus

Question 6

Bacterial gastroenteritis organisms w exotoxins:

Answer 6

Can cause “true food poisoning”, rapid onset N/V/D

Staph aureus, bacillus cereus, clos perfringens, clos botulinum

Question 7

Bacterial gastroenteritis w enterotoxins

Answer 7

Toxins impair absorption –> watery diarrhea

Vibrio (cholera and non cholera), Escherichia coli, Clos difficile

Question 8

Clostridium difficile

Answer 8

Get post antis (nosocomial) or external source
Cytotoxin and enterotoxin –> pseudomembranous colitis
Sxs: watery diarrhea, cramping, (rare N/V)

**complication= TOXIC MEGACOLON.

Question 9

Toxic megacolon Sxs

Answer 9

Fever, ab pain, tachycardia

PE: tender ab, absent bowel sounds, elevated WBCs

Question 10

Causes of TOXIC MEGACOLON

Answer 10

Chrons, ulcerative colitis, E. Histolytica, Yersinia

Question 11

DDX watery diarrhea

Answer 11

Vibrio cholera, E. Coli, C. Difficile

Question 12

Enterohemorrhagic E. coli

Answer 12

Sxs: watery diarrhea that –> bloody

**complications: hemolytic uremic syndrome (hemolytic anemia, thrombocytopenia, acute renal failure) and thrombotic thrombocytopenic purpura (HUS, fever, neurological deficits)

Question 13

Chrons

Answer 13

Skip lesions/cobblestones
imaging: string sign
Complication: obstruction, fistula, squamous cell carcinoma
Pain: steady, esp RLQ
Mass: yes, RLQ
Transmural, non contiguous

Question 14

Ulcerative colitis

Answer 14

Rectum and or colon
Continuous area
Pain: cramping, transient, relieved w BM
Stool: blood
Imaging: lead pipe
Involves mucosa only 
Complication: TOXIC MEGACOLON, adenocarcinoma

Question 15

SIBO

Answer 15

Organisms: strep, bacteriodes, Escherichia, lactobacillus, clostridium, klebsiella
Hx: improvement post antibiotic, worsening w probiotics, worsening w fiber
Work up: glucose breath hydrogen analysis, methane breath test

Question 16

Diverticulitis

Answer 16

Sxs: LLQ pain (most commonly in sigmoid), rectal bleeding/wine colored stool, diarrhea w constipation

**Complication: if perforation/fistula: UTI, feculent vaginal discharge, generalized abdominal pain, low back pain

Question 17

Diverticulitis DDX

Answer 17

Hemorrhoid, anal fissures, UTI, nephrolithiasis, obstruction, colon cancer, IBD

Question 18

Celiac…malabsorption syndrome

Answer 18

Auto immune. Envl trigger: gluten; autoantigen: tissue transglutaminase

Question 19

Celiac Ssxs

Answer 19

Diarrhea, steatorrhea, bloating, vit/mineral def, dermatitis herpetoformis, osteopathy, aphthous ulcers

Question 20

Celiac tests

Answer 20

Serum IgA EMA

Serum IgA anti tissue transglutaminase antibodies (more sp, more sensitive)

Question 21

Celiac confirmatory procedure

Answer 21

Biopsy of small bowel when pt eating gluten for 2-4+ weeks…see villous atrophy

Question 22

Negative Celia, positive gluten intolerance

Answer 22

Negative IgA tTG antibody
Biopsy negative
Positive gliadin antibody
IgA normal