GI 2 highlights

Question 1

What are 2 etiologies of PUD?

Answer 1

NSAIDs & chronic H. pylori infection

Question 2

PUD:
1) What is an important complaint during history?
2) What is a main Sx?

Answer 2

1) Dyspepsia
2) Improvement with milk/food/antacids (duodenal), worse with food (gastric)

Question 3

Coffee-ground emesis is a primary Sx of what PUD complication?

Answer 3

GI hemorrhage (up to 15%):

Question 4

PUD Tx: What specific therapy should you use from the H. pylori eradication agents category?

Answer 4

Quadruple therapy: bismuth/TCN/PPI/metronidazole

(highlighted)

Question 5

What are the 3 categories of PUD Tx?

Answer 5

Acid anti-secretory agents, mucosal protective agents, & H. pylori eradication agents

Question 6

PUD Tx: You should confirm eradication of what 4 weeks after completion of therapy (urea breath test or fecal antigen test)?

Answer 6

H. pylori-associated ulcers

Question 7

PUD Tx: For H. pylori Tx, the pt should adhere to strict alcohol avoidance with __________________

Answer 7

metronidazole

Question 8

PUD: For NSAID-induced ulcers, what is a main part of Tx?

Answer 8

D/c offending agent

Question 9

Who should you give parenteral feedings when able?

Answer 9

Critically ill and mechanically ventilated patients w. gastritis

Question 10

What is the most common form of perirectal abscess?

Answer 10

Perianal abscess

Question 11

Perirectal abscess:
1) What is the Tx for all patients?
2) What is a complication of perirectal abscesses?

Answer 11

1) Incision & drainage for ALL abscesses
2) Anorectal fistula

Question 12

For anorectal fistula, what is an important finding on a physical exam?

Answer 12

External opening

Question 13

Intense pain with defecation is a primary Sx of what?

Answer 13

Anal fissures

Question 14

Hemorrhoids involve severe pain with _________________

Answer 14

thrombosis

Question 15

What is the Tx for an anorectal fistula?

Answer 15

Surgery is mainstay (fistulotomy); seton placement in setting of abscess or inflammation

Question 16

Excision within 48 hours should be done for which hemorrhoids?

Answer 16

Thrombosed external

Question 17

90% of anal fissures occur where?

Answer 17

At posterior midline

Question 18

There is a concern for Crohn’s, infections (TB, HIV/AIDS, syphilis) with ___________ anal fissures

Answer 18

lateral

Question 19

A sentinel tag is a sign of what?

Answer 19

Chronic anal fissure

Question 20

Medications are a potential ____________ cause of constipation

Answer 20

secondary

Question 21

Constipation:
1) Most common causes?
2) Name a systemic disease that can cause it
3) Name 2 medications that can cause it

Answer 21

1) Inadequate fiber & fluid intake, poor bowel habits
2) Hypothyroidism
3) Opioids + iron

Question 22

1) Name a structural abnormality that can cause constipation
2) Can IBS cause constipation?

Answer 22

1) Mass
2) Yes

Question 23

If a pt with constipation has one of the following, what should you do?: > 50 y/o, severe constipation, signs of organic disorder, alarm symptoms, FHx colon cancer or IBD.

Answer 23

Further diagnostic testing

Question 24

On the Bristol stool chart, which type is the gbest?

Answer 24

Type 4 (“like a smooth sausage”)

Question 25

What is a key part of chronic constipation Tx?

Answer 25

Adequate fluid & fiber intake

Question 26

What category of chronic constipation Tx can the body get addicted to?

Answer 26

Stimulants ( bisacodyl (Dulcolax), senna)

Question 27

Seeds, nuts, popcorn, caffeine, & alcohol _______ associated with increased risk for diverticular disease

Answer 27

NOT

Question 28

Acute diverticulitis: 1) Abdominal imaging _____________ (CT with oral & IV contrast) 2) No role for ______________ & should avoid due to risk of perforation

Answer 28

1) required 2) colonoscopy

Question 29

Is diverticular bleeding typically painful or painless?

Answer 29

Painless

Question 30

Diverticular bleeding: ______________ is test of choice for HD stable patients when bleeding abates

Answer 30

Colonoscopy

Question 31

IBDs: Differentiate between Crohn's and ulcerative colitis

Answer 31

1) Crohn’s can involve any part of GI tract from mouth to anus 2) UC affects only the colon

Question 32

IBD: Crohn disease (Crohn’s): 1) What is often seen? 2) What is possibly seen in Crohn's that's not seen in UC?

Answer 32

1) Skip areas 2) Possible fibrosis & strictures leading to obstruction

Question 33

IBD: Crohn disease (Crohn’s): 1) Possibly has sinus tracts leading to microperforations & ___________ formation 2) Most commonly seen in what 2 locations?

Answer 33

1) fistula formation 2) Terminal ileum & proximal colon

Question 34

List the most important external manifestations of Crohn's disease (an IBD). Include which is most frequent.

Answer 34

1) Arthritis (most freq) 2) Pyoderma gangrenosum & erythema nodosum 3) Oral ulcers

Question 35

Ulcerative colitis (UC; an IBD): 1) Limited to mucosal layer of __________ 2) Almost always involves _____________.

Answer 35

1) Colon 2) Rectum

Question 36

Ulcerative colitis (UC; an IBD): List the most important external manifestations

Answer 36

1) Arthritis (most frequent extraintestinal manifestations in IBD) 2) Skin: erythema nodosum & pyoderma gangrenosum 3) Oral ulcers

Question 37

What is the goal of IBD management?

Answer 37

remission