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Chamberlain NR 576/ NR567 Final –
Differential Diagnosis in Adult-Gerontology
Primary Care | 2025/2026 Update | Verified
Correct Questions & Answers | Grade A
Irritable bowel syndrome establish diagnosis
ROMEIV criteria: recurrent pain in the abdomen on avg >= 1 day per week in the previous 3
months with onset of >= 6 months before diagnosis
Irritable bowel syndrome clinical presentation
pain must be assoc. with atleast 2:
-change in stool frequency
-change in stool appearance or form
-pain related to defecation
IBS diagnosis must NOT have the following
Unintentional loss of weight
Age ≥50 years, without previous colon cancer screening
Recent change in bowel habit
Hematochezia or melena i.e. evidence of overt gastrointestinal bleeding
Nocturnal pain in the abdomen or passage of stools
History of inflammatory bowel disease or colorectal cancer in the family
Palpable abdominal mass or presence of lymphadenopathy
Positive fecal occult blood test
Blood testing showing evidence of iron deficiency anemia
Crohn's disease affects:
mouth to anus,
transmural (full wall) - thick intestinal wall
Discontinuous "skip lesions" - cobblestone appearance
fistulas/strictures are common
Crohn's symptoms
Abdominal pain,
diarrhea,
weight loss,
perianal disease;
malnutrition
perforation, stenosis, fistula
,crohn's diagnosis
- BEST: Upper GI series with small bowel follow through or video capsule endoscopy
- Xray shows cobblestoning and "string sign"
- Labs: + ASCA
Crohn's treatment
goal: remission.
meds: antibiotics, sulfasalazine, steroids
Infliximab (Remicade) newer med used for refractory Crohn's
surgery
ulcerative colitis affects:
Limited to colon/rectum, mucosal/superficial, continuous inflammation, bleeding/ulcers.
Ulcerative colitis risk factors
Jewish descent
White
Urban dwelling
Age 15-40 or 50-80
Family history
Diet: refined sugar
Medications: NSAIDs, OCPs
Nicotine DECREASES risk (protective)
UC treatment
steroids to induce remission
aspirin + sulfasalazine to maintain remission
6-MP, Methotrexate, Azithioprine for severe disease \
complications of UC
1. Toxic megacolon (can rupture)
2. Carcinoma (biggest complication)
3. severe bleeding
IBS vs IBD
IBS: Functional, no inflammation; symptoms: Pain, altered bowels constipation vs diarrhea,
bloating. Normal labs/endoscopy; Rome IV
IBD (Crohn's/UC): Inflammatory; systemic symptoms, weight loss, bleeding. Elevated
CRP/ESR; abnormal endoscopy/biopsy; needs imaging
colorectal cancer clinical presentation
Insidious asymptomatic onset; symptoms include rectal bleeding, change in bowel habits
(diarrhea/constipation), abdominal pain, weight loss, fatigue/anemia. Left-sided: Bright red
blood, narrow stools; right-sided: Occult blood, anemia. Advanced: Obstruction, perforation.
, Early: CRC colorectal polyps or often do not experience any symptoms
colorectal cancer risk
underlying cause is unclear, certain environmental and genetic factors increase the risk for
developing CRC. Risk factors include a diet high in fat and low in fiber, sedentary lifestyle,
family history of CRC, obesity, diabetes, smoking, and older age.
Colorectal cancer metastasis
metastasize (spread) through lymph and blood vessels to other areas of the body.
most common site is the liver, connected to the intestines by the hepatic portal vein drainage
system.
also spread to the lungs via the inferior vena cava (a large vein in the abdomen), forming
cannonball-shaped masses.
colorectal cancer screening recommendations
USPTFS
Start at age 50 years
Stop at age 85 years
Between the ages of 76-85 years individualize the decision taking into consideration the patient's
overall health, screening history, and preference.
Testing options:
Fecal occult blood test (FOBT) every year, or
Flexible sigmoidoscopy every 5 years, or
Colonoscopy every 10 years
American College of Gastroenterology
Start at age 50 years in non-blacks
Start at age 45 years for blacks (higher risk)
The preferred test is colonoscopy every 10 years
Patient who declines colonoscopy should be offered a fecal immunochemical test (FIT)
American Cancer Society
Start at age 45 years (for patients with life expectancy greater than 10 years)
Stop screening at age 75
Colorectal cx testing
Chamberlain NR 576/ NR567 Final –
Differential Diagnosis in Adult-Gerontology
Primary Care | 2025/2026 Update | Verified
Correct Questions & Answers | Grade A
Irritable bowel syndrome establish diagnosis
ROMEIV criteria: recurrent pain in the abdomen on avg >= 1 day per week in the previous 3
months with onset of >= 6 months before diagnosis
Irritable bowel syndrome clinical presentation
pain must be assoc. with atleast 2:
-change in stool frequency
-change in stool appearance or form
-pain related to defecation
IBS diagnosis must NOT have the following
Unintentional loss of weight
Age ≥50 years, without previous colon cancer screening
Recent change in bowel habit
Hematochezia or melena i.e. evidence of overt gastrointestinal bleeding
Nocturnal pain in the abdomen or passage of stools
History of inflammatory bowel disease or colorectal cancer in the family
Palpable abdominal mass or presence of lymphadenopathy
Positive fecal occult blood test
Blood testing showing evidence of iron deficiency anemia
Crohn's disease affects:
mouth to anus,
transmural (full wall) - thick intestinal wall
Discontinuous "skip lesions" - cobblestone appearance
fistulas/strictures are common
Crohn's symptoms
Abdominal pain,
diarrhea,
weight loss,
perianal disease;
malnutrition
perforation, stenosis, fistula
,crohn's diagnosis
- BEST: Upper GI series with small bowel follow through or video capsule endoscopy
- Xray shows cobblestoning and "string sign"
- Labs: + ASCA
Crohn's treatment
goal: remission.
meds: antibiotics, sulfasalazine, steroids
Infliximab (Remicade) newer med used for refractory Crohn's
surgery
ulcerative colitis affects:
Limited to colon/rectum, mucosal/superficial, continuous inflammation, bleeding/ulcers.
Ulcerative colitis risk factors
Jewish descent
White
Urban dwelling
Age 15-40 or 50-80
Family history
Diet: refined sugar
Medications: NSAIDs, OCPs
Nicotine DECREASES risk (protective)
UC treatment
steroids to induce remission
aspirin + sulfasalazine to maintain remission
6-MP, Methotrexate, Azithioprine for severe disease \
complications of UC
1. Toxic megacolon (can rupture)
2. Carcinoma (biggest complication)
3. severe bleeding
IBS vs IBD
IBS: Functional, no inflammation; symptoms: Pain, altered bowels constipation vs diarrhea,
bloating. Normal labs/endoscopy; Rome IV
IBD (Crohn's/UC): Inflammatory; systemic symptoms, weight loss, bleeding. Elevated
CRP/ESR; abnormal endoscopy/biopsy; needs imaging
colorectal cancer clinical presentation
Insidious asymptomatic onset; symptoms include rectal bleeding, change in bowel habits
(diarrhea/constipation), abdominal pain, weight loss, fatigue/anemia. Left-sided: Bright red
blood, narrow stools; right-sided: Occult blood, anemia. Advanced: Obstruction, perforation.
, Early: CRC colorectal polyps or often do not experience any symptoms
colorectal cancer risk
underlying cause is unclear, certain environmental and genetic factors increase the risk for
developing CRC. Risk factors include a diet high in fat and low in fiber, sedentary lifestyle,
family history of CRC, obesity, diabetes, smoking, and older age.
Colorectal cancer metastasis
metastasize (spread) through lymph and blood vessels to other areas of the body.
most common site is the liver, connected to the intestines by the hepatic portal vein drainage
system.
also spread to the lungs via the inferior vena cava (a large vein in the abdomen), forming
cannonball-shaped masses.
colorectal cancer screening recommendations
USPTFS
Start at age 50 years
Stop at age 85 years
Between the ages of 76-85 years individualize the decision taking into consideration the patient's
overall health, screening history, and preference.
Testing options:
Fecal occult blood test (FOBT) every year, or
Flexible sigmoidoscopy every 5 years, or
Colonoscopy every 10 years
American College of Gastroenterology
Start at age 50 years in non-blacks
Start at age 45 years for blacks (higher risk)
The preferred test is colonoscopy every 10 years
Patient who declines colonoscopy should be offered a fecal immunochemical test (FIT)
American Cancer Society
Start at age 45 years (for patients with life expectancy greater than 10 years)
Stop screening at age 75
Colorectal cx testing
