Step Up - GI

Question 1

What is the most common form of colorectal cancer? What is the most sensitive and specific screening tool? What cancer marker is used to track disease following treatment?

Answer 1

1) Adenocarcinoma
2) Colonoscopy
3) CEA

Question 2

What are the risk factors for developing colorectal cancer (7)?

Answer 2

1) Age >60
2) Adenomatous polyps - Villous worse than tubular
3) PMHx of CRC
4) IBD - UC > Crohn’s
5) Fam Hx
6) Diet - high fat, low fiber
7) Major polyposis syndromes

Question 3

Describe briefly the major polyposis syndromes (6). Focus on inheritance pattern, malignant potential, and associated symptoms.

Answer 3

1) Familial adenomatous polyposis (FAP) - AD, CRC risk is 100%, colectomy at 40.
2) Gardner syndrome - AD, FAP + bone/skin/soft tissue involvement, CRC risk 100%, colectomy at 40.
3) Turcot syndrome - AD or AR, polyps + CNS tumor
4) Peutz-Jeghers - AD, hamatomas, pigmented skin lesions, low malignant potential
5) Familial juvenile polyposis coli - Rare, childhood, small CRC risk
6) Hereditary nonpolyposis CRC - Lynch Syndrome

Question 4

What are general clinical features for CRC (3)? What are clinical features specific to right (4)/left (3)/rectal (3)?

Answer 4

1) General - abdo pain, wt loss, blood in stool
2) Right - RLQ mass, occult blood, melena, anemia
3) Left - change in caliber, change in BM haboits, hematochezia
4) Rectal - hematochezia, tenesmus, rectal mass

Question 5

What is the appropriate treatment and follow-up to CRC (4)

Answer 5

1) Surgical resection of affected bowel and lymphnodes
2) Annual CT and CXR for 5 years after
3) Colonoscopy at 1 year, then every 3 years
4) Track CEA every 3-6 months
- Radiation therapy useful in rectal cancer

Question 6

Rank the malignant potential of the adenomatous polyps from most to least malignant (3).

Answer 6

Villous > Tubulovillous > Tubular

Question 7

What are the risk factors for diverticulosis (2)? What are the clinical features (4)? What is the diagnostic test of choice? What are the complications (2)?

Answer 7

1) low-fiber diet, fam Hx
2) Clinically - usually asymptomatic, LLQ discomfort, bloating, diarrhea/constipation
3) Barium enema
4) Painless rectal bleeding, diverticulitis

Question 8

What are the clinical features of diverticulitis (3)? What tests are indicated and contra-indicated in the work-up? What are the potential complications (4)? What are the appropriate treatments (2)?

Answer 8

1) Clinically - fever, leukocytosis, LLQ pain
2) CT abdo/pelvis. Contra: Barium enema and colonoscopy
3) Complications - abscess, fistula, perforation, obstruction
4) IV Abx and bowel rest. Surgery if complicated course

Question 9

List and briefly describe the four types of acute mesenteric ischemia.

Answer 9

1) Arterial embolism - cardiac origin
2) Arterial thrombosis - occlusion over pre-existing atherosclerotic disease
3) Nonocclusive mesenteric ischemia - Splanchnic vasoconstriction due to low CO
4) Venous thrombosis - hypercoagulable state, many causes.
- typically occur in superior mesenteric vessels.

Question 10

What are the clinical features of acute mesenteric ischemia (5)?

Answer 10

1) Pain worse than suggested by physical findings
2) Anorexia/Vomiting
3) GI bleed
4) Peritonitis
5) Sepsis/Shock

Question 11

How is acute mesenteric ischemia diagnosed? What is the treatment (5)?

Answer 11

1) Mesenteric angiogram
2) Tx: IV fluids and broad-spectrum Abx
3) If vasoconstrictive - vasodilator intra-arterial injection
4) If embolic - thrombolytics or embolectomy
5) If venous thrombosis - Heparin
6) Surgery for dead tissue (perforation)

Question 12

What vessels are affected in chronic mesenteric ischemia (3)? What activity typically precipitates an episode of pain? What is the Tx?

Answer 12

1) Celiac, superior and inferion mesenteric artery occlusion due to atherosclerosis
2) Eating
3) revascularization surgery

Question 13

What is ogilvie syndrome? Who does it effect? What are the treatments (3)?

Answer 13

1) SSx of large bowel obstruction, with no mechanical obstruction present
2) The ill elderly
3) Stop offending medical agent, decompress with enema or colonoscopy, NG suction.

Question 14

What are the most common offending Abx leading to pseudomembranous colitis?

Answer 14

1) clindamycin
2) Ampicillin
3) Cephalosporins

Question 15

What is the cause of pseudomembranous colitis? What are the clinical features (3)? How is it diagnosed? How is it treated (2)?

Answer 15

1) C. diff
2) watery diarrhea, crampy abdo pain, toxic megacolon
3) C diff toxins in stool
4) Metronidazole > Vancomycin

Question 16

Describe the types of colonic volvuli (2). What are the clinical features (3)? How are they treated (2)?

Answer 16

1) Sigmoid (75%) or Cecal (25%)
2) Clinically - colicky abdo pain, abdo distention, anorexia/nausea/vomiting
3) Tx:
a) Sigmoid - sigmoidoscopy is both diagnostic and therapeutic. Elective sigmoid resection as recurrence is high
b) Cecal - Emergency surgery

Question 17

Liver cirrhosis leads to destruction of liver anatomical architecture. As a result portal HTN and biochemical dysfunction can result. Discuss the clinical features of portal HTN (4), and biochemical dysfunction (2).

Answer 17

1) Portal HTN - ascites, peripheral edema, splenomegaly, varicose veins (gastric, esophageal, anal)
2) Biochemical - reduced albumin and clotting factor synthesis

Question 18

What 5 metrics are used to determine hepatic functional reserve (Child-Pugh classification)?

Answer 18

1) Ascites
2) Bilirubin
3) Encephalopathy
4) INR ratio
5) Albumin

Question 19

What are the most common causes of cirrhosis (2)?

Answer 19

1) Alcoholic liver disease

2) Chronic hep B or C infections

Question 20

Outline the treatment for acutely bleeding esophageal varices (4). What is the long-term therapy?

Answer 20

1) Variceal ligation/banding
2) Endoscopic scleotherapy
3) IV octreotide - reduces portal HTN
4) Esophageal balloon tamponade
- B-blocker for long-term care to prevent rebleed

Question 21

What are the complications associated with liver failure (hint: AC, 9H) (11)?

Answer 21

1) Ascites
2) Coagulopathy
3) Hypoalbuminemia
4) Portal HTN
5) Hyperammonemia
6) Hepatic encephalopathy
7) Hepatorenal syndrome
8) Hypoglycemia
9) Hyperbilirubinemia
10) Hyperestrinism
11) HCC

Question 22

Provide the clinical features of hepatic encephalopathy associated with liver disease (4).

Answer 22

1) Decreased LOC - confusion, poor concentration, coma
2) Asterixis - flapping tremor
3) Rigidity/hyperreflexia
4) Fetor hepaticus - musty odor of breath

Question 23

How is hepatic encephalopathy treated (3)?

Answer 23

1) Lactulose - prevents ammonia absorption in GI tract
2) Rifaximin - Abx to kill gut flora, decrease ammonia production
3) Diet - limit protein to 30-40 g/day

Question 24

What are the clinical features suggestive of hyperestrinism secondary to liver failure (4)?

Answer 24

1) Spider angiomas
2) Palmar errythema
3) Gynecomastia
4) Testicular atrophy

Question 25

How are the coagulopathies of liver failure treated? What lab marker is abnormal?

Answer 25

1) Fresh frozen plasm 2) PT prolonged - vit K doesn't work as liver is diseased

Question 26

What is Wilson's disease? What organs are affected typically (4)? How is the diagnosis made (3)? What is the treatment (2)?

Answer 26

1) AR, dysfunction making ceruloplasmin protein, copper aggregates in liver and other tissues 2) Organs: Liver, CNS, Renal, Cornea 3) Dx: impaired LFTs, low ceruloplasmin levels, liver biopsy with high copper conc. 4) Tx: Chelating agent, Zinc (prevent absorption)

Question 27

What is Hemochromatosis? What are the complications (6)? How is the diagnosis made (3)? What is the treatment (2)?

Answer 27

1) AR, excess absorption of iron 2) Complications: Cirrhosis, cardiomyopathy, DM, arthritis, hypogonadism, hyperpigmented skin 3) Dx: a) High: serum iron, ferritin, transferring sat b) Low: total iron binding capacity c) Liver biopsy 4) Repeat phlebotomies, liver transplant if severe.

Question 28

List and briefly describe 3 common benign tumors of the liver.

Answer 28

1) Hepatocellular adenoma - seen in women using contraceptives. Risk of rupture. D/C drugs, surgical resection if large 2) Cavernous Hemangiomas - Most common tumor of liver. Resect if mass effect present. 3) Focal nodular hyperplasia - bening, no treatment

Question 29

What are the 2 pathological types of hepatocellular carcinoma? What is the most common risk factor for HCC?

Answer 29

1) Nonfibrolamellar - Hep B/C or cirrhosis related. Poor prognosis 2) Fibrolamellar - Not Hep B/C or cirrhosis related. Resectable, better prognosis 3) RF: Cirrhosis

Question 30

What are the clinical features of HCC (3)? How is it diagnosed (2)? How is it treated (2)?

Answer 30

1) SSx: a) Constitutional - anorexia, fatigue, wt loss b) Abdo pain c) signs of liver disease - ascites, jaundice, splenomegaly 2) Dx: Biopsy, track AFP 3) Tx: resection possible in very few cases, liver transplant, local chemo/rad. Poor outcomes.

Question 31

Describe the two most common liver abscesses in terms of their pathophys, diagnosis, and treatment.

Answer 31

1) Pyogenic liver abscess a) Due to obstruction and ascension up biliary tree. b) Dx: U/S or CT c) IV Abx, percutaneous drainage 2) Amebic Liver abscess a) fecal-oral transmission, intestinal amebiasis b) dx: U/S or CT, stool O+P c) Percutaneous drainage, IV metronidazole - both life threatening if not treated

Question 32

What is Budd-Chiari Syndrome? What is seen clinically (4)? How is it treated?

Answer 32

1) Patho: occlusion of hepatic outflow leading to congestion 2) Clinical: looks like cirrhosis, ascites, abdo pain, jaundice 3) Surgery - balloon angioplasty and stent

Question 33

Discuss the impact of hyperbilirubinemia on urine - how does this change with conjugated vs unconjugated billis?

Answer 33

1) Conjugated - loosely bound to albumin, excreted in urine - thus urine is dark 2) Unconjugated - bound to albumin and not water soluble, does not exit in urine - thus no change. - unconjugate billi can cross BBB, thus toxic

Question 34

What are the causes of unconjugated billirubinemia (4)?

Answer 34

1) Increased production - hemolytic anemia 2) Impaired conjugation a) Gilbert Syndrome - AD, benign b) Crigler-Najjar Syndrome - severe, toxic 3) Drugs - sulfa drugs, radiocontrast

Question 35

Which liver enzyme is most specific? What is anticipated in the lab work-up of alcoholic cirrhosis? What is indicated by mild/moderate/severly elevated ALT and AST levels?

Answer 35

1) ALT - specific to liver 2) AST : ALT ratio greater than 2 3) a) Mild - chronic viral or alcoholic hep b) mod - acute viral hep c) Severe - severe viral hep, acetaminophen toxicitiy, ischemia, shock liver

Question 36

What is the DDx for elevated ALT and AST values (hint: ABCDEFGHI) (9)

Answer 36

1) Autoimmune hep 2) Hep B 3) Hep C 4) Drugs 5) Etoh 6) Fatty liver 7) Growths (tumor) 8) Hemodynamic disorder (CHF) 9) Iron, copper, A1AT

Question 37

What is suspected with very high ALP values? What is the value of an elevated GGT when ALP is only moderately high?

Answer 37

1) Biliary tree obstruction | 2) Confirms the reason for ALP elevation is hepatic in origin

Question 38

What clotting factors are synthesized by the liver (8).

Answer 38

I, II, V, VII, IX, X, XII, XIII | - reflected in PT.

Question 39

What is cholelithiasis? What are the 3 types?

Answer 39

1) stones in gallbladder 2) Cholesterol stones - associated with obesity, DM, hyperlipidemia 3) Pigmented Stones - associated with hemolysis, alcoholic cirrhosis, or biliary tract infection 4) Mixed stones - most common

Question 40

What are the clinical features of cholelithiasis (4)? What are the complications (4)? How is cholelithiasis diagnosed and what is the treatment?

Answer 40

1) Clinical: may be assymptomatic, RUQ/epigastric pain, pain after meals (biliary colic), Boas sign (subscapular pain) 2) Complications: cholecystitis, choledocholithiasis, gallstone ileus, malignancy 3) Dx - U/S, CT/MRI 4) Tx - none if asymptomatic, otherwise elective cholecystecomty

Question 41

What are the clinical features of acute cholecystitis (6)? How is it diagnosed (3)? How is it treated (2)?

Answer 41

1) Clinical: constant pain in RUQ/epigastrium with radiation to shoulder, N/V+anorexia, RUQ tenderness with guarding, Murphy sign, hypoactive bowel sounds, fever and leukocytosis 2) Dx: U/S, CT, HIDA 3) Treatment: a) conservative - NPO, IV fluids, analgesics, IV Abx b) Cholecystectomy

Question 42

What is acalculous cholecystitis? How is it treated?

Answer 42

1) Cholecystitis with out stone | 2) Emergent cholecystectomy

Question 43

What is choledocholithiasis? What are the types (2)? What are the clinical features (2)? What is seen on lab work (2)? How is it diagnosed? How is it treated?

Answer 43

1) Stone in CBD 2) Primary or secondary 3) High ALP and billis (direct) 4) ERCP 5) ERCP with sphincterotomy or stone extraction

Question 44

With respect to cholangitis, what is Charcot's triad? What is Reynolds pentad? How is cholangitis diagnosed (3)? What is the appropriate treatment (2)?

Answer 44

1) Charcot's - RUQ pain, jaundice, fever 2) Reynolds - Charcot + shock and altered LOC 3) Dx - U/S, ERCP, labs - high billi, leukos, LEs 4) Tx - IV fluids and Abx until stable, ERCP decompression

Question 45

What is Primary Sclerosis Cholangitis? What disease is it associated with? What are the clinical features (3)? How is it diagnosed? What is the treatment?

Answer 45

1) Idiopathic disease of intra or extra-hepatic bile ducts with associated wall thickening, leading to cirrhosis, portal HTN, liver failure 2) UC 3) jaundice, pruritis, high cholestatic LEs 4) ERCP - bead-like dilatations 5) Liver transplant

Question 46

What is Primary Biliary Cirrhosis? What are the clinical features (5)? What is detected on labs (4)? How is it diagnosed? How is it treated (3)?

Answer 46

1) Autoimmune destruction of intra-hepatic bile ducts 2) Clinical: Pruritis, jaundice, RUQ pain, xanthomas, portal HTN 3) Labs: high ALP+GGT, positive AMAs, high cholesterol, high IgM 4) Dx: liver biopsy 4) Tx: Cholestyramine and ursodeoxycholic acid, liver transplant

Question 47

What is biliary dyskinesia? How is it diagnosed? How is it treated?

Answer 47

1) motor dysfunction at sphincter of Oddi leading to biliary colic without gallstone 2) HIDA scan shows incomplete emptying from gallbladder of radionuclide 3) ERCP sphincterotomy

Question 48

What are the main causes of appendicitis (2)? What are the clinical features (7)? How is it diagnosed (3)? How is it treated?

Answer 48

1) Obstruction of lumen due to hyperplastic lymph tissue or fecalith 2) Clinical: RLQ pain with guarding and rebound, N/V, anorexia (always), fever, positive: rovsign, obturator, psoas signs. 3) Dx - clinical Dx, supported by labs, CT if unsure 4) Tx - appendectomy

Question 49

What are the 3 main causes of acute pancreatitis? What are the clinical feature of pancreatitis (5)?

Answer 49

1) gall stone, alcohol, post-ercp 2) Clinical: Steady and dull epigastric pain that radiates to back, N/V, anorexia, decreased bowel sounds. If hemorrhagic - Grey Turner, Cullen, and Fox signs

Question 50

Describe the Ranson criteria used to determine the prognosis of acute pancreatitis on admission (GA LAW) and after 48 hours (CHOBBS)

Answer 50

1) GALAW a) glucose > 200, Age > 54, LDH > 350, AST > 250, WBC > 16,000 2) CHOBBS a) calcium under 8, hematocrit drop > 10%, PaO2 under 60, BUN increase > 8, Base deficit > 4, fluid sequestration >6L

Question 51

How is acute pancreatitis diagnosed (3)?

Answer 51

1) Labs - high amylase and lipase 2) CT - most sensitive 3) ERCP - useful for gallstone pancreatitis and Tx

Question 52

How is acute pancreatitis treated (hint: dependent on severity) (2)?

Answer 52

1) Mild - NPO, IV fluids, analgesia, NG tube | 2) Severe - ICU admission, 72hr enteral feed with NJ tube

Question 53

What is the most common cause of chronic pancreatitis? What are the clinical features (4)? What are some complications (6)? How is it treated (2)?

Answer 53

1) Alcoholism 2) Clinical: constant abdo pain, N/V, wt loss due to malabsorption 3) Complications: Steatorrhea, pseudocyst, CBD obstruction, DM, Effusions, carcinoma 4) Tx: a) Non-Op: analgesia, NPO, pancreatic enzymes and H2 blocker, insulin, alcohol abstinence, small-meals b) Op: pancreaticojejunostomy, Whipple

Question 54

What are the clinical features (6) of pancreatic cancer? How is it diagnosed ()? How is it treated ()?

Answer 54

1) Clinical: Abdo pain, jaundice, wt loss, DM, migratory thrombophlebitis, Courvoisier sign (palpable gallbladder) 2) Dx: CT, ERCP, tumor markers Ca 19-9 and CEA 3) Tx: Whipple if resectable, stent if not resectable

Question 55

Provide a DDx for upper GI bleed (8)

Answer 55

1) PUD 2) Reflux Esophagitis 3) Esophageal/Gastric varices 4) Gastric erosions 5) Mallory-Weiss tear 6) Hemobilia 7) Aortoenteric fistula 8) Neoplasm

Question 56

Provide a DDx for lower GI bleed (8)

Answer 56

1) Diverticulosis 2) Angiodysplasia 3) IBD 4) Colorectal carcinoma 5) Colorectal adenomatous polyps 6) Ischemic colitis 7) Hemorrhoids 8) Anal fissures

Question 57

Match the clinical signs of hematemesis, coffee ground emesis, melena, hematochezia, and occult blood in stool with either Upper GI bleed, Lower GI bleed, or both. Comment on the rate of bleeding if appropriate.

Answer 57

1) Hematemesis - Upper 2) Coffee Ground Emesis - Upper, lower rate 3) Melena - Upper (90%). May be from jejunum, ileum, or right colon 4) Hematochezia - Lower, or massive Upper 5) Occult blood - Lower or Upper

Question 58

With respect to melena, what other sources can cause dark stool and must be considered on the DDx (5)?

Answer 58

Bismuth, carcoal, licorice, iron, spinach

Question 59

What laboratory value is elevated in an Upper GI bleed?

Answer 59

BUN-Cr ratio (urea-creatinine).

Question 60

What are the indications to proceed with surgery on a GI bleed (5)?

Answer 60

1) Hemodynamically unstable non-reponsive to fluid, transfusion, or endoscopic intervention 2) Recurrence of bleed after endoscopic treatment 3) Continued bleed >24 hours 4) Visible vessel at base of ulcer 5) Ongoing transfusion requirement

Question 61

What are the two types of esophageal cancer? Comment on their prevalence, risk factors, and typical location in the esophagus.

Answer 61

1) SCC a) prev: 50% of cases b) RF: Etoh, smoking c) location: upper and mid esophagus 2) Adenocarcinoma a) prev: 50% of cases b) RF: GERD, Barrett's c) location: lower esophagus

Question 62

What are common clinical features of esophageal cancer (8)?

Answer 62

Dysphagia (solids, then liquid), Wt loss, anorexia, odynophagia, hematemesis, aspiration pneumonia, fistula formation, chest pain

Question 63

How is esophageal cancer diagnosed (3)? What is the appropriate treatment (3)?

Answer 63

Dx - upper endo with biopsy, transesophageal U/S for local staging, CT for met work-up Tx - Palliation, surgery if stage 2A or less, neo-adjuvant chemo/rad for surgical candidates

Question 64

Describe achalasia, what are the clinical features of the disease (5)?

Answer 64

- LES failure to relax, abnormal peristalsis of esophageal body 1) Dysphagia (liquids and solids) 2) Regurgitation 3) Chest Pain 4) Wt loss 5) Pulmonary complications due to aspiration

Question 65

How is achalasia diagnosed (3)? How is it treated (5)?

Answer 65

``` Dx: a) Barium swallow - bird's beak finding b) Upper GI endoscopy - r/o other causes c) Manometry - confirms Dx Tx: a) Adaptive measures (chew food) b) Meds - antimuscarinic, long-acting nitrates, CCB c) Botulinum toxin injection d) Forceful dilatation e) Surgical myotomy ```

Question 66

What are the general characteristic of Diffuse esophageal spasm(2), what are the clinical features (2), how is it diagnosed (2), and how is it treated (3)?

Answer 66

1) Character: spontaneous contraction of esophageal body, sphincter function is normal 2) Clinical: noncardiac chest pain, dysphagia 3) Dx: manometry, barium swallow 4) Tx: Nitrates, CCB, TCAs

Question 67

Describe the character, clinical features (5), diagnosis, and treatment (3) of a type 1 hiatal hernia

Answer 67

1) Character: GE junction and stomach herniate into thorax 2) CF: heartburn, dysphagia, chest pain, GERD, Barrett's 3) Dx: Endoscopy 4) Tx: Medical (PPI, antacid), Nissen fundoplication

Question 68

Describe the character, clinical features (5), diagnosis, and treatment of a type 1 hiatal hernia

Answer 68

1) Character: Only stomach herniates into thorax 2) CF: heartburn, dysphagia, chest pain, incarceration, obstruction 3) Dx: Endoscopy 4) Tx: Elective surgery

Question 69

Differentiate a Mallory-Weiss tear from Boerhaave syndrome. What is associated with M-W tears? How is it treated (2)?

Answer 69

1) M-W: mucosal tear at or near GEJ. B-S: transmural involvement (perforation). 2) Bringe drinking and vomitus 3) 90% self-resolve, surgery

Question 70

Provide the location and cause for the following exophageal diverticuli: Zenker, Traction, Epiphrenic. What is the treatment for Zenker and Epiphrenic?

Answer 70

1) Zenker - Upper third, criocopharyngeal muscle dysfunction, surgery (myotomy) 2) Traction - Middle third, due to inflammatory process of mediastinum 3) Epiphrenic - Lower third, due to esophagea dysmotility (achalasia), surgery (esophagomyotomy)

Question 71

What are the common causes of peptic ulcer disease (4)? What are the common clinical features (5)? How is it diagnosed (4)?

Answer 71

1) Causes: H. Pylori, NSAIDs, Zollinger-Ellison, smoking/EtOH/coffee/stress 2) Clinical: epigastric pain, GI bleed, N/V, early satiety, wt loss 3) Dx: Endoscopy (biopsy), Urea breath test, Serology for H. Pylori antibody (does not confirm active infection), Serum gastrin for Zollinger-Ellison

Question 72

Describe the management of PUD (4).

Answer 72

1) Directives - stop NSAID, stop coffee/EtOH/smoking, no nocturnal eating 2) Acid suppression - H2RB, PPI, antacid 3) Eradicate H. pylori - triple or quad therapy 4) Cytoprotection - Misoprostol

Question 73

Describe triple and quadruple therapy for H. Pylori eradication in PUD. When is either used?

Answer 73

1) Triple - PPI, amoxicillin, clarithromycin 2) Quad - PPI, Bismuth subsalicylate, metronidazole, tetracycline. - Use triple in first infection, quad in recurrence

Question 74

Comment on the pathogenesis, H. pylori prevalence, malignant potential, location, age distribution, associated blood type, and risk factors for duodenal ulcers.

Answer 74

1) Pathogenesis - increased acid into duodenum 2) H.Pylori - 70-90% 3) Malignant potential - low 4) Location - 1-2cm distal to pylorus 5) Age - less than 40 6) Blood type - O 7) RF: NSAIDs

Question 75

Comment on the pathogenesis, H. pylori prevalence, malignant potential, location, age distribution, associated blood type, and risk factors for gastric ulcers

Answer 75

1) Pathogenesis - decreased GI defense 2) H.Pylori - 60-70% 3) Malignant potential - high 4) Location - 4 locations 5) Age - >40 6) Blood type - A 7) RF: Smoking

Question 76

What is the most common cause of gastritis? What is concerning with respect to long term outcomes? How is it treated?

Answer 76

1) H. Pylori 2) Risk of gastric cancer and MALT 3) Tx - if symptomatic, H. pylori eradication (Triple, Quad therapy)

Question 77

What are the three characteristics to consider when investigating a suspected small bowel obstruction? What are the main clinical features (5)?

Answer 77

1) Partial vs. Complete - pass gas? 2) Closed loop vs Open loop 3) Proximal vs Distal - level of distension on CXR, amount of vomiting clinically 4) Clinical: Dehydration (hypochloremic, hypokalemic metabolic acidosis), abdo pain, N/V, Obstipation, abdo distension

Question 78

How are small bowel obstruction treated (4)?

Answer 78

1) Conservative (if no peritoneal signs) a) IV fluids to correct electrolyte imbalance b) NG tube for decompression c) Abx 2) If peritoneal signs present - surgery

Question 79

What is seen on AXR of a paralytic ileus? How is it treated (4)?

Answer 79

- Gas throughout small and large bowel | 1) Tx: IV fluids, NPO, NG tube, decompress if necessary.

Question 80

What are the clinic signs of celiac sprue (4)? What are the complications (3)? What is the associated dermatologic condition? How is it diagnosed?

Answer 80

1) Clinical: diarrhea, wt loss, bloating, fatigue 2) Complications: Low vit D (Osteo), K (clot), B12 (p.anemia) 3) Dermatitis herpetiformis 4) Dx: biopsy of small bowel shows flattening of villi.

Question 81

What are the major characteristics of Crohn's disease (6)?

Answer 81

1) Terminal ileum typically (terminal ileum > small intestine > colon > mouth/esophagus/stomach) 2) skip lesions 3) Transmural 4) Fistulae 5) Noncaseating granulomas 6) Luminal strictures

Question 82

What are the clinical features of Crohn's disease (5)? Provide some common extra-intestinal manifestations (5)?

Answer 82

1) Diarrhea (non-bloody), wt loss, abdo pain, fever, extra-intestinal manifestations 2) EIM: episcleritis, uveitis, erythema nodosum, pyoderma gangrenosum, monarticular arthritis, ank spond, VTE, ITP, OA, gallstones

Question 83

How is Crohn's treated (7)?

Answer 83

1) Medical: a) Sulfasalazine (5-ASA) - PG blocker b) Metronidazole c) Systemic corticosteroid d) Immunosuppressant - azathioprine e) Bile acid sequestration 2) Surgical - for complications, high recurrence 3) Nutritional supplementation

Question 84

What are the general characteristics of ulcerative colitis (5)?

Answer 84

1) involves mucosa and submucosa only 2) Always involves rectum 3) Small bowel typically spared 4) No skip lesions 5) PMNs accumulate in crypts of colon

Question 85

What are the clinical features of ulcerative colitis (6)?

Answer 85

1) Hematochezia 2) Abdo pain 3) frequent, small BMs 4) F, wt loss 5) Tenesmus 6) Extaintestinal symptoms

Question 86

What are some common complications of UC (5)?

Answer 86

1) Iron def anemia 2) Hemorrhage 3) Electrolyte disturbance 4) Strictures 5) CRC 6) Sclerosing cholangitis 7) Toxic megacolon 8) Growth retardation

Question 87

How is UC treated ()?

Answer 87

1) Acute flare - systemic corticosteroids 2) Sulfasalazine - 5-ASA (anti-inflammatory) 3) Immune suppression agents 4) Surgical - colectomy (curative)