Lower GI

Question 1

Appendicitis

Answer 1

Inflammation of the appendix after an obstruction

Question 2

Complications of appendicitis

Answer 2

Abscess, gangrene, peritonitis

Question 3

CM of appendicitis

Answer 3

RLQ pain in periumbilical area, rebound tenderness, dull, steady pain in periumbilical area, progressive over 4-6h to RLQ, low fewer, N, anorexia

Question 4

Peak incidence for appendicitis

Answer 4

10-12Y

Question 5

Sudden relief of pain with appendicitis

Answer 5

CONCERN - BURST - risk of peritonitis

Question 6

Appendicitis dx

Answer 6

US or laporotomy

Question 7

Peritonitis

Answer 7

Inflammation of the peritoneum from stuff in the stomach getting outside the gut; serous membrane that lines the abdominal cavity and covers the visceral organs

Question 8

Risks with peritonitis

Answer 8

Get fluid shifts (3rd spacing) that lead to hypovolemia and sepsis; dec peristalses and paralytic ileus

Question 9

Causes of peritonitis

Answer 9

Perforated ulcers, ruptured gallbladder, pancreatitis, ruptured spleen, ruptured appendix

Question 10

CM of peritonitis

Answer 10

Sudden abdominal pain, tender, rigid, board-like abdomen, N/V, fever, inc WBCs, inc HR, dec BP

Question 11

Peritonitis patho

Answer 11

Pain and fluid shifts causing SNS action

Question 12

tx for peritonitis

Answer 12

Anti-inflammatory, fixing the cause

Question 13

IBS

Answer 13

change in bowel pattern with changes in intestinal motility; includes IBSC (constipation) and IBSD (diarrhea)

Question 14

Sx of IBS

Answer 14

Vary by person
- ab distention, fullness, bloat, flatulence
- intermittent ab pain exac by stress and relieved with pooping
- bowel urgency
- food intolerances (lactulose, gluten, sorbitol)
- non-bloody stool containing mucus

Question 15

Can stress cause IBS?

Answer 15

No but it can exacerbate IBS

Question 16

Cause of IBS

Answer 16

Unknown, triggered by food, stress, hormonal changes, GI infection, menses

Question 17

Inflammatory bowel disease

Answer 17

UC and Crohn’s
- life-changing chronic illness
- chronic inflam of intestines and exac and remissions
- autoimmune activated by infx

Question 18

Risk factors for IBD

Answer 18

women, white, Jewish, smokers

Question 19

Crohn’s

Answer 19

• lymphatic structures of GI tract are blocked
• tissues engage and inflam
• deep liver fissure and ulcer dev in “patchy” pattern on bowel wall (skip lesions aka cobblestone look)

Question 20

Sx of Crohn’s

Answer 20

Anemia, scar tissue, fistula, inc risk of cancer, RLQ cramp, watery diarrhea, wt loss, fatigue, fever, malabsorption of nutrients, palpable ab mass, mouth ulcer

Question 21

What is Crohn’s associated with?

Answer 21

Granulomas

Question 22

UC

Answer 22

inflammation of mucosa in the rectum and colon

Question 23

Risk fx for UC

Answer 23

white euro descent, esp ashkenazi jews, some Black, rare in asians
- often dev in 3rd decade of life

Question 24

UC patho

Answer 24

Inflam begins in rectum and extends into continuous segment that might involve the whole colon
- inflam leads to big ulcers
- necrosis of epithelial tissue (crypt abscesses)
- colon and rectum try to fix w/ new granulated tissue (tissues fragile, bleed easy)

Question 25

Sx of UC

Answer 25

bleeding, diarrhea, wt loss, fatigue, anorexia, fever

Question 26

Complications of UC

Answer 26

hemorrhage, perforation, cancer (colon carcinom), malnutrition, anemia, strictures, fissures and abscesses, liver disease from scarred bile ducts, VTE and DVT, F&E, pH imbalance

Question 27

V dangerous risk of UC

Answer 27

Toxic megacolon - rapid dilation of L intestine--life threatening

Question 28

Diverticular disease

Answer 28

Develop diverticula - small pouches in the lining of the colon that bulge out thru weak spots (often in the descending colon)

Question 29

Is diverticular disease congenital or acquired?

Answer 29

BOTH

Question 30

Diverticulosis

Answer 30

w/o inflam

Question 31

Diverticulitis

Answer 31

with inflam

Question 32

Cause of diverticular disease

Answer 32

May be from low fiber diet resulting with chronic constipation

Question 33

Risk fx of diverticulosis

Answer 33

chronic constipation

Question 34

CM for diverticular disease

Answer 34

Often asymptomatic, diagnosed accidentally or with acute -litis exac

Question 35

Patho of diverticulitis and CM

Answer 35

Inflamed pouch from retained fecal material - LLQ ab pain, fever, inc WBCs, constipation or diarrhea, large frank bleed - may resolve spontaneous

Question 36

Complications of diverticular disease

Answer 36

Perforation, obstruction, peritonitis - depends on severity, if they pop

Question 37

GI tx

Answer 37

Often diet, sometimes surg - may r/t constipation

Question 38

Treating H. pylori

Answer 38

Need several abx, gastric acid inhibition - combo drugs to dec resistance, like acid - need 10-14d tx - very $$$ so adherence is prob

Question 39

Pharm target for GI

Answer 39

dec gastric acid production - Block H2 receptors (which produce GA) or inhibit proton pump (pump makes gastric acid) - occur in parietal cells of stomach