How Much You Know About Gastroenterology? Trivia Quiz

Ulcerative colitis is a chronic inflammatory bowel disease that primarily affects the colon and rectum. One of the key distinguishing features of ulcerative colitis is the increased risk of carcinoma of the colon, which refers to the development of colon cancer. This increased risk is not typically associated with Crohn's disease, another type of inflammatory bowel disease. Therefore, the presence of an increased risk of colon cancer is more closely associated with ulcerative colitis rather than Crohn's disease.

CT of the abdomen and pelvis is recommended as the initial diagnostic procedure in this situation because the patient's symptoms and physical examination findings are consistent with acute diverticulitis. CT scan is the most accurate imaging modality to confirm the diagnosis of diverticulitis and assess the severity of the condition. It can identify complications such as abscess formation, perforation, or fistula. CT scan also helps in ruling out other differential diagnoses such as ovarian torsion or appendicitis. This procedure provides valuable information for guiding further management decisions.

The most likely diagnosis in this case is diverticulitis. Diverticulitis is characterized by inflammation and infection of small pouches called diverticula that develop in the walls of the colon. The symptoms mentioned, such as fever, fatigue, weight loss, and mild diarrhea, are commonly seen in diverticulitis. The presence of a mildly tender mass in the left lower quadrant of the abdomen further supports this diagnosis. Crohn's disease and ulcerative colitis are inflammatory bowel diseases, but they typically present with different symptoms and do not usually involve the formation of masses. Celiac disease is an autoimmune disorder triggered by gluten consumption and does not typically cause abdominal masses. Lymphoma may present with similar symptoms, but the presence of a mass makes diverticulitis more likely.

Based on the information provided, the most appropriate course of action would be to refer the patient for a colonoscopy. This is because a positive fecal occult blood test can indicate the presence of colorectal cancer or other gastrointestinal conditions, and a colonoscopy is the gold standard for diagnosing these conditions. It allows for direct visualization of the colon and the ability to take biopsies or remove any abnormal growths. Repeat testing in 3 months may not be sufficient if there is a potential underlying issue that needs to be addressed promptly. A rectal examination or other imaging tests would not provide the same level of diagnostic accuracy as a colonoscopy.

The most likely cause of the patient's bleeding is ischemic colitis. This is supported by the patient's age, history of multi-infarct dementia, and the presence of lower abdominal pain and bloody diarrhea. Ischemic colitis occurs when there is a decrease in blood flow to the colon, leading to inflammation and injury to the intestinal lining. This can result in symptoms such as abdominal pain and bloody diarrhea.

There is no need for the patient to limit intake of any specific food other than increasing fiber intake. Sigmoid diverticulosis is often associated with a low-fiber diet, so increasing fiber intake is recommended to prevent complications such as diverticulitis. However, there is no evidence to suggest that limiting intake of dairy products, spicy foods, wheat flour, or nuts would have any impact on diverticulosis. Therefore, the patient does not need to make any specific dietary limitations other than increasing fiber intake.

The correct answer is amoxicillin/clavulanate (Augmentin) because it is a broad-spectrum antibiotic that covers both aerobic and anaerobic bacteria, which are commonly involved in diverticulitis. As the patient is allergic to metronidazole, amoxicillin/clavulanate is a suitable alternative as it provides coverage against the bacteria causing the infection. The other options, ciprofloxacin, doxycycline, and azithromycin, may not provide adequate coverage or may not be as effective in treating diverticulitis. Therefore, amoxicillin/clavulanate is the most appropriate choice in this case.

Based on the information provided, the patient is 55 years old and has three hyperplastic polyps on a routine screening colonoscopy. Hyperplastic polyps are generally considered to have a very low risk of developing into cancer. Therefore, the patient can safely wait for a longer interval before the next colonoscopy. The recommended interval for a follow-up colonoscopy in this case would be 10 years, as there is no personal or family history of colon cancer.

According to current guidelines, a 67-year-old male with a 0.5-cm adenomatous polyp with low-grade dysplasia should have his next colonoscopy in 5 years. This is because low-grade dysplasia indicates a low risk for progression to cancer, and the size of the polyp is small (0.5 cm), further reducing the risk. Therefore, a longer interval of 5 years is recommended for follow-up colonoscopy to monitor for any potential changes or growth in the polyp.

Raising both legs off the table while palpating the abdomen causing an increase in pain suggests a hematoma within the abdominal wall musculature. This is because the action of raising the legs increases intra-abdominal pressure, which can put pressure on the hematoma and cause pain. Appendicitis, diverticulitis, pelvic inflammatory disease, and ovarian cysts would not typically be affected by this maneuver.