Questions and Answers
What is a primary characteristic of chronic constipation as per the Rome IV Functional Constipation Criteria?
Which of the following symptoms is NOT typically associated with chronic constipation?
What is a common risk factor for developing Small Intestinal Bacterial Overgrowth (SIBO) in patients with IBS?
Which of the following statements is accurate regarding food sensitivity testing in IBS?
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What defines a red flag feature in constipation?
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Which is a false statement regarding the epidemiology of chronic constipation?
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What are the most common symptoms of chronic constipation?
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Patients with IBS have a higher likelihood of testing positive for SIBO using which of the following tests?
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What is a common characteristic of Small Intestinal Bacterial Overgrowth (SIBO)?
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Which test is commonly used to identify food sensitivities in patients with chronic gastrointestinal symptoms?
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What is the primary symptom associated with Irritable Bowel Syndrome (IBS)?
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Which of the following is a recognized feature of chronic constipation?
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What has been suggested as a personalized intervention for patients with IBS based on microbiome analysis?
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Which mechanism is primarily involved in chronic diarrhea as per current research?
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Which of these conditions is often misdiagnosed as IBS due to similar symptoms?
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What is a potential complication in patients with chronic constipation?
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Which symptom is considered an alarm feature when assessing IBS-D?
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Which stool types indicate IBS-C according to the Rome IV criteria?
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What is the minimum duration for symptoms to be diagnosed as IBS?
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What is a common purpose of food sensitivity testing in IBS management?
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Which of the following is NOT typically associated with chronic constipation features?
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In patients suspected of having IBS-D, which test is recommended?
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Which of the following would likely classify a patient as IBS-U?
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What percentage of bowel movements must consist of Bristol stool types 6 and 7 to meet IBS-C criteria?
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What is the most significant laboratory finding indicative of acute pancreatitis?
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In chronic pancreatitis, which symptom is most commonly reported by patients?
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Which of the following signs is considered rare in the presentation of pancreatitis?
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Which finding would suggest that acute pancreatitis is unlikely?
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What does steatorrhea primarily indicate in chronic pancreatitis?
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What is a common complication associated with chronic pancreatitis?
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Which of the following statements about pain characteristics in pancreatitis is accurate?
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What imaging study is recommended for all patients suspected of having acute pancreatitis?
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What is the estimated prevalence of Peptic Ulcer Disease (PUD) in patients aged 75 years with current NSAID use?
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Which of the following is a common life-threatening complication associated with Peptic Ulcer Disease?
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What percentage of patients with serious complications from Peptic Ulcer Disease had no prior symptoms?
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Which test is NOT typically used for screening H. pylori infection in patients suspected of have Peptic Ulcer Disease?
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What is the typical rate of asymptomatic NSAID-associated ulcers in patients?
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Which symptom is least likely associated with Peptic Ulcer Disease?
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In the context of Ectopic Pregnancies, what is the expected percentage recurrence rate for tubal pregnancies?
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Which of the following is the most common cause of acute pancreatitis?
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What type of imaging is considered most accurate for diagnosing nephrolithiasis?
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Which laboratory finding is commonly associated with cholecystitis?
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Which symptom is NOT typically associated with nephrolithiasis?
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What percentage of patients with acute pancreatitis have low-grade fevers?
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What is the most common type of kidney stone?
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Which factor is considered a risk factor for developing nephrolithiasis?
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Which of the following complications can arise from untreated cholecystitis?
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Study Notes
Chronic Constipation
- Defined as difficult, unsatisfactory, or infrequent defecation.
- More prevalent in females and increases with age.
- Genetic predisposition can play a role.
Signs and Symptoms
- Frequent symptoms include straining and hard stools.
- Differentiate between chronic constipation and IBS-C, which presents without pain or visceral hypersensitivity.
- Digital rectal exam can identify stool, masses, hemorrhoids, fissures, prolapse, and rectoceles.
Rome IV Functional Constipation Criteria
- Straining during bowel movements and hard stools (Bristol types 1-2).
- Sensation of incomplete evacuation and anorectal obstruction.
- Manual maneuvers required for evacuation.
- Less than three spontaneous bowel movements per week, with a 25% prevalence in bowel movements.
- Abdominal pain is absent.
Red Flag/Alarm Features
- Presence of blood in stool, significant weight loss, and anemia.
- Family history of colon cancer, celiac disease, or inflammatory bowel disease.
- Acute onset after age 50, significant abdominal pain, recurrent vomiting, or fever.
Irritable Bowel Syndrome (IBS) Prognosis
- No increased risk for colorectal cancer.
- Slightly elevated risk for celiac disease and inflammatory bowel disease within five years post-diagnosis.
- Quality of life is a crucial consideration for management.
IBS Additional Investigations
- IgG food sensitivity testing may be conducted.
- Small Intestinal Bacterial Overgrowth (SIBO) testing is also relevant.
Small Intestinal Bacterial Overgrowth (SIBO)
- Patients with IBS show a significantly higher likelihood (2.6 to 8.3 times) of positive SIBO tests compared to healthy individuals.
- Diagnostic methods include Glucose Hydrogen Breath Test (GHBT) and jejunal aspirate culture.
Rome IV IBS Subtypes
- IBS-C (Constipation dominant): At least 25% of bowel movements are Bristol stools 1 and 2.
- IBS-U (Unclassified): Patients meeting IBS criteria without clear classification into other types.
IBS-Diarrhea Investigations
- Recommended limited blood testing for suspected IBS-D or functional diarrhea in the absence of alarm features.
- Essential tests include Complete Blood Count, C-reactive protein, and celiac disease screening.
IBS-Diarrhea Alarm Features
- Unintentional weight loss, nocturnal diarrhea, tenesmus, and bright red blood in stool.
- High-volume diarrhea and concerns about malnutrition.
- Family history of colorectal cancer warrants further investigation.
H. Pylori Infection
- Esophagogastroduodenoscopy (EGD) recommended for individuals over 60 or with alarming symptoms.
Cholecystitis
- Inflammation of the gallbladder or bile ducts, usually due to cystic duct obstruction.
- Accounts for one-third of patients over 55 presenting with acute abdominal pain.
Signs & Symptoms
- Murphy’s sign shows high likelihood of cholecystitis (LR+ 5.0).
- Right upper quadrant pain (LR+ 2.5) and fever (LR+ 1.8) also indicative.
- Jaundice has neutral likelihood (LR 1.0), with nausea/vomiting commonly present.
Investigations
- Leukocytosis, defined as >10,000/mcL, in 52–63% of patients.
- Ultrasound shows presence of cholelithiasis in 84–99% of cases.
- Cholecystitis does not significantly elevate lipase or liver tests.
Prognosis
- Untreated cholecystitis can lead to necrosis, infection, and gangrene.
Nephrolithiasis
- Also referred to as kidney stones, with a 35–50% recurrence rate at 5 years.
- More prevalent in men (2-3 times more than women), family history increases risk (relative risk 2.6).
Signs & Symptoms
- Excruciating back and flank pain, possibly radiating to the abdomen or groin.
- Associated discomfort with nausea, vomiting, dysuria, and urinary frequency; hematuria can be present but is not definitive.
Investigations
- Non-contrast renal CT most accurate for diagnosis (LR+ 48; LR− 0.05).
- Stone composition analysis recommended for prevention of recurrence.
Types of Kidney Stones
- Calcium oxalate (75%), calcium phosphate (5%), uric acid (5–10%), struvite (5–15%), as well as cystine and indinavir stones.
Prognosis
- Risks include ureteral obstruction, pyelonephritis, sepsis, and rare acute kidney injury.
Acute Pancreatitis
- Major causes include alcohol abuse and choledocholithiasis (80% of cases).
- 15-25% are idiopathic, potentially due to microlithiasis or sphincter dysfunction.
Signs & Symptoms
- Low-grade fevers in 60% of cases; pain may radiate to the back and is worsened in the supine position.
- Nausea and vomiting present in 75%; rebound tenderness is rare.
Investigations
- Blood tests show lipase > three times upper limit of normal; elevated amylase indicative.
- Transabdominal ultrasound for gallstones or common bile duct dilation.
Chronic Pancreatitis
- Often a consequence of recurrent acute pancreatitis, primarily due to alcohol abuse (70% of cases).
Signs & Symptoms
- Chronic mid-epigastric pain post-meal, radiating to the back.
- Symptoms may include abdominal bloating, weight loss, diarrhea, and steatorrhea.
Steatorrhea
- Characterized by difficult-to-flush oily stools; may indicate malabsorption.
Gynecological Emergencies: Ectopic Pregnancy
- Recurrence rate of repeat tubal pregnancy is about 10%.
- Mortality is rare if managed before rupture; consider high-dose NSAIDs and concurrent H. pylori infection risks.
Peptic Ulcer Disease (PUD)
- Prevalence in dyspeptic patients increases with age and NSAID/H. pylori use.
Signs & Symptoms
- 60% of NSAID-related ulcers asymptomatic; unintentional weight loss noted in 31–55% of benign gastric ulcer cases.
Prognosis
- Life-threatening complications may arise without prior symptoms, including severe hemorrhage or perforation.
Investigations
- Screen for H. pylori using urea breath test, stool antigen test, or blood test (antibodies not distinguishing between past or current infection).
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Description
This quiz explores the definition, epidemiology, and symptoms of chronic constipation. Understanding the key differences between chronic functional constipation and IBS-C is essential for better diagnosis and treatment. Test your knowledge on this common gastrointestinal issue!