GI part III

Question 1

A volvus is….

Answer 1

Rotation of bowel looks around a fixed point. May be the cause of a SBO. Typically due to congenital abnormalities or adhesions.

Question 2

TX of SBO

Answer 2

• NG tube decompression

- If complete or strangulated: Surgery

Question 3

Most common site of Large Bowel Obstruction?

Answer 3

Sigmoid colon

Question 4

Dx of LBO

Answer 4

Abd X ray

Barium Enema

Question 5

What is Toxic Megacolon?

Answer 5

A rare life threatening form of Ulcerative Colitis

Question 6

SS of Toxic Megacolon?

Answer 6

Toxic colitis, fever, tachycardia, abd distention, signs of peritonitis

Question 7

Abd X ray shows what with Toxic Megacolon?

Answer 7

Dilated colon . 6 cm

Question 8

Patient presents with severe anal pain and bleeding with defecation, think…?

Answer 8

Anal fissure

Question 9

First line tx for anal fissure?

Answer 9

Fluid and Fiber
(stool softeners, bulking agents, and sitz baths)
may require Internal anal Sphincterotomy if conservative measures fail

Question 10

A patient wiht severe continuous throbbing anal pain that is worse with ambulation and straining and on exam you see a very tender palpable mass in the external perianal area, think of?

Answer 10

Anorectal Abscess/fistula

Question 11

Tx of Anorectal Abcess/Fistula

Answer 11

Surgical Drainage, may develop a fistula-in-ano

Question 12

What 2 things that an anal fissure off midline might suggest?

Answer 12

Crohn’s, Syphillis, HIV, Neoplasm

Question 13

Abcess in Sacrococcygeal cleft?

Answer 13

Pilonidal disease

Question 14

Zollinger-Ellison Syndrome is also known as a…?

Answer 14

Gastrinoma

Question 15

Diagnosis of Celiac Disease?

Answer 15

Endoscopic Bx

Question 16

Abdominal exam with pain out of proportion to exam, think?

Answer 16

Intestinal Ischemia

Question 17

Painless bright red blood per Rectum, you shoud think?

Answer 17

Hemorrhoids

Question 18

What is more painful? Internal or External Hemorrhoids?

Answer 18

External (Below dentate line) painful

Question 19

Dx of Hemorrhoids

Answer 19

Anoscopy

Question 20

male 15-40 presenting with small midline pits or abscesses near the midline of the coccyx or sacrum with a draining abcess think of?

Answer 20

Pilonidal disease

Question 21

Polyps most common in the….?

Answer 21

distal colon and rectum, dx with colonoscopy

they have neoplastic potential

Question 22

2 types of Hiatal hernias?

Answer 22

Paraesophageal and Sliding

Question 23

Sliding Hiatal Hernias are due to

Answer 23

decreased resting pressure in the LES

Question 24

Paraesophageal hiatal hernias are often asymptomatic but require?

Answer 24

Nissen Fundoplication

Question 25

Risk factors for a Ventral Hernia?

Answer 25

• Prior Abd surgery
• Poor surg technique
• wond infxh
• age
• obesity

Question 26

2 types of Inguinal Hernias?

Answer 26

1) Indirect

2) Direct

Question 27

Indirect hernias are typically?

Answer 27

2 to congenital hernias and typically present in the first year of life.

Question 28

What is more likely to pass into the scrotum, Direct or Indirect hernias?

Answer 28

• Indirect Hernia

Question 29

Indirect Inguinal Hernias?

Answer 29

Occur later in life, when increased intra-abdominal pressure and dilated internal inguinal ring allow abdominal contents to enter the cavity

Question 30

Direct Hernias?

Answer 30

2 to a result of weakness of the transversalis fascia in Hesselbach’s Triangle

Question 31

What is more likely to become incarcerated or strangulated, Direct or Indirect?

Answer 31

Indirect

Question 32

Hernia that appears as a symmetric, circular swelling at the external ring but dissapears when pt supine is…..

Answer 32

Direct Hernia

Question 33

Indirect hernias

Answer 33

Descends into the scrotum, elliptical swelling in inguinal ring that does not reduce easily

Question 34

Most common vessel blocked in Intestinal Ischemia?

Answer 34

Superior Mesenteric Artery

Question 35

2 viral organisms of Infx diarrhea?

Answer 35

Rotavirus and Norwalk

Question 36

Nausea, vomitting, abdominal pain, then diarrhea s/p 1-6 hours after eating Mayonnaise containing foods?

Answer 36

Staph Aureus–self limiting, supportive care

Question 37

Wattery diarrhea with epigastric pain 24 hours after eating canned foods—resolves in 24 hours?

Answer 37

Clostridium perfringens–self limiting

Question 38

Severe diarrhea and fluid loss after drinking bad water or seafood—-RICE water diarrhea?

Answer 38

Vibrio Cholerae: Abx–Doxycycline or TCN agents of choice

Question 39

Abd pain, fever, small volume bloody diarrhea associated with Poultry, Seafood, daycare centers?

Answer 39

Sigella species: Trimeth-Sulfa or Floroquinolones—lasts about 7 days

Question 40

High fever, diarrheak, abd pain s/p eating poultry, eggs, playing with reptiles?

Answer 40

Salmonella species: Third gen cephalo or fluoroquinolones

Question 41

Severe diarrhea, abd pain, N and V s/p eating undercooked beef (Burger etc)

Answer 41

E coli (0157:H7)

Question 42

Name a protozoal infectious diarrhea–bad water?

Answer 42

Entamoeba Histolytica: Treat with Metronidazole

Question 43

Prozoal water with animal vector like beaver–diarrhea with mucus but no blood?

Answer 43

Giardia Lamblia: Treat with Metronidazole

Question 44

Niacin or B3 deficiency?

Answer 44

Pellagra (flushing, hyperglycemia, liver damage)

Question 45

Beriberi is?

Answer 45

Thiamine (B1) deficiency: Lethargy, Ataxia

Question 46

PKA

Answer 46

Phenylketonuria: An inborn error of metabolism-autosomal recessive
If untreated, can cause severe mental retardation, hyperactivity, seizures, light complexion and eczema

Question 47

Positive Fecal Leukocyte indicates

Answer 47

Colonic inflammation: inflammatory diarrhea. Shigela, salmonella, D Diff, etc……