GI Disorders & Diseases 2 — Questions and Answers
Question 1: Which complication of cirrhosis is characterized by bacterial infection of ascitic fluid without an obvious intra-abdominal source?
- Hepatic encephalopathy
- Spontaneous bacterial peritonitis (Correct answer)
- Hepatorenal syndrome
- Variceal hemorrhage
Correct answer: Spontaneous bacterial peritonitis
Spontaneous bacterial peritonitis (SBP) is a serious complication of cirrhosis involving infection of ascitic fluid, typically diagnosed when ascitic fluid PMN count exceeds 250 cells/mm³.
Question 2: A patient presents with dysphagia to both solids and liquids from the start. Barium swallow shows a 'bird-beak' appearance at the lower esophagus. What is the most likely diagnosis?
- Esophageal carcinoma
- Zenker's diverticulum
- Achalasia (Correct answer)
- Esophageal stricture
Correct answer: Achalasia
Achalasia presents with dysphagia to both solids and liquids and shows a classic 'bird-beak' narrowing on barium swallow due to failure of the lower esophageal sphincter to relax.
Question 3: Which type of inflammatory bowel disease is characterized by transmural inflammation that can affect any part of the GI tract from mouth to anus?
- Ulcerative colitis
- Crohn's disease (Correct answer)
- Ischemic colitis
- Microscopic colitis
Correct answer: Crohn's disease
Crohn's disease involves transmural inflammation with skip lesions and can affect any segment of the GI tract, distinguishing it from ulcerative colitis which is limited to the colon mucosa.
Question 4: A patient with long-standing GERD develops Barrett's esophagus. Which cell type replaces the normal squamous epithelium in this condition?
- Transitional epithelium
- Cuboidal epithelium
- Intestinal metaplastic columnar epithelium (Correct answer)
- Stratified squamous epithelium
Correct answer: Intestinal metaplastic columnar epithelium
Barrett's esophagus is defined by replacement of normal squamous epithelium with specialized intestinal metaplastic columnar epithelium containing goblet cells, which increases adenocarcinoma risk.
Question 5: What is the most common cause of acute pancreatitis in the United States?
- Hypertriglyceridemia
- Alcohol use
- Gallstones (Correct answer)
- Medication-induced
Correct answer: Gallstones
Gallstones are the leading cause of acute pancreatitis in the US, accounting for approximately 40-70% of cases, followed by alcohol use.
Question 6: Which condition is characterized by multiple small outpouchings of the colonic mucosa through weakened areas of the muscular wall, predominantly in the sigmoid colon?
- Colonic polyps
- Diverticulosis (Correct answer)
- Volvulus
- Intussusception
Correct answer: Diverticulosis
Diverticulosis is the presence of multiple diverticula (outpouchings) in the colon, most commonly in the sigmoid, and is strongly associated with low-fiber diets.
Question 7: A patient with Zollinger-Ellison syndrome has recurrent peptic ulcers due to a gastrin-secreting tumor. Where is this tumor most commonly located?
- Stomach body
- Pancreas or duodenum (Correct answer)
- Ileum
- Jejunum
Correct answer: Pancreas or duodenum
Gastrinomas (Zollinger-Ellison syndrome) are most commonly located in the gastrinoma triangle, encompassing the pancreas and duodenum, with the duodenum being the most frequent site.
GI Disorders & Diseases 2
Which complication of cirrhosis is characterized by bacterial infection of ascitic fluid without an obvious intra-abdominal source?