GI

Question 1

What organs are located in the Right Upper Quadrant (RUQ)?

Answer 1

Liver, Gallbladder, Ascending Colon, Right Kidney, Pancreas (small)

Question 2

What organs are located in the Left Upper Quadrant (LUQ)?

Answer 2

Stomach, Pancreas, Descending Colon, Left Kidney

Question 3

What organs are located in the Right Lower Quadrant (RLQ)?

Answer 3

Appendix, Ileum, Sigmoid Colon, Right Ovary

Question 4

What organs are located in the Left Lower Quadrant (LLQ)?

Answer 4

Sigmoid Colon, Left Ovary

Question 5

What is the suprapubic region associated with?

Answer 5

Bladder, Uterus, Rectum

Question 6

What are the most common abdominal complaints?

Answer 6

RUQ: Cholecystitis (Gallbladder), Hepatitis (Liver),
RLQ: Appendicitis (Appendix),
LUQ: Pancreatitis (Pancreas),
LLQ: Diverticulitis (Sigmoid Colon)

Question 7

What is Rovsing’s Sign?

Answer 7

Palpation of the LLQ elicits pain in the RLQ.

Think ‘ZING’ as pain signals shoot across the abdominal wall.

Question 8

What is Markle Sign?

Answer 8

Pain in the RLQ when dropping down onto heels, hopping, or driving on bumpy roads.

Known as the ‘heel drop test’.

Question 9

What is Blumberg’s Sign?

Answer 9

Pain upon lifting hand after palpation of the abdomen.

This is also referred to as ‘rebound tenderness’.

Question 10

What is McBurney’s Sign?

Answer 10

Tenderness with palpation of McBurney’s point, which is 2/3 distance between umbilicus and anterior iliac crest.

Question 11

What is the Iliopsoas Sign?

Answer 11

Pain upon lifting the right leg against resistance of the examiner’s hand.

Question 12

What is Obturator’s Sign?

Answer 12

Pain with internal rotation of the right hip joint (with right knee flexed).

Question 13

What is Murphy’s Sign?

Answer 13

Pain on inspiration with palpation into the subcostal area (under rib cage) in the RUQ.

+ cholecystitis

Question 14

What is appendicitis?

Answer 14

Inflamed or ruptured appendix.

Question 15

What are the signs and symptoms of appendicitis?

Answer 15

Acute onset right lower quadrant (RLQ) abdominal pain, nausea, vomiting, low-grade fevers & poor appetite.

Question 16

What are the positive exam findings for appendicitis?

Answer 16

Think of your ‘Pick-Six’ tests.

Question 17

What diagnostics are used for appendicitis?

Answer 17

Refer to ED for ultrasound.

Question 18

What is a high alert sign for appendicitis?

Answer 18

Appendicitis rupture! Rigid ‘board-like abdomen’ with guarding & rebound tenderness.

Question 19

What is the treatment for appendicitis?

Answer 19

Surgical removal (appendectomy).

Question 20

What is cholecystitis?

Answer 20

Inflamed gallbladder.

Question 21

What are the signs and symptoms of cholecystitis?

Answer 21

Right upper quadrant (RUQ) to epigastric abdominal pain after fatty meals or alcohol consumption. Pain can radiate to right shoulder.

Question 22

What is diverticulitis?

Answer 22

Inflamed diverticuli of colon.

Question 23

What are the signs and symptoms of diverticulitis?

Answer 23

Acute onset left lower quadrant (LLQ) abdominal pain with high fever, nausea, vomiting, & poor appetite.

Question 24

What are the positive exam findings for diverticulitis?

Answer 24

+Rovsing, +Blumberg. ‘Board-like abdomen’ description.

Question 25

What are the risk factors for diverticulitis?

Answer 25

Older age, constipation, low fiber intake, obesity, lack of exercise, +/- NSAID use.

Question 26

What diagnostics are used for diverticulitis?

Answer 26

Ultrasound & CBC (high WBC's).

Question 27

What is the treatment for diverticulitis?

Answer 27

Ciprofloxacin & metronidazole (Flagyl).

Question 28

What is pancreatitis?

Answer 28

Inflamed pancreas.

Question 29

What are the hallmark signs and symptoms of pancreatitis?

Answer 29

Signs of intra-abdominal bleeding.

Question 30

What are the risk factors for pancreatitis?

Answer 30

'Fat fertile females over forty' club.

Question 31

What diagnostics are used for pancreatitis?

Answer 31

Positive Murphy's sign, abdominal ultrasound (rule out HIDA scan).

Question 32

What is Cullen's sign?

Answer 32

Blue discoloration around umbilicus.

Question 33

What is Turner's sign?

Answer 33

Blue discoloration around flank.

Question 34

What are the risk factors for pancreatitis?

Answer 34

Drug use, biliary factors, alcohol abuse, elevated lipid levels.

Question 35

What are pancreas specific labs for pancreatitis?

Answer 35

Amylase & lipase (3x normal).

Question 36

What are common symptoms of Barret Esophagus?

Answer 36

Dysphagia, iron deficiency anemia (IDA), weight loss, and hemooccult stool positive.

Question 37

What is the ideal treatment for uninsured patients or those with B12 deficiency?

Answer 37

an H2 blocker “tidine”

Question 38

What is the role of Proton Pump Inhibitors (PPIs) in GERD?

Answer 38

Indicated for moderate to severe GERD symptoms. ## Footnote Try after failed H2 blocker trial.

Question 39

What are the long-term side effects of PPIs?

Answer 39

1. Osteoporosis 2. B12 deficiency 3. C. diff infections.

Question 40

What is Barrett's esophagus?

Answer 40

A condition that results from repeated exposure to stomach acid, common in chronic GERD patients.

Question 41

What diagnostics are used for Barrett esophagus?

Answer 41

Upper endoscopy with biopsy.

Question 42

What medications should be avoided in GERD patients?

Answer 42

Calcium channel blockers (CCBs) as they weaken the gastric sphincter.

Question 43

What are the diagnostic tests for Helicobacter pylori (H. pylori) infections?

Answer 43

Upper endoscopy (+/- biopsy) and urea breath test (most sensitive).

Question 44

What is triple therapy for H. pylori?

Answer 44

Clarithromycin, amoxicillin, and a PPI.

Question 45

What is quadruple therapy for H. pylori?

Answer 45

Metronidazole, PPI, tetracycline, and bismuth salts.

Question 46

What are the new colonoscopy guidelines for screening?

Answer 46

Screening is recommended for patients over 45 years old. ## Footnote Older guidelines recommended screening for patients over 50 years old.

Question 47

How often should colonoscopies be obtained?

Answer 47

Every 10 years with annual fecal occult blood tests. ## Footnote Earlier if there is a personal or family history (1st degree relative) of colon cancer.

Question 48

What are hallmark signs/symptoms of colon cancer?

Answer 48

"Ribbon-shaped" thin stools.

Question 49

Where do most polyps occur?

Answer 49

Descending colon.

Question 50

What is celiac disease?

Answer 50

An immune reaction (ranging from mild to severe intolerance) to eating gluten.

Question 51

What is gluten?

Answer 51

A protein found in foods containing wheat, barley, or rye.

Question 52

What is the treatment for celiac disease?

Answer 52

Avoid and remove gluten from diet.

Question 53

What is nephrolithiasis?

Answer 53

Renal calculi, commonly known as kidney stones.

Question 54

What are signs/symptoms of nephrolithiasis?

Answer 54

Colicky flank pain in waves of 20-60 minute episodes.

Question 55

What are high-risk medications for nephrolithiasis?

Answer 55

Acyclovir, sulfadiazine, and indinavir.

Question 56

What foods should be avoided in nephrolithiasis?

Answer 56

Foods high in oxalate such as chocolate, spinach, rhubarb, beans, tangerines, and coffee.

Question 57

What is the difference between IBS and IBD?

Answer 57

IBS will not show elevated inflammatory markers (i.e., ESR or CRP); etiology is irritation, not inflammation.

Question 58

What is inflammatory bowel disease?

Answer 58

Includes Crohn's disease and ulcerative colitis, can affect any area of the GI tract.

Question 59

What are common symptoms of Crohn's disease?

Answer 59

Relapses are common, hematochezia, fistula, and strictures (jelly/mucus stools).

Question 60

What are the signs/symptoms of C. difficile infections?

Answer 60

10-15 stools per day with cramping and fevers.

Question 61

What is a risk factor for C. difficile infections?

Answer 61

Recent antibiotic use.

Question 62

What is the treatment for C. difficile infections?

Answer 62

Vancomycin antibiotics.