CPD Lower GI

Question 1

What test is performed to find a parasitic infection? How many times?

Answer 1

Ova and parasites (O & A), 3

Question 2

What test is used as a marker for fecal WBCs?

Answer 2

Fecal lactoferrin -differentiates be inflammatory and non-inflammatory causes

Question 3

What test is used as a marker for IBD?

Answer 3

Fecal lysozyme

Question 4

What are the four categories of diarrhea?

Answer 4

Osmotic, secretory, exudative, motility inc.

Question 5

What three types of pain can occur in the abdomen?

Answer 5

Visceral, parietal/somatic, referred

Question 6

What artery most commonly becomes occluded in acute mesenteric ischemia? And why?

Answer 6

Superior mesenteric.

Due to low cardiac output or occlusive dz of vascular supply (embolis)

Question 7

What are the four important qualities of an intestinal obstruction?

Answer 7

Complete or partial
Simple or strangulated
Location (sm, lg intestine)
Onset: acute or gradual

Question 8

What is the m/c cause of gastroenteritis?

Answer 8

INFECTIONS

Question 9

What is the difference in SSX between small intestine and colon obstruction?

Answer 9

sm. intestine: sudden onset, periumbilical pain

colon: gradual

Question 10

Most common cause of infectious diarrhea worldwide?

Answer 10

Rotavirus

Question 11

Which organisms commonly cause bacterial gastroenteritis using an exotoxin? What are the ssx?

Answer 11

S. aureus - severe vomiting 2-6hr after ingestion, explosive diarrhea, rarely fever

B. cereus - no fever, vomiting 2-6 hrs post-ingestion. OR diarrhea 8-16 hrs post-ingestion.

C. perfringens - watery diarrhea, foul-smelling, 8-16 hrs post-ingestion

C. botulinum - 4hr- 8 days after ingestion.
phase 1: fatigues, N/V abd cramps, diarrhea
phase 2: diplopia, decreased acuity, PERRLA defects, ptosis
phase 3: DESCENDING weakness, dysarthria, dysphagia,
65% mortality 2-9 days post-ingestion

Question 12

Which organisms commonly cause bacterial gastroenteritis using an endotoxin? What are the ssx?

Answer 12

Cholera - rice-water stools

E. coli - profuse watery diarrhea lasting 3-5 days, 1-3 days post-ingestion

C. difficile - watery diarrhea, crampy abdominal pain

Question 13

How is C. difficile most often contracted?

Answer 13

Nosocomial, after antibiotic therapy

Question 14

What is the worst complication of C. difficile? And what dx exam is contraindicated?

Answer 14

Toxic megacolon

Colonoscopy

Question 15

Which organisms commonly cause bacterial gastroenteritis by invading the mucosa? What are the ssx?

Answer 15

Salmonella - watery diarrhea (may have blood), malaise, N/V, abd. pain 6-48 hrs post-ingestion

Campylobacter jejuni - prodrome of h/a, myalgia, malaise for 12-24 hrs. Then abd pain, high fever, profuse watery then bloody diarrhea.

Shigella - starts in lower abdominal pain, diarrhea, 50% fever 1-3 days post-ingestion

E. coli 0157:H7 -watery diarrhea becoming blood in > 24hrs. Sx occur 16+ hrs post-ingestion.

Yersinia enterocolita -water or bloody diarrhea, fever, mimics appendicitis if infects ileum.

Question 16

What organism is the most common cause of bloody diarrhea in the U.S.?

Answer 16

Campylobacter jejuni

Question 17

What are two complication of a E. Coli 0157:H7 infection?

Answer 17

Hemolytic-uremic syndrome (HUS)

Thrombotic thrombocytopenic purpura (TTP)

Question 18

Which organisms commonly cause parasitic gastroenteritis? What are the ssx?

Answer 18

Giardia lamblia - mild watery diarrhea, abd. bloating, cramps, flatulence for 1-3 wks, stools bulky and foul-smelling. Sx 7 days after ingestion.

Cryptosporidium parvum - profuse watery diarrhea, anorexia, low-grade fever 5 days post ingestion.

Entamoeba histolytica - mild-crampy abd. pain, intermittenet diarrhea. If severe, bloody diarrhea tenesmus, fever, toxic megacolon

Question 19

In which population would you be more concerned about a C. parvum infection?

Answer 19

Immunocompromised- water diarrhea can cause severe dehydration.

Question 20

What four patterns are present in Crohn’s dz?

Answer 20

inflammation, obstruction, diffuse jejunoileitis, abd. fistulas/abscesses

Question 21

What are the two m/c complications of Crohn’s dz? What two are rare?

Answer 21

Intestinal obstruction and fistula/abscess formation.
(also increased risk for developing squamous cell carcinoma)

Perforation and hemorrhage RARE

Question 22

What would be seen on barium swallow for Crohn’s dz?

Answer 22

String sign (advanced), irregularity, nodularity, stiffness, thickening of terminal ileum, narrowed ileum lumen.

Question 23

What would be seen in colonoscopy of Crohn’s dz?

Answer 23

“skip areas,” cobblestone appearance, longitudinal ulcers, rectal sparing, narrowing, fistulas

Epithelial granulomas - pathognomonic

Question 24

What are the most common complications with ulcerative colitis?

Answer 24

Hemorrhage, toxic megacolon, colorectal cancer

Question 25

What are the red flag features for IBS?

Answer 25

``` Onset after 50yo Severe, unrelenting diarrhea Nocturnal sx Unintentional weight loss Hematochezia Family hx of IBD, celiac sprue, CA ```

Question 26

What is the Rome III criteria for diagnosing IBS?

Answer 26

abd pain or discomfort +3d/month for 3months, associated with at least 2 of the following: relieved by defacation onset assoc. w/ change in stool frequency onset assoc w/ change in stool form/appearance

Question 27

Ulcerative colitis vs. Crohn's dz

Answer 27

UC: cramping pain, lower abd, relieved by BM, bloody stool, no abd. mass, always involves rectum, mucosal, diffuse, continuous spread. Crohn's: constant pain, RLQ, not relieved by BM, usu no blood in stool, abd mass in RLQ, can affect any part of GI, transmural, granulomas, skip areas, fistulas/abscesses or obstruction

Question 28

Extraintestinal manifestations of Crohn's?

Answer 28

Cholelithiasis, renal oxalate stones, Vit B12 def, obstructive hydronephrosis, aphthous ulcers

Question 29

What is a "keynote" for SIBO?

Answer 29

transient improvement of sx w/ antibiotic tx, worsening when on pro/prebiotics, worsening when eating more fiber.

Question 30

What test is most often done for SIBO?

Answer 30

Hydrogen breath test (also Methane)

Question 31

What are general sx of malabsorption?

Answer 31

Chronic diarrhea, steatorrhea, abd. bloating, weight loss, amenorrhea

Question 32

What are ssx of diverticulitis?

Answer 32

Pain: LLQ, steady, severe, deep fever/chills previous episodes of dull, colicky, and diffuse pain with flatulence, distention, and change in bowel habits. Rectal bleeding: bright red or wine-colored stools.

Question 33

What are the complications of diverticulitis?

Answer 33

Perforation or fistula

Question 34

Congenital bulge in distal ileum, remnant of omphalomesenteric duct.

Answer 34

Meckel's diverticulum

Question 35

What is used to diagnose lactose intolerance?

Answer 35

Hydrogen breath test

Question 36

SSX of tropical sprue

Answer 36

1) acute phase: diarrhea w/ fever and malaise 2) chronic phase: diarrhea, nausea, anorexia, steatorrhea, parasthesia SX of vitamin deficiency: glossitis, stomatitis, cheilosis, cutaneous hyperpigmentation, dry rough skin, abd. distension, tenderness and edema, weight loss

Question 37

What is the difference between non-celiac gluten intolerance and celiac's dz?

Answer 37

Look similar w/p villous atrophy Neg IgA tTG Ab Neg biopsy Pos gliadin Ab Total IgA normal

Question 38

What is the best test to determine the presence of celiac's dz?

Answer 38

Serology! 1) Total IgA 2) IgA anti-endomysial Ab 3) IgA anti-tissue transglutaminase Ab 3) Deamidated gliadin peptide IgA or IgG.

Question 39

What is Whipple's disease?

Answer 39

rare, systemic infection by Tropheryma whipplei. SSX: diarrhea, weight loss, arthralgia, fever, and malabsorption

Question 40

What are some risk factors for celiac's dz?

Answer 40

Heredity, early intro to gluten, absent breastfeeding, crohn's dz, type 1 DM, down syndrome, chronic fatigue syndrome, AI thyroid dz. viral exposure, adenovirus 12