Rapid Review: Gastrointestinal

Question 1

A patient presents with sudden onsent of severe, diffuse abdominal pain. Examination reveals peritoneal signs, and AXR reveals free air under the diaphragm. Management?

Answer 1

Emergent laparotomy to repair a perforated viscus

Question 2

The most likely cause of acute lower GI bleed in patients >40 years of age

Answer 2

Diverticulosis

Question 3

Diagnostic modality used when ultrasound is equivocal for cholecystitis

Answer 3

HIDA scan

Question 4

Risk factors for cholelithiasis

Answer 4

Fat, female, fertile, forty, flatulent

Question 5

Inspiratory arrest during palpation of the RUQ

Answer 5

Murphy’s sign, seen in acute cholecystitis

Question 6

The most common cause of SBO in patients who no history of abdominal surgery

Answer 6

Hernia

Question 7

The most common cause of SBO in patients with a history of abdominal surgery

Answer 7

Adhesions

Question 8

Identify key organisms causing diarrhea:

1. Most common
2. Recent antibiotic use
3. Camping
4. Traveler’s
5. Church picnics/mayonnaise
6. Uncooked hamburgers
7. Fried rice
8. Poultry/eggs
9. Raw seafood
10. AIDS
11. Pseudoappendicitis

Answer 8

1. Campylobacter
2. Clostridium difficle
3. Giardia
4. ETEC
5. Staph aureus
6. E coli O157:H7
7. Bacillus cereus
8. Salmonella
9. Vibrio, HAV
10. Isospora, Cryptosporidium, Mycobacterium avium complex (MAC)
11. Yersinia

Question 9

A 25 year old Jewish man presents with pain and watery diarrhea after meals. Examination shows fistulas between the bowel and skin and nodular lesions on his tibias

Answer 9

Crohn’s disease

Question 10

Inflammatory disease of the colon with an increased risk of colon cancer

Answer 10

Ulcerative colitis (greater risk than Crohn’s)

Question 11

Extraintestinal manifestations of IBD

Answer 11

Uveitis, ankylosing spondylitis, pyoderma gangrenosum, erythema nodosum, primary sclerosing cholangitis

Question 12

Medical treatment for IBD

Answer 12

5-ASA agents and steroids during acute exacerbations

Question 13

Difference between Mallory-Weiss and Boerhaave tears

Answer 13

Mallory-Weiss: superficial tear in the esophageal mucosa

Boerhaave: Full-thickness esophageal rupture

Question 14

Charcot’s triad

Answer 14

RUQ pain, jaundice, and fever/chills–signs of ascending cholangitis

Question 15

Reynolds’ Pentad

Answer 15

Charcot’s triad plus shock and mental status changes—signs of suppurative ascending cholangitis

Question 16

Medical treatment for hepatic encephalopathy

Answer 16

Decreased protein intake, lactulose, rifaximin

Question 17

The first step in the management of a patient with an acute GI bleed

Answer 17

ABCs

Question 18

A 4 year old child presents with oliguria, petechiae, and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause?

Answer 18

Hemolytic uremic syndrome due to E coli O157:H7

Question 19

Post-HBV exposure treatment

Answer 19

HBV immunoglubulin

Question 20

Classic causes of drug induced hepatitis

Answer 20

TB medications, acetaminophen, and tetracycline

Question 21

A 40 year old obese woman with elevated alkaline phosphatase, elevated bilirubin, pruritus, dark urine, and clay colored stools

Answer 21

Biliary tract obstruction

Question 22

Hernia with highest risk of incarceration?

Answer 22

Femoral

Question 23

A 50 year old man with a history of alcohol abuse presents with boring epigastric pain that radiates to the back and is relieved by sitting forward. Management?

Answer 23

Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make the patient NPO and give IV fluids, O2, analgesia, and “tincture of time”