GI Exam Questions With Complete Solutions
3 main functions of the large intestine Correct Answer 1.)
absorb remaining water from undigested food
2.) transport undigested food for removal via feces
3.) absorb certain vitamins produced by bacteria (vitamin K,
biotin)
acetylcholine Correct Answer directly stimulates the parietal
cells to secrete hydrochloric acid
the parasympathetic system (primarily via the vagus nerve)
increases GI activity (secretion and motility)
ACh is the "rest and digest" NT
achalasia dx Correct Answer esophageal manometry *gold
standard*. shows increased LES pressure >40mmHg, decreased
peristalsis
double-contrast esophagram *birds beak appearance of LES
(narrowing)* w/ proximal esophageal dilation, loss of peristalsis
distally. manometry is more definitive than esophagram
endoscopy: may be needed to r/o esophageal carcinoma or other
etiologies
achalasia pathophys Correct Answer idiopathic proximal loss
of auerbach's plexus --> increased LES pressure. MC in 5th
decade
,failure of LES relaxation (LES tone) --> obstruction and lack of
peristalsis.
Auerbachs plexus = esophageal wall ganglion cells which
normally produce nitric oxide, leading to smooth muscle
relaxation of the LES
*increased risk of squamous cell carcinoma*
achalasia sx Correct Answer *dysphagia to both solids and
liquids*, malnutrition, weight loss, dehydration, regurgitation of
undigested food, CP, cough. sx usually btwn 25-60y
achalasia tx Correct Answer decrease LES pressure --
botulinum toxin injection lasts 6-12mo, nitrates, CCBs,
pneumatic dilation of LES, esophagomyomectomy
acute acalculous cholecystitis Correct Answer MC occurs in
the *seriously ill* (post op, ICU) 2ry to dehydration, prolonged
fasting, total parental nutrition, gallbladder stasis, burns, DM,
due to gallbladder sludge (not stones)
acute cholangitis dx Correct Answer labs: leukocytosis,
cholestasis (increased alk phosphatase w/ increased GGT,
increased bilirubin >ALT, AST)
US, CT may show dilation of the common bile duct
*cholangiography: gold standard* via ERCP or PTC
(percutaneous transhepatic cholangiography)
,acute cholangitis pathophys Correct Answer biliary tract
infection 2ry to obstruction (gallstones, malignancy)
MC due to gram neg enteric organisms that ascend from the
duodenum -- e.coli (*MC*), klebsiella, enterobacter, b. fragilis,
anaerobes or enterococcus
acute cholangitis sx Correct Answer *charcots triad:
fever/chills, RUQ pain jaundice*
*reynolds pentad*: charcots triad + shock + AMS
acute cholangitis tx Correct Answer abx vs colonic bacteria:
mono therapy (augmentin, pip/tazo) or
-ceftriazone + metronidazole
-fluoroquinolone + metronidazole
-ampicillin + gentamicin
-common bile duct decompression/stone extraction via ERCP
-PTC catheter drainage if unable to do ERCP
-open surgical decompression + T-tube insertion
acute cholecystitis dx Correct Answer US: *initial test* --
thickened gallbladder >3mm, distended gallbladder, sludge,
gallstones, pericholecystic fluid, +sonographic murphys sign
(pain when gallbladder palpated w/ US probe)
CT: alternative to US
, abdominal radiographies: 10% stones seen. usually incidental
finding on AXR
labs: increased WBCs (leukocytosis w/ L shift), increased
bilirubin, increased alkaline phosphatase, increased LFTs
*HIDA: gold standard* -- + scan shows non visualization of the
gallbladder
acute cholecystitis pathophys Correct Answer gall bladder
(cystic duct) obstruction by gallstone --> inflammation/infection
e. coli MC (50-80%), klebsiella, enterococci, b. fragilis,
clostridium
acute cholecystitis sx Correct Answer RUQ/epigastric pain
*continuous* in duration. may be associated w/ nausea and may
be precipitated by *fatty foods or large meals*
guarding, anorexia, jaundice not common but may be seen if
choledocholithiasis present
*fever* low grade
*enlarged palpable gall bladder, + murphys sign*
*+ boas sign*: referred pain to the R shoulder/scapular area
(phrenic nerve irritation)
3 main functions of the large intestine Correct Answer 1.)
absorb remaining water from undigested food
2.) transport undigested food for removal via feces
3.) absorb certain vitamins produced by bacteria (vitamin K,
biotin)
acetylcholine Correct Answer directly stimulates the parietal
cells to secrete hydrochloric acid
the parasympathetic system (primarily via the vagus nerve)
increases GI activity (secretion and motility)
ACh is the "rest and digest" NT
achalasia dx Correct Answer esophageal manometry *gold
standard*. shows increased LES pressure >40mmHg, decreased
peristalsis
double-contrast esophagram *birds beak appearance of LES
(narrowing)* w/ proximal esophageal dilation, loss of peristalsis
distally. manometry is more definitive than esophagram
endoscopy: may be needed to r/o esophageal carcinoma or other
etiologies
achalasia pathophys Correct Answer idiopathic proximal loss
of auerbach's plexus --> increased LES pressure. MC in 5th
decade
,failure of LES relaxation (LES tone) --> obstruction and lack of
peristalsis.
Auerbachs plexus = esophageal wall ganglion cells which
normally produce nitric oxide, leading to smooth muscle
relaxation of the LES
*increased risk of squamous cell carcinoma*
achalasia sx Correct Answer *dysphagia to both solids and
liquids*, malnutrition, weight loss, dehydration, regurgitation of
undigested food, CP, cough. sx usually btwn 25-60y
achalasia tx Correct Answer decrease LES pressure --
botulinum toxin injection lasts 6-12mo, nitrates, CCBs,
pneumatic dilation of LES, esophagomyomectomy
acute acalculous cholecystitis Correct Answer MC occurs in
the *seriously ill* (post op, ICU) 2ry to dehydration, prolonged
fasting, total parental nutrition, gallbladder stasis, burns, DM,
due to gallbladder sludge (not stones)
acute cholangitis dx Correct Answer labs: leukocytosis,
cholestasis (increased alk phosphatase w/ increased GGT,
increased bilirubin >ALT, AST)
US, CT may show dilation of the common bile duct
*cholangiography: gold standard* via ERCP or PTC
(percutaneous transhepatic cholangiography)
,acute cholangitis pathophys Correct Answer biliary tract
infection 2ry to obstruction (gallstones, malignancy)
MC due to gram neg enteric organisms that ascend from the
duodenum -- e.coli (*MC*), klebsiella, enterobacter, b. fragilis,
anaerobes or enterococcus
acute cholangitis sx Correct Answer *charcots triad:
fever/chills, RUQ pain jaundice*
*reynolds pentad*: charcots triad + shock + AMS
acute cholangitis tx Correct Answer abx vs colonic bacteria:
mono therapy (augmentin, pip/tazo) or
-ceftriazone + metronidazole
-fluoroquinolone + metronidazole
-ampicillin + gentamicin
-common bile duct decompression/stone extraction via ERCP
-PTC catheter drainage if unable to do ERCP
-open surgical decompression + T-tube insertion
acute cholecystitis dx Correct Answer US: *initial test* --
thickened gallbladder >3mm, distended gallbladder, sludge,
gallstones, pericholecystic fluid, +sonographic murphys sign
(pain when gallbladder palpated w/ US probe)
CT: alternative to US
, abdominal radiographies: 10% stones seen. usually incidental
finding on AXR
labs: increased WBCs (leukocytosis w/ L shift), increased
bilirubin, increased alkaline phosphatase, increased LFTs
*HIDA: gold standard* -- + scan shows non visualization of the
gallbladder
acute cholecystitis pathophys Correct Answer gall bladder
(cystic duct) obstruction by gallstone --> inflammation/infection
e. coli MC (50-80%), klebsiella, enterococci, b. fragilis,
clostridium
acute cholecystitis sx Correct Answer RUQ/epigastric pain
*continuous* in duration. may be associated w/ nausea and may
be precipitated by *fatty foods or large meals*
guarding, anorexia, jaundice not common but may be seen if
choledocholithiasis present
*fever* low grade
*enlarged palpable gall bladder, + murphys sign*
*+ boas sign*: referred pain to the R shoulder/scapular area
(phrenic nerve irritation)
