GIGU Quiz 2 study guide + notes

There are 2 forms of gastritis. The non-erosive gastritis produces inflammation but is not accompanied by ulcerations.

a. True

b. False

True

Which is NOT associated with gastritis? (select all that apply)

a. A patient may have no symptoms.

b. Chronic NSAID use is a risk factor.

c. In the US this condition is not common.

d. Erosive gastritis could lead to ulcers.

e. Possible belching & flatulence

f. Heavy alcohol use is a risk factor.

g. Clay colored stool

h. Heartburn not relieved by antacids.

i. A patient that has been diagnosed as having H. Pylori

In the US this condition is not common

Clay colored stool

A 35-year-old Life grad comes into your office complaining of upper abdominal pain. History reveals that she drinks 1-2 glasses of wine per day for dinner, consumes NSAIDs (3-4g/day) for a week every month when she has her periods. What is your diagnosis?

a. Barret's esophagus

b. Gastritis

c. Cholecystitis

d. Appendicitis

Gastritis

Gastritis includes all these symptoms EXCEPT:

a. Pain

b. Vomiting

c. Steatorrhea

d. Bloating

Steatorrhea

A stool test is performed for detecting & diagnosing gastritis looking for the presence of bilirubin.

a. True

b. False

False

Which tests would rule in gastritis if suspected?

a. MRI

b. Blood test looking for H. Pylori

c. Upper GI endoscopy

d. Lower GI endoscopy

e. Barium X-Ray

Blood test looking for H. Pylori

Upper GI endoscopy

Barium X-Ray

A hiatal hernia develops when the opening of the diaphragm is enlarged either from tearing or mechanical stretching through into the thoracic cavity.

a. True

b. False

True

The rolling hernia is the most common hernia & occurs when the cardia of the stomach moves superior to lie next to the esophagus.

a. True

b. False

False

There are different types of hernias. The paraesophageal (rolling) hiatal hernia is the most common.

a. True

b. False

False

Select the risk factors for hiatal hernias. (select all that apply)

a. Lifting heavy weights

b. Lying down after a large meal

c. Eating disorders such as bulimia

d. Hard sneezing

Lifting heavy weights

Hard sneezing

Which is found above the diaphragm in a sliding hiatal hernia?

a. LES & cardia

b. Cardia only

c. Fundus only

d. LES & fundus

LES & cardia

Which symptom is expressed for a larger hiatal hernia?

a. Pyrosis

b. Diarrhea

c. Swollen abdomen

d. Nausea

Pyrosis

A patient with a hiatal hernia should eat less at each meal, but more frequently & to not lay down after a meal.

a. True

b. False

True

Obstruction of the appendix can lead to appendicitis. What can lead to that obstruction? (select all that apply)

a. Excessive refined carbohydrates

b. Fecaliths

c. Abnormal contractions

d. Lymphatic hyperplasia

Fecaliths

Lymphatic hyperplasia

Which is correct regarding appendicitis?

a. Fatty stools are a symptom of appendicitis

b. Appendicitis is inflammation of the small intestine producing pain at the lower right quadrant

c. It is usually due to the blockage of the ileocecal valve

d. If a person develops appendicitis, it is usually seen in childhood to early adulthood

If a person develops appendicitis, it is usually seen in childhood to early adulthood

Which is NOT correct regarding appendicitis?

a. If a person develops appendicitis, it is usually seen in childhood to early adulthood.

b. It is usually due to blockage of the appendix.

c. Swelling of the abdomen is found in appendicitis.

d. Appendicitis is inflammation of the small intestine producing pain at the lower right quadrant

Appendicitis is inflammation of the small intestine producing pain at the lower right quadrant

All are symptoms of appendicitis except:

a. Swelling of abdomen

b. Abdominal pain

c. Constipation

d. Decreased urination

Decreased urination

In appendicitis, pain is diffuse initially, but then moves to the lower right quadrant. What is the name of this sign?

a. Psoas sign

b. Blumberg sign

c. Kosher's sign

d. Obturator sign

Kosher's sign

Passive internal rotation of a flexed thigh producing pain for a patient that has appendicitis is referred to as a positive?

a. Rovsing's sign

b. Blumberg

c. Obturator sign

d. Psoas sign

Obturator sign

Which tests/signs would be positive for a patient having appendicitis: (select all that apply)

a. Inflammation

b. Rebound tenderness test

c. Tenderness on rectal exam

d. Murphy's test

e. Increased pain with extension of right hip

f. CBC for increased WBC presence

g. Palpation tenderness of the lower right quadrant

h. Abdominal CT scan

i. Abdominal X-Ray

Rebound tenderness test

Tenderness on rectal exam

Increased pain with extension of right hip

CBC for increased WBC presence

Palpation tenderness of the lower right quadrant

Abdominal CT scan

Crohn's affects the GI tract, especially the stomach & small intestine.

a. True

b. False

False

Which is correct regarding Crohn's disease? (select all that apply)

a. Fecal blood test is the only method of testing for this condition

b. It is only seen in patients in their 6th decade of life

c. It is mostly in the rectum & can only affect the colon

d. It is usually seen affecting the ileum as well as parts of the large intestine

e. A symptom of this condition is diarrhea with blood

f. This condition will cause excessive weight due to the edema accumulating in the abdomen

g. Identification of Crohn's is very difficult because very little pathology results in the GI

h. Diagnosis of this condition is more prevalent in people ages 15-35 years of age

i. A complication is encephalopathy

It is usually seen affecting the ileum as well as parts of the large intestine

Diagnosis of this condition is more prevalent in people ages 15-35 years of age

Which correctly describes Crohn's disease?

a. A person with Crohn's may present with skin lesions &/or mouth ulcers

b. A sign of this disease includes jaundice

c. This disease is only found affecting the small intestine

d. Pseudopolyps are a characteristic for Crohn's

A person with Crohn's may present with skin lesions &/or mouth ulcers

What are characteristics of Crohn's disease? (select all that apply)

a. Mesentery granular & gray with fat

b. Polyarthritis

c. Transmural involvement

d. None of the above

Polyarthritis

Transmural involvement

Skin rash with joint pain may indicate Crohn's.

a. True

b. False

True

Which diagnostic test would help identify Crohn's? (select all that apply)

a. Murphy's sign

b. Blood test to measure urea/nitrogen

c. Lower GI endoscopy for signs of inflammation

d. Urinalysis for bacteria

e. A CT scan with contrast medium showing a narrowed segment of intestine

f. A blood test that is positive for hyperbilirubinemia

g. MRCP positive for obstruction

h. A blood test that is positive for anti-tissue transglutaminase

Lower GI endoscopy for signs of inflammation

A CT scan with contrast medium showing a narrowed segment of intestine

Why perform a blood test when Crohn's is suspected?

a. Look for B12 deficiency

b. Look at liver function

c. Look for mineral deficiency

d. Look for H. Pylori

Look for B12 deficiency

Look at liver function

Look for mineral deficiency

Which is correct regarding ulcerative colitis? (select all that apply)

a. An effective test would include an upper GI endoscopy to reveal the inflammation

b. If treatment begins early the disease can be cured

c. This disease has a high propensity to affect the ileum of the GI tract

d. It is an inflammatory disease that affects the colon & appears between the ages of 15-30 as well as older individuals over 60

e. A blood test would show hypoalbuminemia

f. A stool sample would show evidence of viral infection

g. Abdominal tenderness & guarding may be observed

h. Ulcerations of the skin

It is an inflammatory disease that affects the colon & appears between the ages of 15-30 as well as older individuals over 60

A blood test would show hypoalbuminemia

Abdominal tenderness & guarding may be observed

Which is associated with ulcerative colitis?

a. A patient may describe having 10 or more bowel movements per day

b. Excessive ingestion of NSAIDs may be a risk factor

c. Jaundice

d. Demineralization of teeth

A patient may describe having 10 or more bowel movements per day

All are signs & symptoms of ulcerative colitis EXCEPT:

a. Yellowing of the skin

b. Painful joints may be identified

c. Abdominal tenderness

d. Diarrhea with blood

Yellowing of the skin

Which is a symptom of ulcerative colitis? (select all that apply)

a. Fatty stools

b. Having more than 10 bowel movements per day

c. Rectal discharge of mucus, RBC & WBC

d. Spider hemangiomata

e. Positive psoas sign

f. Urgency to defecate

g. Hematuria

h. Malabsorption of fats and proteins

Having more than 10 bowel movements per day,

Rectal discharge of mucus, RBC & WBC.

Urgency to defecate

Common symptoms from ulcerative colitis include frequent diarrhea & a feeling of incomplete defecation.

a. True

b. False

True

Which can be found in people affected with ulcerative colitis?

a. Fistulas

b. Skip lesions

c. Pseudopolyps

d. String sign

Pseudopolyps

One of the complications of fulminant ulcerative colitis could lead to toxic megacolon.

a. True

b. False

True

There is only one type of erosive gastritis T/F?

False

What are the risk factors for gastritis?

H Pylori

Cocaine use

alcohol

NSAID/aspirin

surgery

trauma

bile reflux

radiation

What are the signs and symptoms of gastritis if any?

Hematemesis

Melena

Heaviness

Belching

Bloating

Vomiting

Flatulence

Pain

What exam findings would you expect with Gastritis?

Tenderness/pain over the epigastric region

Tachycardia

Palor

What tests would you do if you suspect Gastritis?

Upper GI endoscopy (preffered test)

barium xray

blood test (to look for H pylori, anemia, or antibodies)

stool test (to look for H pylori or blood) (fecal immunoacid test)

What is the most common type of hiatal hernia?

Sliding

What are the risk factors for hiatal hernia

obesity

smoking

heavy lifting

hard cough

pregnancy

hereditary

If a hiatal hernia has symptoms (typically asymptomatic) what are they?

heartburn

pyrosis

water brash

regurgitation

dysphagia

chest pain

nocturnal cough

What exam findings would be present with a hiatal hernia?

damage to teeth or mouth from associated GERD

What tests would be completed if a hiatal hernia is suspected?

Upper GI endoscopy

upper GI series

Barium swallow

Warm water fix

What is the typical cause of appendicitis?

obstruction of the appendiceal lumen

which of the following are potential causes of appendicitis?

fecalith (MC)

worms

lymphoid hyperplasia

foreign bodies

What are the risk factors for appendicitis?

Crohns disease

Ulcerative colitis

What are the symptoms for appendicitis?

Epigastric or periumbilical pain

nausea and vomiting

right lower quadrant pain (may start diffuse)

What is blumberg sign?

pain or tenderness when tests for rebound tenderness in the right lower quadrant

What is rovsing sign?

Pain or tenderness on palpation in the left lower quadrant that comes from the right

What is psoas sign?

extension of RIGHT the hip leading to RLQ pain (appendicitis)

What is obturator sign?

passive internal rotation of the flexed hip leading to RLQ pain (appendicitis)

What type of fever is associated with appendicitis?

Low grade (100-101)

What tests should be completed if appendicitis is suspected from history? (mostly diagnosed through history)

Contrast CT

Blood test (To look for infection/incresed WBC count)

Ultrasound

Crohns affects the GI tract, especially the duodenum and rectum? (T/F)

False

Common symptoms noted with ulcerative colitis include frequent diarrhea and a feeling of incomplete defecation (T/F)

True

Which one of the following is a potential complication of Crohn's?

Apthous stomatitis

Which one of the following options are found above the diaphragm in a type ll or rolling hiatal hernia?

Only Fundus

Hiatal hernia has risks factor that include alcohol consumption, antibiotics, and excessive NSAIDS? (T/F)

False

In appendicitis pain is diffuse initially but then moves to the right lower quadrant. What is the name of this sign?

Kocher's sign

The majority of people diagnosed with gastritis have symptoms. (T/F)

False

Which one of the following may be found in people that have ulcerative colitis?

Joint complaints

If a patient is suspected of suffering with erosive gastritis which one of the following positive tests could help to diagnose this condition?

A blood test to check for anemia

What part of the GI tract is affected by Crohn's?

Ileum and colon (small and large intestine)

What is the peak age(s) of Crohn's?

15-30 and 50-70

What layers can Crohn's affect?

Transmural

What sign may be present with Crohn's?

Creeping fat sign

What type of lesions are present with Crohn's?

Skip lesions

What are the potential extraspinal effects of Crohn's?

Peripheral arthritis

Ankylosing spondylitis

primary sclerosing cholangitis

Aphthous stomatitis (mouth ulcer)

Uveitis

Erythema nadosum (pimples of extremities)

Pyoderma gangrenosum

What are the common symptoms of Crohn's?

Diarrhea

abdominal pain

fever

vomiting

constipation

What signs are typically present in Crohn's?

abdominal guarding

palpable RLQ mass

peri anal lesion (second ********)

What special tests should be ordered if Crohn's is suspected?

Abdominal xray or ct

colonoscopy

capsule endoscopy

blood test (looking for B12 deficency)

What is the name of the xray sign found in Crohn's?

String sign

What part of the GI tract does ulcerative colitis affect?

Colon (Large intestine)

What layers of the GI tract does UC affect?

Submusoca and Mucosa

Where does UC start?

rectum

UC has skip lesions present (T/F)

False

What can be found as a characteristic of UC?

Pseudopolyps

What are the extraintestinal effects of UC? (same as Crohn's)

peripheral arthritis

ankylosis spondylosis

primary sclerosing cholangitis

aphthous stomatitis

uveitis

What can occur in the entire region as a result of UC?

Fulminant colitis

What can Fulminant colitis cause?

Toxic megacolon

People with UC are at a higher risk of developing colon cancer? (T/F)

True

What is UC that affects only the rectum called?

Proctitis

What is UC that affects the rectum and sigmoid colon called?

Terminal colitis?

What is the largest symptom to rule IN UC and rule OUT Crohn's?

Bloody Diarrhea

What are the common symptoms of UC?

Bloody diarrhea

Urgency to defecate

Lower abdominal pain

Rectal mucus, WBC, and RBC discharge

Tenesmus

What are typical signs of UC?

High fever

History of 10+ bowel movements daily

Skin lesions

Joint complaints

What tests would be done for a patient that you suspect UC in?

Sigmoidoscopy

Stool culture (looking for bacteria)

Barium enema