GI 3 highlights

Question 1

______% of mechanical intestinal obstructions involve small bowel

Answer 1

80

Question 2

Complete SBO almost always results in bowel ischemia leading to _____________ & __________

Answer 2

necrosis & perforation

Question 3

Mechanical SBO results in progressive dilation __________ to obstruction, & decompression _________ to obstruction

Answer 3

proximal; distal

Question 4

What is the result of a proximal mechanical SBO?

Answer 4

Hypovolemia

Question 5

What is the most common cause of mechanical SBO?

Answer 5

Intraperitoneal adhesions

Question 6

Are mechanical SBOs most commonly acute or chronic?

Answer 6

Acute

Question 7

What is a characteristic sign of SBO on a plain radiograph?

Answer 7

Dilated loops of bowel with air-fluid levels

Question 8

Give the main points on how to perform a CT abdomen with contrast if a pt has an acute mechanical SBO

Answer 8

1) Perform with PO/IV contrast (if not contraindicated)
2) Omit oral contrast if complete bowel obstruction
-When looking at CT, identify specific site (transition point)

Question 9

What is the initial diet for someone with an SBO?

Answer 9

NPO

Question 10

What kind of atrophy is characteristic of Celiac disease?

Answer 10

Villous atrophy

Question 11

Celiac disease pathophys:
1) 90-95% affected carry __________.
2) >90% of remaining 5-10% carry ____________.

Answer 11

1) HLA-DQ2
2) HLA-DQ8

Question 12

What are found in >99% Celiac patients?

Answer 12

HLA-DQ2 and/or HLA-DQ8

Question 13

True or false: Subclinical/ non-classic Celiac is asymptomatic

Answer 13

True

Question 14

What Serologic evaluation for Celiac disease should you do?

Answer 14

While on gluten diet:
1) Tissue transglutaminase (tTG)-IgA: preferred test
2) If total IgA deficiency: Endomysial Ab (EMA)-IgA

Question 15

What are the genetic markers for Celiac?

Answer 15

HLA-DQ2 & DQ8

Question 16

What is the gold standard for diagnosing someone with Celiac disease?

(starred slide/ probs on test)

Answer 16

Mucosal intestinal biopsy of duodenal bulb, distal duodenum or proximal jejunum with clinical response to dietary withdrawal of gluten

Question 17

What will be seen on histology with Celiac disease?

Answer 17

blunted or complete loss of villi

Question 18

What is the main part of Celiac disease mgmt?

Answer 18

Gluten-free diet

Question 19

List 3 etiologies of acute pancreatitis

Answer 19

Gallstones (40-70%)
Alcohol (25-35%)
Idiopathic (15-25% after inconclusive work-up)

Question 20

List 2 risk factors for acute pancreatitis

Answer 20

Alcohol and smoking

Question 21

List 2 things you may see on an acute pancreatitis Hx

Answer 21

1) Heavy alcohol intake
2) Pain often radiates to back

Question 22

Acute pancreatitis: ___________ onset severe, steady, boring epigastric pain

Answer 22

Sudden

Question 23

List some labs for acute pancreatitis

Answer 23

1) Sr lipase (& amylase) >3x ULN
2) Lipase elevated longer and more accurate for diagnosis
3) Elevated bilirubin

Question 24

Ranson Criteria is used to figure out the severity of what?

Answer 24

Acute pancreatitis

Question 25

What imaging should you get for acute pancreatitis?

Answer 25

IV Contrasted CT abdomen

Question 26

Mild acute pancreatitis: When can you use a clear liquid diet?

Answer 26

When pain free & bowel sounds present

Question 27

Acute pancreatitis: The presence of ___ to ____ Ranson criteria represents mild pancreatitis; the mortality rate rises significantly with ______ or more criteria

Answer 27

1 to 3; 4

Question 28

Chronic pancreatitis occurs in _____% of all patients with recurrent acute pancreatitis

Answer 28

36%

Question 29

List some important S/Sx of chronic pancreatitis

Answer 29

1) Epigastric/LUQ pain through to back 2) Steatorrhea (pancreatic insufficiency)

Question 30

Name one important lab for chronic pancreatitis

Answer 30

Lipase

Question 31

What are 2 forms of imaging you should get for chronic pancreatitis? Which is most sensitive?

Answer 31

1) CT 2) ERCP: most sensitive study

Question 32

Chronic pancreatitis: What is a main Sx of Exocrine pancreatic insufficiency (EPI)?

Answer 32

Steatorrhea that sticks to sides of bowl

Question 33

What is a key part of chronic pancreatitis management?

Answer 33

Absolute cessation from alcohol

Question 34

What are the 2 main parts of acute appendicitis pathogenesis?

Answer 34

1) Luminal obstruction 2) Inflammatory process

Question 35

Define McBurney’s Point tenderness for acute appendicitis

Answer 35

Maximal tenderness 1.5-2 cm from ASIS on straight line from ASIS to umbilicus

Question 36

"Non-compressible" is a positive ultrasound finding for what?

Answer 36

Acute appendicitis

Question 37

Interventional radiation for either perforated or non-perforated acute appendicitis: CT-guided drainage & IV antibiotics for _________ found on imaging; appendectomy follows

Answer 37

abscess

Question 38

What skin condition may be seen with Celiac disease?

Answer 38

Dermatitis herpetiformis

Question 39

What 3 labs should you draw for alcoholic hepatitis?

Answer 39

AST, ALT, GGT