What is the most common location for a large bowel obstruction?
What would be the expected findings on KUB in a patient with a mechanical obstruction?
Dilated loops of bowel with air fluid levels and little or no gas in the colon
What is the most common cause of mechanical obstruction in a patient with history of abdominal surgery?
A patient undergoes a barium study of the colon and an “Apple core” lesion is found. What do you suspect?
What is the most common type of colon cancer?
A 17 year old presents with abdominal pain, bloating, flatulence, and diarrhea after ingesting dairy. What is the test used to make the diagnosis?
Lactase breath hydrogen test
what lab antibodies would likely be positive in a patient with Celiac sprue?
+anti endomysial antibodies
Celiac sprue is an abnormal immune response to what food product?
What finding on abdominal X-ray is suggestive of acute mesenteric ischemia?
Thumb-printing of small bowel or right colon due to submucosal bleeding (Thumb printing may also be seen with toxic megacolon)
What is the gold standard for diagnosis of mesenteric ischemia?
A diabetic presents with abdominal pain that begins one hour after eating and resolves a few hours later. What is your suspected diagnosis?
Chronic mesenteric ischemia
A 55 year old male presents with acute abdominal pain. He is in atrial fibrillation and has a relatively benign exam. What is your diagnosis?
What antibodies will be found positive in Crohn’s disease?
+ anti-saccharomyces cerevisiae antibodies (ASCA)
What antibodies will be found positive with ulcerative colitis?
+ anti-neutrophil cytoplasmic antibodies (pANCA)
Patient presents with alternating diarrhea and then constipation. A complete workup and physical exam are normal. What do you suspect?
Irritable bowel syndrome
What are the three major complications of ulcerative colitis?
Primary Sclerosing Cholangitis
Crohn’s disease affects what part of the GI tract?
Mouth to anus
Which type of diverticular problem generally is painless bleeding?
A patient having less than two bowel movements per week is defined as having what?
Which type of laxative is first in the line of treatment after lifestyle changes and adequate fiber?
Osmotic Laxatives - These laxatives include milk of magnesia, magnesium citrate, sorbitol, polyethylene glycol, and lactulose
What is the test of choice to diagnose appendicitis in an adult?
What is the test of choice to diagnose appendicitis in a child?
What is Iliopsoas sign?
RLQ pain with R hip extension
What is Obturator sign?
RLQ pain upon flexion and internal rotation of RLE
What is Rovsing’s sign?
RLQ pain upon palpation of LLQ
What is McBurney’s sign?
Pain upon palpation of the RLQ
What tumor marker is elevated in pancreatic cancer?
What is the most common cause of painless rectal bleeding in pediatric population?
What are the three borders of Hesselbach’s triangle?
Medial border: rectus abdominus
Superior border: inferior epigastric artery
Lateral border: inguinal ligament
What is intestinal pseudo-obstruction without evidence of mechanical cause called?
List the 6 “rule of 2” characteristics of Meckel’s diverticulum.
2% of population - 2 feet proximal to ileocecal valve - 2 inches long - 2 years old - 2:1 M:F ratio - 2 tissues: gastric & pancreatic
Which disorder commonly has cobblestoning or skip lesions on imaging?
What test is used to diagnose lactase deficiency?
Lactose breath hydrogen test
What disorder is colon dilation air fluid levels and thumbprinting sign on imaging suggestive of?
Toxic megacolon (Thumbprinting may also occur with mesenteric ischemia)
What is the Dx? Acute abdominal pain. KUB shows dilated loops of bowel with air fluid levels.
small bowel obstruction
At what age should routine colonoscopy screening begin for men and women?
Most common type of colon cancer?
What is the DX? 65-year-old male 3 months of recent weight loss poor appetite new constipation and anemia.
think colon cancer
Celiac sprue intestinal biopsy findings?
Good test for malabsorption?
Fecal fat testing
chronic mesenteric ischemia
What is the Dx? 60-year-old male smoker complains of recurrent dull abdominal cramps/pain within 1 hour of eating meals.
chronic mesenteric ischemia
What is severe abdominal pain out of proportion to physical exam findings suggestive of?
acute mesenteric ischemia
Acute thrombosis or embolism of the celiac or mesenteric arteries?
acute mesenteric ischemia
Name the criteria used to diagnose Irritable bowel syndrome.
Rome criteria: Pain relieved with defecation Change in frequency and form Altered stool passage Passage of mucus
Irritable bowel disease that may affect the entire GI tract from mouth to anus?
What are the extraintestinal manifestations that can be seen in ulcerative colitis patients?
Pyoderma gangrenosum Arthritis Ankylosing spondylitis Erythema nodosum Uveitis
Inflammatory bowel disease that only affects the large intestines?
Inflammatory bowel disease that often presents with bloody diarrhea?
What is the Dx? Newborn with double bubble sign on abdominal X-ray.
List 3 antibiotic regimens which can be used for diverticulitis?
Quinolone with metronidazole
Treatment for acute diverticulitis?
Initial: NPO/IV fluids antibiotics - May require surgery if perforation or abscess
+anti-tissue transglutaminase +anti gliadin and +anti endomysial antibodies are suggestive of what disorder?
What cardiac disorders are acute mesenteric ischemia associated with?
AFib, CHF, MI
Sign seen with appendicitis with pain over the right lower quadrant one-third of the distance from the ASIS to the umbilicus?
Medications to treat gastroparesis?
A sausage shaped mass and currant jelly stool are consistent with what diagnosis?
A newborn with bilious vomiting and a non-distended abdomen is found to have a double bubble sign on KUB. What is your diagnosis?
What exam finding would be possibly seen on radiologic work up for child with pyloric stenosis?
US for identification shows a Double-track - Follow up barium studies show String sign and Shoulder sign
Use of what antibiotic is associated with increased risk of pyloric stenosis?
Clarithromycin (Note: erythromycin is also associated)
A baby presents with vomiting and abdominal exam reveals an olive like mass in the RUQ. What do you suspect?
Both mesenteric ischemia and toxic megacolon may have a thumb printing sign on imaging. What differentiates the two on physical exam?
Mesenteric ischemia has a soft abdomen - Toxic megacolon as rigid abdomen