Gastroenterology

Question 1

Normal Flora (esophagus & stomach)

Answer 1

surviving bacteria from food

Question 2

Normal Flora (small intestine)

Answer 2

lactobacillus, enterococcus (E.Coli)

Question 3

Normal Flora (large intestine)

Answer 3

E. Coli
Clostridium, Bacteroides
Candida

Question 4

Gastritis

Answer 4

Bacterial: H pylori
Hx: Dyspepsia, abdominal pain
PE: Diffuse tenderness
Tx: Eradicate, treat cause

Question 5

Peptic Ulcer Disease

Answer 5

Bacterial: H. Pylori
Disruption of mucosa
Tx: eradicate, abx & ppi

Question 6

acute cholecystitis

Answer 6

Bacterial: enterobacteriaceae
*bile duct obstruction
Hx: RUQ pn, F/C/N/V
Test: WBC
TX: anagesics, IV abx, surgery

Question 7

hepatitis

Answer 7

Viral: hepatitis A, B, C; mono 
	○ Hepatitis A/E are fecal-oral
	○ B,C,D parenterally or mucous membrane
Toxins: alcohol
Hx: Fatigue, malaise
PE: Jaundice
Tests: Serology
Tx: Acute viral hep A supportive

Question 8

hepatic abscess

Answer 8

Bacterial: Enterobacteriaceae
*biliary tract source
Hx: nonspecific
PE: normal --> jaudice, RUQ pn, fever
Tx: IV abx, admin

Question 9

acute pancreatitis

Answer 9

viral, bacterial, fungal
*biliary tract disease
*eoth
Hx: diffuse upper abd pn --> back/flank, F/N/V
Tx: IV abx, admin

Question 10

appendicitis

Answer 10

bacterial: enterobacteriaceae
*luminal obstruction
Hx: 1-anorexia, 2-abd pn periumbilical –> RLQ 3-N/V, diarrhea or constipation
Tx: surgery, SG

Question 11

diverticulitis

Answer 11

Hx: LLQ pn, tenderness, fever
Tx: bed rest, abx

Question 12

secretory diarrhea

Answer 12

large volume w/o inflammation

Question 13

inflammatory diarrhea

Answer 13

bloody w/fever

*invasive organisms or IBD

Question 14

antibiotic associated diarrhea

Answer 14

clostridium difficile colitis

Question 15

infectious diarrhea tests

Answer 15

WBC in stool
bacterial cultures
parasite microscopy

Question 16

diarrhea - norovirus

Answer 16

source: food, h2o, p2p
onset: 1-3d; duration 1-2d
F/N/V; watery
Tx: h2o

Question 17

diarrhea - rotavirus

Answer 17

source: p2p
onset: 1-3d; duration 5-8d
F/N/V; watery
Tx: h2o

Question 18

diarrhea -staphylococcus aureus (toxin)

Answer 18

source: food after cooking
onset: 1-7hr; duration 1-2d
N/V; crampy, mild
Tx: supportive

Question 19

diarrhea - clostridium perfringens (toxin)

Answer 19

source: food before cooking
onset: 8-14hrs; duration: 24hrs
crampy, watery
tx: supportive

Question 20

diarrhea - vibrio spp. (cholera)

Answer 20

source: h20
onset: 2-3d; duration: days
some N/V; profuse, water
tx: h2o, tetracycline, macrolide, fluoroquinolone

Question 21

diarrhea - enterotoxic E. coli

Answer 21

source: food
onset: 5-15d; duration: 1-5d
some N/V, low F; crampy, water
Tx: h2o, bismuth/loperamide

Question 22

diarrhea - giardia lamblia

Answer 22

source: h2o, p2p
onset: 5-25d; duration: until tx
N; bloating
Tx: metronidazole

Question 23

diarrhea - cryptospordia

Answer 23

source: h2o, outbreaks
onset: 2-10d; duration: 30d
N/V; water
Tx: supportive

Question 24

diarrhea - salmonella

Answer 24

source: poultry
onset: 6-72hrs; duration: 4-7d
F/N/V; purulent
Tx: h2o

Question 25

diarrhea - enterohemorrhagic E. Coli (invasive)

Answer 25

source: under-cooked ground beef onset: 12-60hrs; duration: 5-10d F; purulent, blood, crampy Tx: supportive, no abx

Question 26

diarrhea - shigella (invasive)

Answer 26

source: fecal-oral onset: 1-6d; duration: 1-7d F; purulent, blood, crampy tx: supportive, cipro

Question 27

diarrhea - campylobacter (invasive)

Answer 27

source: under-cooked poultry onset: 2-5d; duration: 2-5d F, some N/V; purulent, blooding, crampy Tx: supportive, cipro or azithromycin

Question 28

diarrhea - empiric

Answer 28

source: travelers duration: 1wk blood, purulent Tx: cipro