Irritable Bowel Syndrome & Colorectal Cancer Screening

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Questions and Answers

What symptom is most likely associated with a lower gastrointestinal bleed?

Coffee ground emesis

Melena

Hematochezia (correct)

Abdominal tenderness

Which of the following can cause a false-positive for upper gastrointestinal bleeding?

Hemorrhoids

Dietary iron intake

Hematochezia

Pepto-Bismol (correct)

What is a likely presentation for a patient with a small bowel obstruction?

High pitched bowel sounds near the site of obstruction (correct)

Bright red blood in stool

Absent bowel sounds

Flank pain

Which abdominal region is primarily associated with the right kidney?

Right Hypochondriac Signup and view all the answers

What condition commonly causes melena, indicating an upper gastrointestinal bleed?

Gastric ulcer Signup and view all the answers

Which of the following is NOT one of the Rome IV Criteria for diagnosing IBS?

Change in appetite Signup and view all the answers

What is the recommended age range to start colonoscopy screening for colorectal cancer in average-risk patients?

45-50 years Signup and view all the answers

Which of the following symptoms is most commonly associated with changes in bowel habits indicating potential colorectal cancer?

Pencil thin stools Signup and view all the answers

Which testing method is generally recommended annually for detecting occult blood when colonoscopy is not an option?

Fecal Immunochemical Testing Signup and view all the answers

What is an indicator of hyperactive bowel sounds during auscultation?

Loud overactive gurgling sounds Signup and view all the answers

Which condition is likely indicated by the presence of bruits upon auscultation of the abdomen?

Atherosclerotic plaque build-up Signup and view all the answers

What is the recommended testing frequency for Cologuard in older patients or those with increased risk?

Every 1-3 years Signup and view all the answers

What is a common characteristic of absent bowel sounds during a clinical examination?

No bowel sounds heard after 2 minutes in one position Signup and view all the answers

Which of the following signs are associated with appendicitis?

Positive Psoas Sign Signup and view all the answers

Which condition is identified as an emergency referral due to its risk factors?

Pancreatitis Signup and view all the answers

What characteristic is commonly associated with peritonitis?

Rigid abdomen that does not move with respiration Signup and view all the answers

Which of the following conditions might result in large bowel obstruction?

Intestinal Obstruction due to adhesions Signup and view all the answers

Which of the following statements is true concerning diverticulitis?

It is associated with outpouchings of the colon. Signup and view all the answers

What symptom is most characteristic of pancreatitis?

Relief when leaning forward Signup and view all the answers

Which of the following findings would rule out a diagnosis of ascites?

Negative Fluid Wave Test Signup and view all the answers

Which condition may cause rebound tenderness in the abdomen?

Cholecystitis Signup and view all the answers

Which symptom is NOT typically associated with diverticulitis?

Weight gain Signup and view all the answers

What laboratory test is commonly used to identify inflammation in patients with inflammatory bowel disease?

C-reactive protein (CRP) Signup and view all the answers

Which condition is least likely to cause right upper quadrant pain?

Colitis Signup and view all the answers

Which statement about Crohn’s Disease is accurate?

It can cause macrocytic anemia. Signup and view all the answers

In patients with ulcerative colitis, which laboratory finding is commonly observed?

Elevated white blood cell count Signup and view all the answers

Which condition is most commonly associated with H. pylori infection?

Peptic ulcer disease Signup and view all the answers

What is a less common differential diagnosis for left upper quadrant pain?

Acute cholecystitis Signup and view all the answers

Which of the following is a complication associated with diverticulitis?

Bowel obstruction Signup and view all the answers

What is the initial presentation of genital herpes caused by HSV?

Multiple vesicles and ulcers Signup and view all the answers

Which condition presents with multiple, moist, flat, round lesions?

Condylomata lata Signup and view all the answers

What is the treatment for primary syphilis?

IM penicillin G benzathine Signup and view all the answers

Which lesion is characterized by a single well-demarcated ulcer with a clean base?

Chancre Signup and view all the answers

What distinguishes condylomata acuminata from other genital lesions?

Painless verrucous formations Signup and view all the answers

What is the appearance of a lesion caused by Chancroid?

Nonindurated with a friable base Signup and view all the answers

Which of the following dietary changes is advised for managing genital herpes?

Low arginine, high lysine diet Signup and view all the answers

Which characteristic is NOT associated with molluscum contagiosum?

Severe pain Signup and view all the answers

Study Notes

Irritable Bowel Syndrome (IBS)

Rome IV Criteria
- Recurrent abdominal pain, at least 1 day per week in the last 3 months
- Associated with two or more of the following:
  - Related to defecation
  - Associated with a change in stool frequency
  - Associated with a change in stool form (appearance)

Colorectal Cancer Screening

Recommended for those at high risk or average risk starting at ages 45-50
Colonoscopy every 10 years
Fecal Immunochemical Testing (FIT) for occult blood annually for those unable to have a colonoscopy
Cologuard (Stool DNA testing) every 1-3 years for older patients or those with colonoscopy risk
CT colonography every 5 years is an alternative
If any of the above tests are positive, a colonoscopy is recommended

Abdominal Sounds

Hyperactive: loud, gurgling, and rushed sounds, common with diarrhea.
Hypoactive: soft, low, widely separated sounds, common with constipation, fasting.
Absent: No bowel sounds present in one position after 2 minutes of auscultation, could be obstruction.
Bruits: Due to atherosclerotic plaque build-up in an artery narrowing the lumen and turbulent blood flow. May be present with abdominal aortic aneurysm (AAA) or renal artery stenosis.

Causes of Jaundice

Liver disease, biliary obstruction, pancreatitis, or pancreatic cancer.
Viral Hepatitis (A, B, C)

Causes of Upper and Lower Gastrointestinal Bleeding

Hematochezia (bright red blood)
- Lower GI bleed
- Examples: colon cancer, diverticular disease, ulcerative colitis, hemorrhoids
Melena (black, tarry, “coffee ground” appearance)
- Upper GI bleed
- Examples: gastric or duodenal ulcer, esophageal bleed
- Note: iron supplements, Pepto-Bismol, and Maalox can also cause melena.

Abdominal Examination Findings

Soft and non-tender to palpation, no organomegaly or masses
Negative McBurney’s and Rovsing’s Signs (for appendicitis)
No hepatomegaly, (-) Murphey’s Sign (for gallbladder), No splenomegaly
Abdominal aorta is 2-4 cm in width (AAA)
Negative Fluid Wave Test (for ascites)
Negative CVA tenderness (for pyelonephritis)

Emergency Referrals

Abdominal Aortic Aneurysm (AAA)
Appendicitis
Cholecystitis/Cholangitis
Diverticulitis (if severe)
Intestinal Obstruction
Large Bowel Obstruction
Pancreatitis
Peritonitis

Diverticulosis vs. Diverticulitis

Diverticulosis
- Outpouching of sacs in the colon
- Can have intermittent LLQ (sometimes RLQ), constipation, and rectal bleeding.
Diverticulitis
- Inflammation and infection of the diverticula (sacs)
- LLQ pain, fever, chills, nausea, vomiting, constipation or diarrhea.
- Do NOT perform a colonoscopy during an active episode.
- Seek emergency care if symptoms are severe.

Inflammatory Bowel Disease (IBD)

Structural disorder dx by labs/imaging
CRP, ESR, and lactoferrin can help identify inflammation.
Autoantibodies support autoimmune etiology.

Differentials for RUQ, RLQ, and LUQ pain

RUQ Pain

Acute cholecystitis/cholelithiasis
Pleuritic pain
Lung/cardiac causes
Pancreatitis
Perforated duodenal ulcer
Subphrenic abscess
Pyelonephritis
Colitis
Hepatic carcinoma

RLQ Pain

Appendicitis
Perforated duodenal ulcer
Ovarian cyst/torsion
Ectopic pregnancy

LUQ Pain

Spleen pain/enlargement
- Examples: Epstein-Barr Virus (EBV), mononucleosis, splenic rupture, splenic cancers.
Abdominal Aortic Aneurysm (AAA)
Subphrenic abscess
Perforated gastric ulcer
Pyelonephritis
Colitis
Colon cancer

Conditions Caused by H. pylori

Gastritis
Peptic ulcer disease (PUD)
Positive H. pylori urea breath test

Genital Lesion Differentials

Painful Genital Lesions
- Herpes Simplex Virus (HSV) (Genital Herpes)
  - Multiple ulcers, vesicles. Initial outbreak is more severe with multiple ulcers, recurrent episodes often have single ulcers
- Chancroid
  - Nonindurated, serpiginous border, friable base that bleeds
- Condylomata lata (Secondary syphilis)
  - Multiple, moist, flat, round papules. Chancre is the primary lesion of syphilis.
- Molluscum contagiosum
  - Usually painless but can be itchy
Painless Genital Lesions
- Chancre (Primary syphilis)
  - Single, well-demarcated ulcer with a clean base and indurated border.
- Condylomata acuminata (Genital warts)
  - Multiple, verrucous growths
- Molluscum contagiosum
  - 1-5 mm umbilicated papules, often in clusters, can express caseous material from center

Treatment for Genital Lesions

Genital Herpes (HSV)
- Outbreak management with antivirals (acyclovir, valacyclovir/famciclovir)
- Dietary changes (low arginine, high lysine)
- L-lysine supplements (antiviral nutrients)
Syphilis (primary)
- IM penicillin G benzathine, 2.4 million units in a single dose.

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Description

This quiz covers essential topics related to Irritable Bowel Syndrome (IBS) and colorectal cancer screening protocols. It includes the Rome IV criteria for IBS diagnosis, recommended screening methods based on risk levels, and differentiating abdominal sounds. Test your knowledge on these crucial aspects of gastrointestinal health.