GI (Colon/Rectum) Quiz 2

The statement is true because diverticula are small pouches that can form in the lining of the digestive system, particularly in the colon. When these diverticula become inflamed or infected, they can lead to a condition called diverticulitis. In severe cases, the diverticula can ulcerate, causing damage to the submucosal artery. This can result in bleeding and potentially lead to a rupture of the artery. Therefore, ulceration of the diverticula can indeed rupture the submucosal artery.

Adenomas are a type of tumor that are typically benign, meaning they are not cancerous. However, they are considered premalignant because there is a potential for them to develop into cancer if left untreated. This is why it is important to monitor and potentially remove adenomas, even though they are initially benign.

Neutropenic patients have a low count of neutrophils, which are a type of white blood cell responsible for fighting off infections. As a result, their immune system is compromised, making them more susceptible to developing sepsis, a severe and potentially life-threatening infection that can spread throughout the body. Therefore, it is true that neutropenic patients are prone to overwhelming sepsis.

After endoscopic treatment of high-risk ulcers, intravenous proton pump inhibitors (PPI) should be initiated to reduce acid secretion and promote healing. If no re-bleeding occurs within 24 hours, it indicates that the treatment has been successful in controlling the bleeding. At this point, the patient can be switched to oral PPI, which is more convenient for long-term maintenance therapy. This approach ensures that the patient receives the necessary acid suppression and reduces the risk of re-bleeding. Therefore, the statement "After endoscopic treatment of high-risk ulcers, IV PPI should be started and if no re-bleeding occurs in 24 hours the pt can be switched to oral PPI" is true.

Bleeding occurs more frequently in ulcerative colitis (UC) compared to Crohn's disease. This is because UC primarily affects the inner lining of the colon and rectum, leading to inflammation and ulceration. The constant inflammation and damage to the blood vessels in this area can cause bleeding. In contrast, Crohn's disease can affect any part of the digestive tract, including the small intestine, which may not result in as much bleeding as UC. Therefore, the statement that bleeding occurs more in UC than Crohn's disease is true.

If the carcinoembryonic antigen (CEA) levels do not return to normal within one month after surgery, it indicates that the cancerous tumor was not completely removed. CEA is a protein that is often elevated in individuals with certain types of cancer, including colorectal cancer. After surgery, the CEA levels should decrease as the tumor is removed. Therefore, if the CEA levels remain elevated, it suggests that there are still cancer cells present in the body. Hence, the statement is true.

Splanchnic vasoconstriction refers to the narrowing of blood vessels in the splanchnic circulation, which includes the blood vessels supplying the intestines. This vasoconstriction can lead to decreased blood flow to the intestines, resulting in mesenteric ischemia, a condition where the intestines do not receive enough oxygen and nutrients. Non-occlusive mesenteric ischemia is a type of mesenteric ischemia that occurs without a physical blockage in the blood vessels. Therefore, it is correct to say that splanchnic vasoconstriction is the cause of non-occlusive mesenteric ischemia.

A rectal prolapse occurs when the rectum protrudes from the anus. This can be caused by weakened pelvic muscles and tissues, which can be a result of chronic straining with defecation. Constipation can contribute to this condition as it often leads to increased pressure on the rectum during bowel movements. Infection of the internal hemorrhoid, diverticulitis of the sigmoid colon, and the presence of earthworms or pinworms are not typically associated with rectal prolapse.

The given statement suggests that the clinical diagnostic accuracy for acute abdominal pain is around 50%. This means that healthcare professionals are only able to accurately diagnose the cause of abdominal pain in about half of the cases. This could be due to the fact that abdominal pain can have various causes and symptoms can be similar for different conditions, making it challenging to pinpoint the exact cause accurately. It also emphasizes the need for further research and improved diagnostic methods in this area.

Herpes Zoster, also known as shingles, is a viral infection caused by the varicella-zoster virus. While it primarily affects the nerves and causes a painful rash, it can also lead to abdominal pain. This occurs when the virus affects the nerves that supply the abdominal area, resulting in pain in that region. Therefore, it is true that Herpes Zoster can be an extraintestinal cause of abdominal pain.

Defecography refers to the evaluation of anorectal function using a barium paste that is introduced into the rectum. The patient is then examined by fluoroscopy while defecating. This procedure helps to assess the movement and coordination of the rectum and anal sphincter muscles during defecation. It provides valuable information about any structural abnormalities or dysfunctions that may be causing symptoms such as constipation or fecal incontinence.

If a parent is affected by Familial Adenomatous Polyposis (FAP), there is a 50% chance that their child will develop the condition. This means that there is an equal probability of inheriting the genetic mutation that causes FAP from the affected parent.

A pilonidal cyst may develop when a dead hair is pushed into tiny abrasions in the skin. This can happen when hair follicles become blocked, causing the hair to grow inward instead of outward. The trapped hair can then cause inflammation and infection, leading to the formation of a cyst.

An "apple core lesion" may be seen in adenocarcinoma. This term is used to describe a specific appearance of a tumor in the colon or rectum, where the tumor narrows the lumen of the bowel and creates a characteristic appearance resembling an apple core on imaging studies such as a barium enema or colonoscopy. Adenocarcinoma is a type of cancer that arises from the glandular cells lining the inner surface of organs, and it is commonly associated with the development of apple core lesions in the colon or rectum.

Angiography should be used for upper GI bleed when endoscopy fails to locate the source of bleeding. This means that when the usual method of using endoscopy to visualize and locate the bleeding site in the upper gastrointestinal tract is unsuccessful, angiography can be an alternative diagnostic procedure. Angiography involves injecting contrast dye into the blood vessels and using X-rays to visualize the blood flow, which can help identify the source of bleeding and guide further treatment decisions.

Cirrhosis is a condition characterized by scarring of the liver, which can lead to increased pressure in the veins of the liver. This increased pressure can cause the development of varices, which are enlarged veins in the esophagus or stomach. The question asks for the percentage of patients with cirrhosis who will develop varices. The correct answer is 60%, indicating that a majority of patients with cirrhosis will develop varices.

The TIPS procedure, or Transjugular Intrahepatic Portosystemic Shunt, is used as a treatment option for portal hypertension with varices. Portal hypertension is a condition characterized by increased blood pressure in the portal vein, which carries blood from the digestive organs to the liver. Varices are enlarged veins that develop in the esophagus or stomach due to increased pressure in the portal vein. The TIPS procedure involves creating a shunt, or bypass, between the portal vein and the hepatic vein to relieve the pressure and reduce the risk of bleeding from varices.

Hematochezia refers to the presence of red or maroon blood in the stools. This condition can occur due to various reasons such as gastrointestinal bleeding, hemorrhoids, or inflammatory bowel disease. It is important to identify the cause of hematochezia as it may indicate a serious underlying condition that requires medical attention.

The risk of malignancy is related to the size of the polyp. Larger polyps have a higher likelihood of being cancerous or developing into cancer. Therefore, the statement that the risk of malignancy has no relation to the size of the polyp is false.

H. pylori, NSAIDS, ASA, and antibiotics commonly cause PUD (peptic ulcer disease). PUD is a condition characterized by the formation of ulcers in the lining of the stomach or the first part of the small intestine. H. pylori is a bacteria that can infect the stomach and lead to the development of ulcers. NSAIDs and ASA (aspirin) can irritate the stomach lining and increase the risk of ulcers. Antibiotics, when used improperly or for a prolonged period, can disrupt the balance of bacteria in the stomach and contribute to the development of ulcers.

Surgical procedures for rectal prolapse will only be considered for fecal incontinence and incarceration. This means that surgery is only recommended if the patient is experiencing fecal incontinence (inability to control bowel movements) or incarceration (the prolapse becomes trapped and cannot be pushed back in). Surgical intervention is not typically necessary for symptoms such as intense anal itching, restless sleep, or pruritus ani (itching around the anus).

In the management of the acute abdomen, it is most important to keep the patient NPO (nothing by mouth) until decisions about management have been made. This is because the cause of the acute abdomen needs to be determined before any interventions or treatments can be initiated. Allowing the patient to eat or drink may worsen their condition or interfere with diagnostic tests. Therefore, keeping the patient NPO ensures that they are in the best possible condition for further evaluation and appropriate management.

The major risk factors for stress gastritis include mechanical ventilation, trauma, and burns. These factors can lead to increased stress on the body, which can disrupt the normal functioning of the digestive system and increase the risk of developing gastritis. Mechanical ventilation can cause increased pressure in the abdomen, trauma can lead to tissue damage and inflammation, and burns can cause significant stress on the body. These factors can all contribute to the development of stress gastritis.

A SMA thrombosis refers to the formation of a thrombus, or clot, specifically at the blockage point within a blood vessel. Unlike other options, it does not involve diffuse vasoconstriction or the origin of an embolism from a left or right atrial mural thrombus. Additionally, it is not associated with frequent miscarriages.

Squamous Cell Carcinoma of the Anus is strongly related to HPV infection, specifically HPV types 16 and 18. This type of carcinoma arises from the squamous cells lining the anal canal. Dark blood stained stool can be a symptom of squamous cell carcinoma of the anus, indicating bleeding in the gastrointestinal tract. Adenocarcinoma of the rectum, Krukenberg Tumor, Kaposi's Sarcoma, and Melanoma are not typically associated with HPV infection or dark blood stained stool.

30% of colorectal cancer is found in the rectum

A patient with an upper GI bleed would most likely exhibit hematemesis, which is the vomiting of blood. This is because the blood from the upper gastrointestinal tract can be expelled through the mouth, resulting in the presence of blood in the vomit. Other options such as melena (dark, tarry stools), hematochezia (bright red blood in the stool), blood streaked stool, and occult blood in the stool may indicate lower GI bleeding or other conditions, but hematemesis is specifically associated with upper GI bleeding.

The ligament of Treitz is a fibrous band that connects the duodenum to the diaphragm. It is located at the duodenal/jejunal junction, which is the point where the duodenum transitions into the jejunum in the small intestine. This ligament helps to support and stabilize the small intestine, ensuring proper functioning and movement of food through the digestive system.

Endoscopy is the test of choice for Mallory-Weiss Tears. Mallory-Weiss Tears are lacerations or tears in the mucous membrane of the lower part of the esophagus or upper part of the stomach, usually caused by severe vomiting or retching. Endoscopy allows for direct visualization of the esophagus and stomach, enabling the identification and evaluation of any tears or bleeding. Bronchoscopy is used to examine the airways, flexible sigmoidography is used to examine the colon, echocardiogram is used to evaluate the heart, and transesophageal echo is used to view the heart and surrounding structures.

Patients with congestive heart failure (CHF), atrial fibrillation, and recent myocardial infarction (MI) are at higher risk for systemic mesenteric artery (SMA) emboli. CHF can cause blood stasis and increased clot formation, increasing the risk of emboli. Atrial fibrillation can lead to the formation of blood clots in the atria, which can travel to the SMA and cause an embolism. Recent MI can also increase the risk of clot formation and subsequent emboli. These conditions can impair blood flow and increase the likelihood of embolic events in the mesenteric arteries.

Hematochezia refers to the passage of bright red blood in the stool, indicating that the bleeding is occurring in the lower digestive tract. The answer suggests that the source of bleeding is from the left colon, but it can also originate from any part of the colon. This means that the bleeding can potentially come from the right colon as well. The other options provided do not accurately describe the characteristics or potential sources of hematochezia.

Intestinal angina is the correct answer because it refers to the symptom that patients usually express prior to acute mesenteric ischemia. Intestinal angina is characterized by severe abdominal pain that occurs after eating and is caused by inadequate blood flow to the intestines. This symptom is a result of reduced blood supply to the mesenteric arteries, leading to ischemia in the intestines.

Mesenteric angiography is the diagnostic test that confirms Acute Mesenteric Ischemia. This procedure involves injecting a contrast dye into the blood vessels of the mesentery, which supplies blood to the intestines. The dye helps visualize any blockages or narrowing of the blood vessels, which can indicate acute mesenteric ischemia. This test is considered the gold standard for diagnosing the condition as it provides detailed and accurate information about the blood flow in the mesenteric arteries.

A person with a moderately increased risk for colon cancer, specifically having one first-degree relative with colorectal cancer diagnosed at age 60 or older, should get their first colonoscopy at age 40 and then repeat it every 10 years. This is because having a first-degree relative with colorectal cancer increases the risk of developing the disease, and starting screening at age 40 allows for early detection and intervention if any abnormalities are found. The 10-year interval between colonoscopies is recommended for individuals with average risk, but in this case, it is important to start earlier due to the family history.

The statement "A lower GI bleed in anything above the ligament of Treitz" is false. The ligament of Treitz marks the boundary between the upper and lower gastrointestinal tract. Therefore, a lower GI bleed would occur below the ligament of Treitz, not above it.

Pinworms, also known as Enterobius vermicularis, are a common cause of pruritus ani. These small, thread-like parasites infect the intestines and lay their eggs around the anus, causing intense itching. The eggs can easily be transferred to the fingers, bedding, or clothing, leading to reinfection and the spread of the infection to others. Proper hygiene, including washing hands regularly and keeping the anal area clean, is essential in preventing and treating pinworm infestations.

The patient's symptoms of rectal bleeding, anemia, abdominal pain, and changes in stool diameter suggest a possible malignancy in the rectum. Adenocarcinoma is the most common type of colorectal cancer, and it typically presents with symptoms such as rectal bleeding, changes in bowel habits, and abdominal pain. Squamous cell carcinoma of the anus is less likely because the patient's symptoms are more consistent with rectal involvement. Familial Adenomatous Polyposis and Ulcerative Colitis can also cause rectal bleeding, but they are less likely given the patient's other symptoms. Rectal prolapse does not typically cause anemia or changes in stool diameter.

Placing a nasogastric (NG) tube is a common initial step in the management of upper gastrointestinal (GI) bleeding. It helps to assess the severity of bleeding, determine the source, and potentially aid in stopping the bleeding. By aspirating the gastric contents, the color and amount of blood can be assessed, providing important information about the bleeding site. Additionally, the NG tube can be used for lavage, administration of medications, or as a conduit for endoscopy or surgery if necessary. Therefore, if there is suspicion of an upper GI bleed, placing an NG tube promptly is recommended.

The correct answer is "Get a detailed history." When managing unstable active GI bleeds, the immediate action steps include NG or OG placement to decompress the stomach and prevent further bleeding, intubation to protect the airway in case of massive bleeding or aspiration, blood transfusion as needed to replace lost blood, and fluid resuscitation to maintain hemodynamic stability. However, obtaining a detailed history is not an immediate action step as it can be done once the patient's condition is stabilized.

The "scotch tape" test involves applying a piece of transparent tape to the skin around the anus and then examining it under a microscope for the presence of pinworm eggs. Pinworms are a common cause of pruritus ani, which is itching around the anus. Therefore, the "scotch tape" test is most useful in the diagnosis of pruritus ani.

Chronic Mesenteric Arterial Occlusion may need a balloon angioplasty to fix because this condition is caused by the narrowing or blockage of the arteries that supply blood to the intestines. Balloon angioplasty is a procedure that involves inserting a balloon-tipped catheter into the blocked artery and inflating the balloon to widen the artery and improve blood flow. This helps to relieve symptoms such as abdominal pain and improve the overall blood supply to the intestines.

Melena occurs when hemoglobin is degraded by bacteria over a period of at least 14 hours. This degradation process results in the black, tarry appearance of the stool. Hemoglobin is a protein found in red blood cells that carries oxygen throughout the body. When it is broken down by bacteria in the gastrointestinal tract, it produces a substance called hemosiderin, which gives the stool its characteristic color. The duration of at least 14 hours is important because it indicates that the blood has had enough time to travel through the digestive system and undergo this degradation process.

The presence of hyponatremia and porphobilinogen in the urine during an attack suggests a diagnosis of Acute Intermittent Porphyria. Acute Intermittent Porphyria is a rare genetic disorder characterized by a deficiency of the enzyme porphobilinogen deaminase, leading to the accumulation of porphobilinogen and other porphyrin precursors. This can cause abdominal pain, neurologic symptoms, and hyponatremia. Lead poisoning, Munchausen's syndrome, ovarian cyst rupture, and chronic mesenteric arterial occlusion are not associated with the specific lab findings mentioned.

Papaverine is a vasodilator medication that relaxes the smooth muscles in blood vessels, increasing blood flow. Acute Mesenteric Ischemia is a condition where there is a sudden decrease in blood flow to the intestines, which can lead to tissue damage and necrosis. By infusing Papaverine into the Superior Mesenteric Artery (SMA), it can help dilate the blood vessels and improve blood flow to the intestines, thus reducing the risk of tissue damage and improving the prognosis for the patient.

Amylase/Lipase is a routine test for the acute abdomen because it helps in diagnosing pancreatitis. Pancreatitis is a condition characterized by inflammation of the pancreas, which can cause severe abdominal pain. The levels of amylase and lipase, enzymes produced by the pancreas, are often elevated in cases of pancreatitis. Therefore, measuring the levels of amylase and lipase in the blood can help in the diagnosis and management of acute abdominal pain.

The term "pain out of proportion to findings" refers to a condition where a patient experiences severe pain that is not consistent with the physical examination findings. Chronic Mesenteric Arterial Occlusion is a condition that can cause this type of pain. It occurs when there is a gradual narrowing or blockage of the arteries that supply blood to the intestines, leading to inadequate blood flow and oxygenation. The severe abdominal pain experienced by patients with this condition may be disproportionate to the physical examination findings, making it a fitting explanation for the given term.

Acute Mesenteric Ischemia is the likely disease where a dilated small bowel and "thumb printing" on the abdominal x-ray will be seen. This condition is caused by a sudden decrease in blood flow to the intestines, leading to tissue damage and potentially life-threatening complications. The "thumb printing" appearance is due to edema and inflammation of the bowel wall. This finding is characteristic of acute mesenteric ischemia and helps differentiate it from other conditions listed.

The term "C1" of the Modified Duke staging system refers to the tumor penetrating into, but not through the muscularis propria of the bowel wall, with pathologic evidence of colon cancer in the lymph nodes. This means that the cancer has invaded the layers of the bowel wall but has not spread beyond it. The presence of cancer in the lymph nodes indicates that it has started to spread locally.

The portal vein is not involved in splanchnic circulation. Splanchnic circulation refers to the blood flow to the abdominal organs, including the stomach, liver, spleen, and intestines. The portal vein is responsible for carrying nutrient-rich blood from the gastrointestinal tract to the liver for processing before it enters the systemic circulation. The other options, including the celiac artery, superior mesenteric artery (SMA), inferior mesenteric artery (IMA), and abdominal aorta, are all involved in supplying blood to the abdominal organs and are therefore part of the splanchnic circulation.

SMA embolus refers to the obstruction of the superior mesenteric artery (SMA) by an embolus, which is a blood clot or other material that travels through the bloodstream and blocks a blood vessel. This condition can lead to mesenteric ischemia, which is the inadequate blood supply to the intestines. Nonocclusive mesenteric ischemia, rectal abscess, and deep vein thrombosis (DVT) are not typically associated with SMA embolus.