Gastrointestinal System

A comprehensive set of Q&A flashcards covering acute GI emergencies, abdominal signs, imaging and lab markers, GI diseases (IBD, GERD, PUD, NAFLD), hepatic diseases with serology, and common diagnostic/treatment principles.

What is Acute Appendicitis?

Inflammation of the vestigial vermiform appendix; presents with periumbilical pain that localizes to McBurney’s point over 12–24 hours, anorexia, low-grade fever, RLQ pain with rebound/guarding; psoas and obturator signs may be positive; rupture leads to involuntary guarding and a board-like abdomen; refer to ED.

What is Acute Cholecystitis?

Inflammation of the gallbladder, often due to gallstones; severe RUQ or epigastric pain after fatty meals with possible radiation to the right shoulder; nausea/vomiting; may progress to gallbladder gangrene and require hospitalization.

What is Acute Diverticulitis?

Inflammation of diverticula, often from perforation; LLQ abdominal pain with fever, anorexia, nausea/vomiting; leukocytosis with neutrophilia and left shift; rebound and Rovsing’s sign may be present; complications include abscess, perforation, fistula, obstruction; may be life-threatening.

What is Acute Pancreatitis?

Acute inflammatory process of the pancreas; sudden onset epigastric pain radiating to the back with nausea/vomiting; 2/3 cases due to gallstones and chronic alcohol use; Cullen’s sign and Grey Turner’s sign may appear in hemorrhagic pancreatitis; refer to ED.

What is Clostridium Difficile Colitis?

Colitis caused by C. difficile (spore-forming, toxin-producing bacterium) often after antibiotic exposure; presents with severe watery diarrhea, abdominal pain, fever; risk factors include age >65 and recent hospitalization; diagnose by NAAT or stool toxin tests; treat with fidaxomicin or vancomycin (or metronidazole in some cases) and consider fecal microbiota transplant for recurrences.

What are the key features of Colon Cancer presentation and screening?

Gradual progression with GI symptoms, possible iron-deficiency anemia, change in bowel habits, hematochezia; screening recommended for ages 45–75; higher risk in African Americans; colonoscopy/endoscopy referral for at-risk individuals.

What characterizes Crohn’s Disease (CD)?

IBD with transmural inflammation and skip areas; can affect any GI tract segment; ileal involvement → watery diarrhea without blood; colonic involvement → bloody diarrhea with mucus; relapses with fever, weight loss, abdominal pain; fistulas and anal disease possible; higher risk of toxic megacolon and colon cancer; lymphoma risk with azathioprine.

What characterizes Ulcerative Colitis (UC)?

IBD limited to colon/rectum; bloody diarrhea with mucus; left-sided cramping pain; relapses with fever, anorexia, weight loss, fatigue; arsenals of arthralgias; increased risk of colon cancer and toxic megacolon.

What is Zollinger–Ellison Syndrome?

Gastrinoma causing excess gastrin and gastric acid secretion; multiple and severe peptic ulcers in stomach/duodenum; epigastric to midabdominal pain; screen with fasting serum gastrin; refer to gastroenterologist.

What is the Route of Food/Drink from the Mouth through the Digestive Tract?

Esophagus → stomach (HCl, intrinsic factor) → duodenum (bile, amylase, lipase) → jejunum → ileum → cecum → ascending colon → transverse colon → descending colon → sigmoid colon → rectum → anus.

Which organs are in the RUQ?

Liver, gallbladder, ascending colon, right kidney (lower than left due to liver), and a small portion of pancreas.

Which organs are in the LUQ?

Stomach, pancreas, descending colon, left kidney.

Which organs are in the RLQ?

Appendix, ileum, cecum, right ovary.

Which organs are in the LLQ?

Sigmoid colon, left ovary.

What is in the suprapubic abdominal region?

Bladder and uterus (in females), and rectum.

What is the Psoas/Iliopsoas sign?

With patient supine, raise the right leg while applying downward pressure; RLQ pain with passive hip extension indicates irritation of iliopsoas muscles and suggests retrocecal appendicitis.

What is the Obturator sign?

RLQ pain caused by internal rotation of the hip; positive with pelvic appendix; low sensitivity, not frequently performed.

What is Rovsing’s sign?

Deep palpation of LLQ causes referred pain in RLQ; indicates appendicitis; indirect tenderness with good specificity but low sensitivity.

What is McBurney’s point?

Point of maximal tenderness in RLQ about 1.5–2 inches from the ASIS along a line to the umbilicus; suggestive of acute appendicitis.

What is the Markle Test (Heel Jar Test)?

Have patient raise heels and drop them or jump; positive if RLQ pain occurs or patient cannot perform due to pain.

What is Involuntary Guarding?

Tensing of abdominal muscles on palpation, producing a board-like abdomen; suggests acute abdomen.

What is Rebound Tenderness?

Increased pain when palpation is released, compared with pain during deep palpation; indicates acute or surgical abdomen.

What is Murphy’s Maneuver?

Deeply press on RUQ under costal border during inspiration; mid-inspiratory arrest with RUQ pain (Murphy’s sign) suggests cholecystitis or gallbladder disease.

What is Carnett’s Sign?

Have patient lift shoulders (or perform straight-leg-raise) to tense abdominal wall; increased pain suggests abdominal wall source; decreased pain suggests intra-abdominal organ source.

What is Cullen’s Sign?

Ecchymosis around the umbilicus, indicating intra-abdominal bleeding in pancreatitis or other acute processes.

What is Grey Turner’s Sign?

Bruising of the flank indicating retroperitoneal hemorrhage, often in hemorrhagic pancreatitis.

What does a positive IgM anti-HAV indicate?

Acute hepatitis A infection; patient is contagious.

What does a positive IgG anti-HAV indicate?

Lifelong immunity to hepatitis A; no active infection.

What does Hepatitis B Surface Antigen (HBsAg) positivity indicate?

HBV infection; may reflect current infection or past infection (per notes).

What does Hepatitis B Surface Antibody (Anti-HBs) positivity indicate?

Immunity to HBV, from past infection or vaccination.

What does Hepatitis B e Antigen (HBeAg) indicate?

Actively replicating HBV; highly infectious.

What does the presence of anti-HBc (IgM) indicate in HBV?

Acute HBV infection; IgM anti-HBc may persist up to about 2 years.

What does the presence of anti-HBc (IgG) indicate in HBV?

Past infection with HBV and, with anti-HBs, immunity after recovery.

What is the Hepatitis C Virus Antibody (Anti-HCV) test used for?

Screening for HCV exposure; a positive anti-HCV does not confirm immunity; require HCV RNA testing to determine infection status.

What confirms current Hepatitis C infection?

Positive HCV RNA (PCR) with positive anti-HCV; refer to GI for management.

What is the relationship between Hepatitis D and Hepatitis B?

HDV infection requires presence of HBV; HDV tests include anti-HDV and HDV RNA; vaccination against HBV prevents HDV.

What is the purpose of the HBsAg test in hepatitis B evaluation?

HBsAg is a serologic marker of HBV infection; its presence indicates current or past infection.

What is the purpose of anti-HBs in hepatitis B evaluation?

Anti-HBs indicates immunity to HBV from past infection or vaccination.

What is the purpose of anti-HBc testing in HBV evaluation?

IgM anti-HBc indicates acute HBV; IgG anti-HBc persists with anti-HBs after recovery.

What are the typical causes and tests for C. difficile infection?

Antibiotic exposure commonly precedes C. difficile colitis; diagnose with NAAT on stool or stool toxin test; treat with appropriate antibiotics and infection control; discontinue inciting antibiotics.

What are the basic categories of acute gastroenteritis and their typical etiologies?

Viral (e.g., norovirus, rotavirus) is most common; bacterial (e.g., E. coli, Salmonella, Shigella, Campylobacter, C. difficile, Listeria); protozoal (e.g., Giardia, Entamoeba, Cryptosporidium).

What is the difference between viral, bacterial, and protozoal gastroenteritis in presentation?

Viral: vomiting with non-bloody diarrhea, short duration. Bacterial: high fever, bloody diarrhea, severe abdominal pain; may have rapid onset after ingestion. Protozoal: prolonged watery diarrhea, may be travelers’ diarrhea; often longer, sometimes with cramps.

What is GERD and its key pathophysiology and screening concern?

Gastroesophageal reflux disease: low LES tone allows reflux of gastric contents; chronic GERD can lead to Barrett’s esophagus and esophageal adenocarcinoma; diagnosis is clinical; endoscopy with biopsy is gold standard when indicated.

What is Barrett’s esophagus and its cancer risk?

Metaplastic change from squamous to intestinal-type epithelium in the distal esophagus; precursor to esophageal adenocarcinoma; risk increases with chronic GERD; diagnosed by upper endoscopy with biopsy.

What are common lifestyle and dietary triggers that worsen GERD?

Foods and factors that relax the LES or irritate the esophagus include peppermint, chocolate, caffeine, alcohol, carbonated drinks, tomato/acidic foods, fatty meals; smoking and obesity worsen symptoms.

What is typical management for mild GERD vs erosive esophagitis?

Mild/intermittent: lifestyle changes + antacids or H2RAs. Moderate-to-severe/erosive esophagitis: start PPIs (once daily before meals); if poor response, step up to PPIs or refer to GI for upper endoscopy.

What is Irritable Bowel Syndrome (IBS) and its main subtypes?

Chronic functional disorder of the colon with episodic pain; may be diarrhea-predominant or constipation-predominant (or alternating). Management includes dietary fiber, low FODMAP diet, stress reduction, antispasmodics, and targeted therapies depending on subtype.

What is Nonalcoholic Fatty Liver Disease (NAFLD) and its spectrum?

Hepatic steatosis without significant inflammation (NAFL) or with inflammation (NASH); risk factors include central obesity, type 2 diabetes, metabolic syndrome, dyslipidemia; diagnosed by imaging and biopsy; management focuses on weight loss and avoiding hepatotoxins.

What are typical features and diagnostic steps for NAFLD?

Often asymptomatic or mild RUQ discomfort; ALT/AST mildly elevated; ultrasound as initial imaging; liver biopsy for diagnosis; assess fibrosis with NAFLD fibrosis score; manage with weight loss and lifestyle changes.

What defines Peptic Ulner Disease (PUD) and its major risk factors?

Disruptions in gastric/duodenal mucosa due to H. pylori infection and NSAID use; smoking and alcohol contribute; gastric ulcers vs duodenal ulcers; test for H. pylori (urea breath test or stool antigen); endoscopy with biopsy is gold standard.

How is H. pylori-related ulcers treated vs non-H. pylori ulcers?

H. pylori-negative ulcers: stop NSAIDs, lifestyle changes; PPI or H2RAs for 4–8 weeks. H. pylori-positive ulcers: antibiotic therapy (triple or quadruple therapy) plus PPI for about 14 days; success depends on eradication.

What is the typical HBV vaccination schedule and rationale?

HBV vaccination involves doses given in infancy (birth, 1–2 months, 6–18 months) with additional regimens for adults at risk; vaccination confers immunity and reduces HBV and HDV risk.

What is the general approach to Hepatitis A vaccination and prevention?

Hepatitis A vaccine (inactivated HAV) provides protection; HAV infection is usually self-limited and immunization is primary prevention; Hepatitis A is reportable to public health.

What does a positive HAV IgM indicate vs HAV IgG in serology?

IgM anti-HAV indicates acute hepatitis A infection; IgG anti-HAV indicates past infection and lifelong immunity.

What is the significance of HBsAg, Anti-HBs, and Anti-HBc in HBV infection status?

HBsAg indicates current or past infection; Anti-HBs indicates immunity; Anti-HBc (IgM) indicates acute infection, Anti-HBc (IgG) indicates past exposure and recovery with possible long-term immunity.

What is the role of HBeAg in HBV infection?

HBeAg indicates actively replicating HBV and high infectivity.

What is the approach to suspected acute HCV infection testing?

Screen with anti-HCV antibody; if positive, confirm with HCV RNA testing; if RNA is positive with positive antibody, infection is present; if RNA negative, acute infection unlikely.

What are the major signs of acute pancreatitis (Cullen’s and Grey Turner’s signs)?

Cullen’s sign: periumbilical bluish discoloration; Grey Turner’s sign: flank bluish discoloration; both indicate hemorrhagic pancreatitis and potential severe disease.

What labs are used to evaluate liver injury in hepatitis?

AST (SGOT), ALT (SGPT), ALP, bilirubin, GGT; AST/ALT elevated in hepatocellular injury; ALT is more liver-specific; AST:ALT ratio >2 may suggest alcohol-related liver disease.

What is a common initial management approach for mild GERD?

Lifestyle modifications (smaller meals, avoid late meals, weight loss, smoking cessation) plus antacids or H2RAs.

What is a common initial management approach for GERD with erosive esophagitis?

PPI therapy (e.g., omeprazole, esomeprazole, pantoprazole) with lifestyle modifications; step-up approach may apply; monitor for red flags.

What is the purpose of protean tests in hepatitis serology and what is a key testing tip?

PCR tests detect viral RNA; do not rely on antibody tests alone; use RNA testing to confirm active infection (e.g., HCV, HDV).