GI-CASEs Flashcards
- A 40 yo female c/o severe RUQ pain after eating fatty meals intermittently over the past several weeks. On exam she has a soft, obese abdomen with active bowel sounds, negative Murphy’s sign, tender to deep palpation in the RUQ, no HSM or jaundice; her exam is otherwise unremarkable. What diagnostic study should you order to make the diagnosis?
· Abdominal US is the diagnostic study of choice for evaluating biliary colic and diagnosis of cholelithiasis
- A 36 yo female had a baby 6 months ago and reports that she sometimes has blood in her stool. The blood is bright red on the toilet paper, not in the toilet bowl. On examination you do not find any anal fissure, active bleeding or prolapsing hemorrhoids; guaiac is positive. What is the most likely diagnosis?
· Hemorrhoids
- A 60 yo male c/o pain in the middle of his chest, worse at night, for the past few months; it is getting worse. He has tried Tums, which helped initially but no longer help. He eats dinner late and has a few beers after dinner while he watches TV in his recliner. He notes a sour taste in his mouth lately. On exam he has a BMI of 29 and mild epigastric tenderness on deep palpation. What is the pathophysiology of his problem?
· Gastric acid refluxing from the stomach into the esophagus from relaxation/hypotension of the lower esophageal sphincter; may be associated with hiatal hernia
- What is the appropriate management of the above patient?
· PPI or H2 blockers for GERD; lifestyle modifications including decreased alcohol, eating dinner earlier, remain upright after eating, less fatty foods, weight loss
- A 27 yo male comes in for a routine physical exam; he has no complaints, no PMH, no meds, no significant FH; VSS, PE is unremarkable. His labs are normal except a mildly elevated total bilirubin. What is the most likely cause of elevated bilirubin?
· Gilbert’s syndrome
- A 65 yo male presents for his “welcome to Medicare” physical. He heard about recent recommendations for hepatitis testing in his generation. He denies past or present IVDU, he has been in a monogamous marriage for 43 years, he never served in the military or lived abroad, and has been an accountant for 40 years. What do you recommend for hepatitis testing?
· Screening for hepatitis C (with anti-Hep C IgG) is recommended based on his age; hepatitis B risk factors are not present
- The above patient tests positive for the Hep C antibody. What is the next step in his management?
· HCV RNA to determine viral load; refer patient to GI/Hepatologist for genotype, abdominal US, possibly liver biopsy, to determine if treatment is indicated.
- A 34 yo female c/o intermittent diarrhea and constipation, bloating and gas for several months, maybe longer. Her symptoms do not seem related to foods, milk, but may be worse with stress; she has no travel history. No weight loss, blood/mucous in stool, recent antibiotic use. You order labs, including CBC, CMP, TTG, stool culture; all results are normal. What is the most likely diagnosis?
· Irritable bowel syndrome
- A 52 yo male c/o abdominal pain and bloody diarrhea x 2 days; he reports low grade fever, no nausea/vomiting. He had an episode like this a few years ago. No recent travel, antibiotics. On exam he has a tender LLQ, no peritoneal signs, guaiac positive, otherwise unremarkable. What is the best treatment for his current complaint?
· Ciprofloxacin + metronidazole for acute diverticulitis
- A 72 yo alcoholic c/o severe, constant epigastric pain radiating straight through to the back x 1 day. Labs indicate elevated amylase and lipase. What is the pathophysiology of this problem?
· The pathogenesis of chronic pancreatitis appears to be multifactorial, and is probably initiated by two distinct events. The first is a decrease in bicarbonate secretion, due to either functional impairment caused by genetic abnormalities of the ductal cells, or mechanical obstruction such as strictures or tumors. The second involves intraparenchymal activation of digestive enzymes within the pancreatic gland. This may be due to genetic abnormalities (such as those seen in hereditary pancreatitis) that directly cause impairment in enzyme activation and regulation or predispose to toxic injury from environmental exposures, such as alcohol.
- A 38 yo female c/o severe RUQ pain x 5 days; it was intermittent and worse after meals but it is constant x 1 day, associated with nausea/vomiting. On exam she has a low grade fever, tenderness in the RUQ with a positive Murphy’s sign, no jaundice or peritoneal signs. What is the most likely diagnosis?
· Acute cholecystitis
- A 24 yo male c/o abdominal pain, fever, nausea and vomiting x 4 days. He was on a kayaking trip in Mexico about a month ago. No medications or PMH. VSS; PE indicates a WDWN, mildly dehydrated male who appears moderately ill but not toxic, skin appears jaundiced, sclera anicteric, abdomen diffusely tender with marked tenderness in the RUQ and mild hepatomegaly, no peritoneal signs, no splenomegaly, negative Murphy’s sign. His AST/ALT are markedly elevated, with the ALT significantly higher. What is the most likely diagnosis?
· Acute hepatitis A
- A 28 yo female with h/o Crohn’s disease presents with acute abdominal pain and diarrhea x 3 days. She admits to dietary indiscretion and stress recently. She is not taking any medications currently. What is the best management of her today?
· Restart sulfasalazine, manage symptoms with anti-diarrheal, have patient follow up with her GI doctor
- What is the pathophysiology of this condition?
· Transmural inflammation and thickened wall of the entire GI tract, often occurring in “skips”
- A 44 yo male with chronic hepatitis B comes in for a routine visit; he had labs done last week and wants to discuss the results. He is HBeAg positive; His AST/ALT are stable, mildly elevated; HBV DNA low. What is the management plan of this patient?
· Monitor LFT’s, HBeAg every 3-6 months; refer to GI if ALT becomes significantly elevated
