Gastroenterology

Laxatives that contain antraquinones can induce a dark pigmentation in the colonic mucosa.

A 65-year-old multiparous woman presents complaining of having to spend up to 30 minutes on the commode with difficulty evacuating stool. Which of the following tests should be performed next?

Anorectal manometry would be most beneficial in testing the patient's internal and external anal sphincter function.

Proton pump inhibitors have been associated with magnesium deficiency, pneumonia, and Clostridium difficile infection.

All of the following have been associated with long-term proton pump inhibitor use except . . . ?

Previous antibiotic use and hospitalization are well known risk factors for C difficile infection. Are age, PPI use, immunosuppression, and BMI all also risk factors?

Age; proton pump inhibitor us; immunosuppression; BMI: which of these is not a risk factor for Clostridium difficile infection?

Food impaction, uncontrollable secretions, progressive dysphagia, and endoscopic findings of concentric rings and longitudinal furrows in the esophagus. The likely diagnosis?

In patients with non-dysplastic Barrett esophagus, what regimen of proton pump inhibitors should be initially prescribed for management?

Most patients respond to once-daily dosing of a proton pump inhibitor. If symptoms persist, increasing to twice daily or titrating dosage based on pH studies are both options.

What study would you order to determine the cause of progressively worsening crampy abdominal pain and unintentional weight loss in an older patient with diabetes?

The clinical presentation-crampy abdominal pain after meals, weight loss, and loose stools-is consistent with chronic mesenteric ischemia given this patient's history of diabetes.

Several treatment options improve symptoms. Which one doesn't?

Topical corticosteroids, special diets that eliminate the 6 most common food allergens, endoscopic dilation, and medical therapy effectively control symptoms. Mast cell inhibitors are not a recommended treatment.

In patients in whom cholelithiasis with numerous stones is incidentally noted on imaging, should ursodeoxycholic acid be considered to help dissolve the stones and reduce the risk of biliary disease?

Ursodiol has not been demonstrated to be very effective in stone dissolution.

Hematocrit on admission; gallstones in common bile duct on admission; BUN on admission; pleural effusion on a chest x-ray film.

An elevated hematocrit and BUN, both the result of hemoconcentration, are important prognostic indicators for several risk stratification scoring systems.

Barrett screening is controversial, but the American College of Gastroenterology supports this step in Caucasian men older than 50 with long-standing disease.

GERD of long-standing duration may require on-demand PPI dosing-and evaluation for esophageal damage.

How many subtypes? Commonly associated drugs? Are men or women most often affected? What agent offers effective treatment?

Microscopic colitis affects more women than men; it has two subtypes; it occurs in older age; is associated with several medications; and can be effectively treated with budesonide.

Research suggests that consuming seeds and nuts carries no increased risk of diverticulitis.

Is consumption of nuts and seeds a relative contraindication in patients with diverticulosis?

There are 3 classes of medications associated with pancreatitis. Class 3 drugs have been rarely implicated; diphendydramine has not been implicated with pancreatitis to date.