Miscellaneous GI disorders

Question 1

Irritable Bowel Syndrome

Answer 1

Chronic and relapsing abdominal pain, bloating, and changes in bowel habits including diarrhea and constipation

This is a syndrome not a disease
The pathogenesis is poorly understood, Psychologic stress, diet, abnormal GIT mtility, visceral Hypersensitivity

20s- 40s, significant female predominance, developed countries, post infectious IBS

Normal labs

Question 2

Rome 4 criteria

Answer 2

related to defactaion etc

Question 3

Diverticular disease

Answer 3

aka pseudodiverticular outpoutchings of the colonic muscularis propria and submucosa (not muscularis)

Unique structures of the colonic muscularis propria
Nerves and arterial vasa recta penetrate the inner circular muscle coat to create discontinuities in the muscle wall

Rare in young, prevalence approaches 50% in western adult populations beyond the age of 60

Dev under conditions elevated intraluminal pressure in the sigmoid colon
Can be exacerbated by low fiber diet which reduce stool bulk

Can lead to inflammation–> diverticulitis–> perforation–> obvi bad

Asymptomatic– crampbin, resolve

Question 4

acute appeendicitis

Answer 4

most common, males> fem, 50% to 80% is luminal obstruction, ischemic injury and stasis

Mcburneys point where it come into appendix

Question 5

Ischemic colitis

Answer 5

Ranges from mucosal infarct to transmural infarction
Mucosal infarction from hypoperfusion (Hypotension, and arterial spasm) Transmural infarction from arterial occlusion

comon water shed zone, usually self limited,

sudden sever pain

Question 6

Small intestinal bacterial overgrowth

Answer 6

small intestine is usually sterile compared to the colon

Protected by gastric acid and ICV at either end as well as relatively fast transit of contents

Disruption of any of these mechanisms leads to increased bacterial contact with unabsorbed carbs, Surgery, antacid, slow motility

Difficult to diagnose, duodenal aspirate, hydrogen breath test- duodenal aspirate, H breath test