Lower GI - Part III

Question 1

DDX for RUQ pain

Answer 1

Hepatitis
Cholecystitis/Cholelithiasis
Peptic Ulcer Disease
Pancreatitis
Myocardial Ischemia
Pericarditis
Ruptured Aortic Aneurism

Question 2

DDX for Epigastric pain

Answer 2

GERD
Gastritis
Peptic Ulcer Disease
Pancreatitis
Myocardial Ischemia
Pericarditis
Ruptured aortic aneurism

Question 3

DDX for LUQ pain

Answer 3

Spleen infarct
Splenic rupture
Gastritis
Gastric Ulcer
Pancreatitis
Hiatal Hernia (incarcerated)

Question 4

DDX for Right Flank pain

Answer 4

Kidney Inflm

Pyelonephritis

Question 5

DDX for Periumbilical pain

Answer 5

Early appendicitis
Gastroenteritis
Bowel obstruction
Peritonitis

Question 6

DDX for Left Flank pain

Answer 6

Kidney inflm

Pyelonephritis

Question 7

DDX for RLQ pain

Answer 7

Appendicitis
Inflammatory bowel disease
Cecal diverticulitis
Inguinal hernia
Nephrolithiasis
Female: Ovarian cyst, Salpingits, Enometriosis, Ectopic pregnancy
Male: testicular or epididymal inflm

Question 8

DDX for Suprapubic pain

Answer 8

Cystitis
Acute urinary retention
Female: Uterine cramps, Cervicitis, Endometriosis, PID
Male: acute prostatitis

Question 9

DDX for LLQ pain

Answer 9

Diverticulitis
Inflammatory bowel disease
Irritable bowel syndrome
Nephrolithiasis
Female: Ovarian cyst, Salpingits, Enometriosis, Ectopic pregnancy
Male: testicular or epididymal inflm

Question 10

Diffuse early abdominal pain DDX

Answer 10

early appendicitis, gastroenteritis, intestinal obstruction, mesenteric ischemia, peritonitis, IBS

Question 11

Extra abdominal causes of abdominal pain

Answer 11

early appendicitis, gastroenteritis, intestinal obstruction, mesenteric ischemia, peritonitis, IBS, 
abdominal wall (hematoma), infectious (herpes zoster), metabolic (DKA, porphyria, sick cell disease), thoracic (MI, PE, radiculitis), toxic (spider bite, heavy metal poisoning, opioid withdrawal)

Question 12

Diarrhea

Answer 12

defined by >200g/day of stool weight (normal is 100-200g/d)
increase in stool fluidity
or >3 BM a day

Question 13

Pathophysiology of diarrhea

Answer 13

1) osmotic (too much water is drawn into the bowels, increase amount of poorly absorbable solutes)
2) secretory (increase in active secretion (Cl, water) or an inhibition of absorption (Na, water) with little to no structural damage
3) exudative (mucus, blood, protein inflammation)
4) motility (inc. or decreased contact btwn GI contents and mucosal surface)

Question 14

Red flags of diarrhea

Answer 14

blood, pus, fever, signs of dehydration, chronicity, unintended wt loss, failure to thrive in kids
complications include: dehydration & electrolyte imbalance

Question 15

definition of constipation

Answer 15

difficult to pass, infrequent, hardness of stool, incomplete feeling

Question 16

Causes of acute constipation

Answer 16

obstruction, adynamic ileus, medications

Question 17

Causes of chronic constipation

Answer 17

carcinoma, hypothyroid, CNS disorders, slow transit, irritable bowel syndrome

Question 18

Red flags of constipation

Answer 18

abdominal distention, vomiting, blood in stool, weight loss, sever or worsening symptoms

Question 19

definition of gas

Answer 19

colonic bacterial fermentation of nutrients, air swallwoing

Question 20

Types and causes of gas

Answer 20

1) belching - caused by air swallowing, carbonated beverages, voluntary
2) bloating/distention - caused by air swallowing, IBS, gastroparesis, eating d/o, gynecologic
3) flatus - diet, carbohydrate insufficiency, celiac, pancreatic insufficiency

Question 21

Red flags of gas

Answer 21

weight loss, blood in stool (can be benign like in hemorrhoids,)

Question 22

definition of GI bleeding

Answer 22

gross or occult blood

hematochezia (gross blood)- suggests lower GI bleed

Question 23

causes of small bowel bleeding (occult)

Answer 23

angioma, A-V malformation, tumors, Meckel’s diverticulum

Question 24

causes of colon, anus bleeding (frank)

Answer 24

anal fissure, colitis, carcinoma, polyps, diverticular disease, IBD, hemorrhoids

Question 25

definition of dyschezia

Answer 25

difficulty evacuating (feel urge, but cannot defecate

Question 26

cause of dyschezia

Answer 26

from discoordination of rectal muscles and sphincter: hypotonia, prolapse

Question 27

stool findings correlating with small intestines

Answer 27

``` watery in appearance, large in volume, increased frequency, blood possible but never gross pH possibly < 5 hpf ```

Question 28

stool findings correlating with colon

Answer 28

``` mucoid and/or bloody in appearance, small in volume, highly increase in frequency, blood commonly gross, pH >5 WBC commonly >10 hpf ```

Question 29

Labs: O& P (ova and parasites)

Answer 29

to find protozoa, worms, worm eggs, other parasites | if one family member is positive, usu tx whole family

Question 30

Stool culture

Answer 30

perform: immunocompromised patient, severe, inflammatory diarrhea, in those with IBD to distinguish between flare and infection

Question 31

Fecal occult blood (hemoccult)

Answer 31

to detect upper GI bleed

Question 32

Fecal leukocytes

Answer 32

when assessed along with occult blood can help confirm bacterial cause of diarrhea

Question 33

Fecal lactoferrin (latex agglutination assay)

Answer 33

marker for fecal WBCs. Used to distinguish between inflammatory diarrhea (bacterial infxn, IBD) and non-inflammatory causes (viral infxn, IBS)

Question 34

Fecal lysozyme

Answer 34

N= absence of colonic inflammation and suggests irritation only used as a marker to measure success of treatment for IBD

Question 35

Comprehensive digestive stool analysis (CDSA)

Answer 35

markers for digestion, absorption, metabolism, plus microbiology

Question 36

Salival secretory secretory IgA (sIgA)

Answer 36

low in: celiac, IBD, allergy, chronic infx, chronic stress, more susceptible to GI infection high in: acute GI infxn

Question 37

serology

Answer 37

eg Celica testing for antibodies

Question 38

bowel transit time

Answer 38

variable, but usu start to see test substance at 12-14 hrs

Question 39

Anoscopy

Answer 39

in-office procedure for visualizing hemorrhoids