Gastrointestinal/Genitourinary Diagnosis quiz 2

What are the two types of gastritis?

Erosive

Non-erosive

What is the term for gastritis that lasts a short time and comes on abruptly?

Acute gastritis

What is the term for gastritis with insidious onset and long history?

Chronic gastritis

What is the term for gastiritis that causes erosion into the submucosa?

Ulcerative gastritis

What is the term for gastritis that causes erosion that does not penetrate to the submucosa?

Erosive gastritis

What is the term for gastritis that is inflammatory, but doesn’t produce an erosion. There is no blood.

non-erosive gastritis

What are the risk factors for gastritis?

NSAIDS

caffeine

nicotine

alcohol

cocaine

radiation therapy

H. pylori

What is the major risk factor for gastritis?

H.pylori

What % of acute gastritis can be accounted by critical illness (e.g. large burn, heart attack, stroke)?

5%

What are the symptoms of gastritis?

May have no symptoms

What is the primary vitamin deficiency caused by erosive gastritis?

B12

What symptoms can result from bleeding in erosive gastritis?

Hematemesis

Melena

What exam finding of the skin can accompany hematemesis and melena?

Pallor

What are the exam findings of gastritis?

Tenderness or pain during palpation or percussion over epigastric region

What are the special tests for gastritis?

Upper GI endoscopic exam

Barium X-ray

Blood test

Stool

What are the endoscopic findings of gastritis?

Inflammation or erosions of the stomach

What is the finding of erosive gastritis on barium x-ray?

Disrupted contour of the stomach

What are the possible blood test findings of gastritis?

Anemia

H. pylori antibodies

reduced number of WBC

What are the possible stool findings of gastritis?

H. Pylori antigen

Blood

What foods are good to eat with gastritis?

Green tea

Ginger

Yogurt

Tumeric

Slippery elm

Peppermint and garlic

What layer does an erosion have to reach to be considered an ulcer?

Submucosa or deeper

What part of the GI tract is most common for peptic ulcers?

Duodenum

Stomach

What are the risk factors for peptic ulcers?

NSAIDS

H. pylori

Zollinger Ellison syndrome

What is Zollinger Ellison syndrome?

Gastrin-producing tumor (tumor of G cell)

What age group is most affected by peptic ulcers?

Over 40 yo

What are the common symptoms of peptic ulcers?

Pain and burning (may be relieved by antacids)

Bloating

Nausea

Fullness

peritonitis

If symptoms of a peptic ulcer increases in the morning before eating, are relieved by eating, and reemerge after a period of not eating, where is the ulcer likely to be?

Duodenum*

What are the exam findings of peptic ulcer?

distress

Tenderness to palpation or percussion over epigastric region

Pallor (if hematemesis or melena is present)

decreased bowel sounds

rock hard abs

loss of weight

What special tests are used for gastric ulcers?

Upper GI endoscopic exam

Gastric secretion studies

Testing for H. pylori

X ray

Why would a gastric secretion study be performed with a gastric ulcer?

To see if it is caused by Zollinger Ellison syndrome

What is the most dangerous complication of peptide ulcers?

Perforation of the GI

What demographic is most affected by gastric tumors?

Men over 50 yo (outside the U.S.)

What are the risk factors for gastric tumors?

H. pylori

Damage to the stomach

Polyps (peutz-jegher's)

Family history of cancer

smoking

Diet (nitrates and nitrites)

What foods contain nitrates and nitrites?

Pickled and smoked foods

What type of cancer are 95% of gastric tumors?

Adenocarcinoma

What are the 4 classifications of gastric tumors?

Protruding

Penetrating

Superficial spreading

Linitis plastica

What is a protruding tumor?

Polyp-like

What is a penetrating tumor?

Ulcerating tumor

What is linitis plastica tumor

tumor with serious fibrous reaction - looks synthetic

What are the symptoms of gastric cancer?

Asymptomatic until late in course of disease

Late symptoms:

Loss of appetite, abdominal discomfort or fullness

Bloating, nausea, vomiting, bleeding (anemia), unexplained weight loss

What causes the symptoms of gastric tumors?

Dysfunction of the stomach

What are the exam findings of gastric tumors?

Rigid abdomen palpation

mass in the abdomen

painful palpation

unexplained weight loss

bloated abdomen

What are the special tests for gastric tumors?

Upper GI endoscopic exam

Barium swallow x-ray

CT scan

Biopsy

Blood test - for anemia

What are the 3 types of hiatal hernia?

Sliding

Rolling

Mixed

What is the most common type of hiatal hernia?

Sliding (95%)

What is the term for the cardia of the stomach and LES rising superior through the diaphragm?

Sliding hiatal hernia

What is the term for when the fundus of the stomach is superior to the diaphragm?

Rolling hiatal hernia

What is the term for when the fundus and LES have moved through the diaphragm?

Mixed hiatal hernia

What are the risk factors for hiatal hernia?

Smoking

Hereditary

Obesity

Pregnancy

Heavy lifting

Hard coughing/sneezing

People over 50

What are the symptoms of hiatal hernia?

Usually asymptomatic

large hiatal hernias only have symptoms due to associated GERD

What are the exam findings of Hiatal Hernia?

If symptoms exist, exam findings would be from GERD

(lesions of oral mucosa and demineralization of teeth)

What are the special tests for hiatal hernia?

Upper GI series

Upper GI endoscopy

Barium swallow

What is the endoscopic finding of Hiatal hernia?

Hourglass-shaped esophagus

(first constriction is the LES, second constriction is the diaphragm around the stomach)

What is an upper GI series?

X-ray

What are the findings of Upper GI series with a hiatal hernia?

Larger air pocket above diaphragm

What is the term for a laceration of the distal esophagus and/or proximal stomach?

Mallory weiss tear

What causes mallory weiss tears?

Severe retching

Vomiting

Prolonged hiccups

Where do mallory weiss tears occur?

Gastro-esophageal junction

What is the peak age of mallory weiss tears?

40-60 yo

Who is mallory weiss tear associated with?

Alcoholics and eating disorders

What % of all upper GI bleeds are caused by mallory weiss tears?

5%

What are the symptoms of mallory weiss tears?

Hematemsis

Coffee-gorund emesis

What is the term for black flecks in vomit due to hardened blood?

Coffee ground emesis

What are the special tests for mallory weiss tears?

Endoscopic exam

Arteriography

CBC

What is the CBC finding of mallory weiss tears?

Decreased hematocrit (RBC count)

What part of the intestines does IBS affect?

Large intestine

What % of the population is affected by IBS?

15%

What age group is most commonly affected by IBS?

Teens and 20s

T or F: IBS diagnosis requires diarrhea

False (can have constipation, or diarrhea)

What are the risk factors for IBS?

Severe enteric infection

Stressful life event

family history

What is IBSC?

IBS with constipation

What is IBSD?

IBS with loose stools, diarrhea

What is IBSM?

Mixed IBS with both constipation and diarrhea

What IBS is deranged

IBSD

What IBS is paralytic

IBS C

What is the Rome criteria used for?

Diagnosis of IBS

What is the Rome criteria?

3 month history where you have:

1. Complain of abdominal/discomfort (which could be relieved by defecation)

2. Presence of disturbed defecation (changes in pressure and consistency)

3. defecation involved in at least 2:

• altered stool freq

• altered stool form

• straining and pushing, but nothing comes out

• passage of mucus

What are the symptoms of IBS?

Abdominal pain

Bloating

Cramping

Diarrhea

Constipation

Whitish mucous in stool

What are the exam findings of IBS?

Swollen or bloated abdomen

Palpable sigmoid

Tender abdomen on plaption

Abnormal bowel sounds (borborygmi)

What are the special tests for IBS?

Blood test to rule out infection or inflammation

Stool test to rule out infection or blood

Colonoscopy to rule out pathology

Barium x-ray

CT to rule out other pathological process

T or F: There are no specific special tests for IBS, it is diagnosed if all special tests come back negative

True

What is the special diet for IBS?

FODMAP

What is the purpose of the FODMAP diet?

By eating less sugars, there is less product for intestinal bacteria to ferment and produce gas

What part of the large intestine does the appendix come off of?

Cecum

What are the potential causes of appendicitis?

Lymphoid hyperplasia (most common)

Fecolith - hard piece of stool

Foreign object

Worm infection

What is the most common cause of appendicitis?

Lymphoid hypertrophy/metaplasia

What age group is most commonly affected by appendicitis?

Teens - 20s

What % of the population develops appendicitis?

over 7-9%

What are the symptoms of appendicitis?

Epigastric or periumbilical pain

Nausea and vomiting

After a few hours, pain shifts to lower right quadrant

What are the signs for appendicitis?

Blumberg sign

Rovsing's sign

Psoas sign

Obturator sign

Kosher's sign

Low grade fever

What is the term for appendicitis pain moving to the lower right quadrant?

Kosher's sign

What is a positive blumberg sign?

Increase in discomfort as the doctor presses in sharp pain as pressure is released (+ rebound tenderness at mcburney’s point)

What is a positive rovsing's sign?

Pain in the right lower quadrant when pressing into the left lower quadrant

What is a positive psoas sign?

Extension of the right hip increases pain in RLQ

What is a positive obturator sign?

Passive internal rotation of the flexed right thigh causes pain in the RLQ

What special test is typically used to diagnose appendicitis?

History

What special test is used to diagnose appendicitis with atypical presentation?

Contrast-enhanced CT

US

Blood test

What is a finding of appendicitis on blood tests?

Leukocytosis

What is the AKA of bilaiary cholangitis?

primary sclerosing cholangitis

What other condition is associated with Biliary cholangitis?

Inflammatory bowel disease