Multiple GI Conditions/Diseases

Question 1

Provide differential diagnoses for abdominal pain by location (RUQ, LUQ, Epigastric, RLQ with diarrhea, LLQ with diarrhea).

Answer 1

RUQ:
- Cholecystitis
- Acute hepatitis
- Other (i.e., hepatobiliary)

LUQ:
- Acute MI
- PUD (peptic ulcer disease)
- GERD
- Pancreatitis
- Gastritis
- Splenic etiologies

Epigastric:
- Pancreatitis
- Gastric etiologies

RLQ with diarrhea:
- Crohn’s

LLQ with diarrhea:
- Diverticulitis

Question 2

Describe the signs, symptoms, and patient presentation associated with acute cholecystitis.

Answer 2

• RUQ or epigastric pain
• Fever
• Lying down and/or sitting still
• Murphy sign = classic sign:
  - inspiratory arrest with RUQ palpation
• Lymphocytosis (elevated WBCs)

Question 3

What is the gold standard diagnostic test for acute cholecystitis and the corresponding positive result?

Answer 3

Test:
Ultrasound of the abdomen

Result:
Thickening of gall bladder wall due to increased muscle use

Question 4

What abnormal labs would be expected with complicated cholecystitis? What do they indicate?

Answer 4

Elevated:
- ALT, AST: liver involvement
- Amylase: pancreas involvement

Question 5

Describe diagnostic signs associated with acute appendicitis.

Answer 5

McBurney:
- RLQ pain with RLQ palpation

Rovsing:
- RLQ pain with LLQ palpation

Dunphy:
- RLQ pain with coughing

Psoas:
- RLQ pain with passive extension of R leg and resistance of R hip

Obturator:
- RLQ pain with internal rotation of flexed R thigh

Question 6

Describe the signs, symptoms, abnormal labs and diagnostic test results associated with acute appendicitis.

Answer 6

S/S:
- Fever/chills
- Nausea/vomiting
- Decreased appetite
- Abdominal distension/rigidity

Abnormal labs:
- WBCs > 10,000
- Bands present

Diagnostic Tests:
- Ultrasound
- CT

Question 7

Define diverticulum and diverticula.

Answer 7

Diverticulum: Sac-like protrusion [of the colon]
(singular)

Diverticula: Many small sac-like protrusions [of the colon]
(plural)

Question 8

Of patients with diverticula, approximately what percentage were asymptomatic? What percentage experience diverticular bleeding? What percentage develop diverticulitis?

Answer 8

Asymptomatic: 70% - 80%
Diverticular bleeding: 5% - 15%
Diverticulitis: 4% - 15%

Question 9

What are possible complications of diverticula/um or diverticulitis?

Answer 9

• Abscess
• Obstruction
• Fistula
• Perforation

Question 10

List signs and symptoms associated with uncomplicated diverticulitis.

Answer 10

• Low-grade fever
• Leukocytosis
• LLQ abdominal pain
• Nausea/vomiting

Question 11

For patients with diverticulitis, what is the recommended timeframe for maintenance colonoscopy?

Answer 11

Every 1 - 2 years

Question 12

Name potential etiologies of diarrhea.

Answer 12

• Infectious etiology
• Irritable bowel syndrome
• Inflammatory disease:
  - Crohn’s disease
  - Ulcerative colitis
• Colitis
• Other, including lactose intolerance

Question 13

When evaluating a patient with diarrhea, what details should be gleaned from the patient’s history?

Answer 13

• Duration
• Frequency
• Associated signs and symptoms

Question 14

Describe diarrhea characteristics associated with the small intestine and large intestine.

Answer 14

Small intestine:
- Watery
- Bloating
- Large volume
- Gas
- Cramping

Large intestine:
- Frequent
- Painful
- Regular
- Small volume
- Fever
- Bloody
- Mucoid

Question 15

What is important to assess in patients with diarrhea other than the details and characteristics of the diarrhea itself?

Answer 15

Fluid volume status

Question 16

Describe the course of diarrhea of infectious etiology.

Answer 16

Usually:
- Viral
- Self-limiting

Question 17

Name the likely non-viral infectious agents of diarrhea of infectious etiology.

Answer 17

Bacterial:
- Salmonella
- Shigella
- Campylobacter
- Staph
- C Difficile
- Others

Parasitic:
- Giardia
- Others

Question 18

What are red flags associated with diarrhea?

Answer 18

• Rectal bleeding
• Nocturnal or progressive abdominal pain
• Weight loss
• Labs:
  
  • Anemia
  • Elevated inflammatory markers
  • Electrolyte imbalance

Question 19

How prevalent is Irritable Bowel Syndrome?

Answer 19

Most commonly diagnosed GI condition

NOTE: Condition involving a QUALITY of life problem, not a QUANTITY of life problem

Question 20

Describe signs and symptoms associated with Irritable Bowel Syndrome.

Answer 20

Crampy, abdominal pain, variable in location and character:
- Diarrhea
- Constipation
- Diarrhea and constipation alternating
- Normal bowel habits alternating with diarrhea and/or constipation
- Mucus present in stools

Other GI symptoms:
- GERD
- Nausea/vomiting
- Early satiety
- Chest pain

Question 21

Provide potential differential diagnoses for the following signs and symptoms associated with hematochezia:
- Anal pain with/after defection
- Night sweats, fever, weight loss
- Diarrhea before/with passage of blood
- Change in frequency/caliber of stools

Answer 21

Anal pain with/after defection:
- Anal fissure
- Rectal carcinoma

Night sweats, fever, weight loss:
- Malignancy
- Chronic infection/inflammation

Diarrhea before/with passage of blood:
- Colitis

Change in frequency/caliber of stools:
- Malignancy

Question 22

Per guidelines, at what age should the general population have colorectal cancer screening?

What is the gold standard diagnostic test for colorectal cancer screening?

Answer 22

> 45 years

Colonoscopy