lower gi bleed/ibd/gallbladder

Question 1

what are the risk factors for occlusive ischemic colitis. and then non-occlusive

Answer 1

emboli, a-fib ,mesenteric venous thrombosis, vasculitis, hypercoagubility.
non-occlusive - hyperprofusion, heart ds, medications, exercise.

Question 2

Name the 2 tip-off symptoms for occlusive colitis.

Answer 2

Acute severe abdominal pain

Hematocheizia

Question 3

How would you diagnose an ischemic colitis?

Answer 3

See a thick colon wall on CT

Colonscopy and biopsy

Question 4

How do you treat ischemic colitis?

Answer 4

Treat the underlying cause and if it stops wait to do a colonscopy for a few month.
If sepsis send to surgery

Question 5

define angiodysplasia

Answer 5

same as angionestasia -torturous submucosal capillaries or veins without smooth muscle in R colon.

Question 6

Tx/Dx for angiodysplasia

Answer 6

Colonsopy with ablation or colectomy (if you can find it)

Question 7

Risk factors for angiodysplasia

Answer 7

Aortic stenosis, renal failure and old people.

Question 8

What is the most deadly cause of lower GI bleeding?

Answer 8

Upper Gi bleed

Question 9

What is the treatment for diverticular hemorrhage

Answer 9

rehydrate, NPO (bowel rest) most self limited. possibly antibiotics? Metronidazole or cipro

Question 10

What are the serological findings for UC vs. Crohn’s?

Answer 10

UC- pANCA

Crohn’s - ASCA

Question 11

UC or Crohn’s? pancreatitis, frequent pain, transmural

Answer 11

Crohn’s

Question 12

UC or Crohn’s? Anti-TNF biologics very effective, increased risk CRC, some hematochezia, small superficial ulcers, backwash ileitis, and crypt abscesses

Answer 12

UC

Question 13

UC or Crohn’s? ASCA +, large punched out ulcers, large/frequent obstructions

Answer 13

Crohn’s

Question 14

What are some side effects of an ileal resection >100 cm?

Answer 14

vit. B12 def., bile salt diarrhea, oxylate stones

Question 15

What tests would indicate hepatocellular parenchymal inflammation?

Answer 15

AST/ALT

Question 16

What tests would indicate a cholestatic/intra-/extra-hepatic obstruction?

Answer 16

ALP, GGT, Bilirubin

Question 17

A pregnant woman in her first trimester presents with jaundice. What is the most likely cause?

Answer 17

viral hepatitis

Question 18

A YA presents with jaundice, what is the most likely cause?

Answer 18

viral hepatitis or EtOH

Question 19

Name some risk factors for cholesterol stones

Answer 19

biliary stasis, concentrated bile, F, rapid wt. loss, increased TGA’s, estrogen supplement, Octroetide anti-diarrheal

Question 20

Describe some symptoms related to liver malfunction

Answer 20

jaundice, icterus, caput medusae, intense pruritis, palmar erythema, ascites, Dupuitren’s contracture, Xanthoma/Xanthelasma, asterixis “flapping tremor”

Question 21

Describe the differences b/t cholelithiasis and choledocholithiasis and how you would diagnose them

Answer 21

cholelithiasis- stones in gallbladder - easier to find on US

choledocholithiasis- stones in CBD

Question 22

What is differential for a patient with CAD, claudication, intermittent abdominal pain and bright red rectal blood

Answer 22

acute ischemic colotis (IMA) self resolves

Question 23

What is the best way to diagnose pyloric stenosis?

Answer 23

Ultrasound - sphincter 3 mm x 1.7 cm

Question 24

How do you diagnose Hirschprung disease?

Answer 24

1. full thickness rectal bx.
2. barium enema
3. manometry

Question 25

How do you diagnose Hirschprung disease?

Answer 25

1. full thickness rectal bx. 2. barium enema 3. manometry

Question 26

What would you expect to see on a Hirschprung bx.?

Answer 26

Hypertrophied nerve trunks of muscularis propria and lamina propria w/ AChE stain

Question 27

What are the signs of appendicitis?

Answer 27

Psoas sign- bend/ lift leg pain, McBurney's point pain , Obturator sign - internal rotation pain, Rovsing sign - push LLQ= pain RLQ