Digestive Disorders Practice Questions

Celiac disease is a T cell-mediated autoimmune, inflammatory condition of the small intestine, prompted by the consumption of gluten (contained in foods such as wheat, rye, and barley) in genetically susceptible individuals. Between one and two percent of the U.S. population is believed to suffer from celiac disease.

Gastroesophageal reflux disease (GERD) is persistent acid reflux and is a risk factor for the development of Barrett’s Esophagus, the condition in which the lining of the esophagus is replaced by mucosal tissue like that which lines the intestines. A small percentage of persons with Barrett’s esophagus develop a form of esophageal cancer.

Hepatitis A is viral infection that is preventable. The hepatitis A vaccine consists of two injections administered 6 months to one year apart. Hepatitis A is commonly spread by contact with an infected person’s stool.

Chronic hepatitis B is treated with interferon and peginterferon as well as with orally administered agents, including lamivudine, telbivudine, adefovir and entecavir. When chronic hepatitis B results in liver failure, liver transplantation may be indicated.

Crohn’s disease is an inflammatory bowel disease that frequently presents in young adults ages 20 to 30. Symptoms include pain in the lower right quadrant of the abdomen, diarrhea, weight loss, arthritis, and rectal bleeding. Complications include intestinal blockage, nutritional deficiencies, skin problems, gallstones, and kidney stones.

The presence of diverticula (pouches in the intestines) is common with advancing age; nearly half of persons age 60 and older have diverticulosis, which is generally asymptomatic. In contrast, persons with diverticulitis experience abdominal pain and other symptoms such as cramping, fever, and chills.

Bowel diversion surgeries such as colostomy, ileostomy, and ileoanal reservoir surgery remove damaged or diseased portions of the intestines. Gastroparesis, or delayed gastric emptying, may be treated with diet, drugs including metoclopramide, erythromycin, domperidone, parenteral nutrition, or gastric electrical stimulation.

Abdominal surgery, especially bowel and gynecological procedures, is the most frequent cause of abdominal adhesions. Abdominal adhesions may cause intestinal obstruction and female infertility.

Appendicitis, an acute infection and inflammation of the appendix, results in more emergency abdominal surgeries than any other condition. Medical history and physical examination are often sufficient to establish the diagnosis; however, laboratory tests and imaging studies may be performed if the patient presents with atypical symptoms.

In addition to worsening right abdominal pain, the symptoms of appendicitis may include nausea and vomiting, constipation or diarrhea, low-grade fever, and abdominal swelling. Guarding, rebound tenderness, and Rovsing’s sign (pain in the right lower quadrant when pressure is applied to the left) are also indicative.

Rectal bleeding is not a typical finding in acute appendicitis. Guarding, rebound tenderness, and Rovsing’s sign (pain in the right lower quadrant upon left-sided pressure) are common exam findings.

Ulcerative colitis symptoms are often chronic and intermittent. They may include fatigue, anorexia, malnutrition, skin lesions, and impaired growth in children, but not bradycardia.

Although stress and spicy foods may exacerbate symptoms, they do not cause peptic ulcers. H. pylori infection, NSAID use, and malignancy can directly lead to ulcer formation.

Peptic ulcer pain is typically dull and gnawing, often intermittent, and may be relieved by eating or antacids, but is not unrelenting and rapidly worsening.

Dyspepsia includes epigastric pain, fullness, and burning, but black tarry stools indicate gastrointestinal bleeding rather than simple indigestion.

All listed conditions can cause cirrhosis; in the U.S., excessive alcohol use, hepatitis C infection, and obesity-related nonalcoholic fatty liver disease are the leading causes.

Salmonella enteritidis is the classic pathogen from raw or undercooked eggs. Other common egg-associated pathogens include Campylobacter jejuni and Listeria monocytogenes. Botulism is linked to improperly canned foods.

An estimated 10% of the population has gallstones but most people are asymptomatic and require no treatment. In instances where gallstones injure or lodge in bile ducts or impede the flow of bile or digestive enzymes, oral dissolution therapy, contact dissolution therapy, or surgery—laparoscopic cholecystectomy or in about 5% of cases open procedures—may be indicated.

Populations at risk for gallstones include the above-mentioned groups as well as persons who are overweight or obese, persons who experience rapid weight loss such as bariatric surgery patients, diabetics, persons with a family history of gallstones, and persons who take statin drugs.

Chronic pancreatitis often presents in adults ages 30 to 40 and in addition to chronic, excessive alcohol use, cystic fibrosis, and hypercalcemia may be caused or precipitated by hyperlipidemia, hypertriglyceridemia, or autoimmune disorders. Untreated, chronic pancreatitis results in calcification, which is permanent damage, and may require surgical excision.