Chapter 5 of 158% of exam

Gastrointestinal System/Nutrition

The GI and nutrition block covers the whole tract from esophagus to rectum plus liver, biliary tree, pancreas and nutritional disorders. Pediatric surgical conditions such as pyloric stenosis and intussusception are listed alongside adult disease.

Biliary and pancreatic disease

Right upper quadrant pain is sorted by fever, jaundice and imaging. Obstruction of the common duct with infection is more dangerous than gallbladder inflammation alone. Pancreatitis has explicit diagnostic criteria, so imaging is not always required.

Acute cholecystitis

RUQ pain with a Murphy sign; ultrasound is the first imaging test, and early cholecystectomy is preferred.

Merck Manual Professional Edition, Acute Cholecystitis

Cholangitis

Fever, jaundice and RUQ pain (Charcot triad) require antibiotics and biliary drainage, typically by ERCP.

Merck Manual Professional Edition, Choledocholithiasis and Cholangitis

Acute pancreatitis

Any two of typical pain, amylase or lipase above 3 times normal, and characteristic imaging; gallstones and alcohol are the most common triggers.

Merck Manual Professional Edition, Acute Pancreatitis

The acute abdomen in children and adults

Timing, age and the character of pain, vomiting or stool point to the surgical diagnoses. Migration of pain, the color of vomitus and the presence of blood in stool are high-yield clues. Ultrasound is the preferred first image in many pediatric conditions.

Appendicitis

Periumbilical pain migrating to the right lower quadrant with McBurney point tenderness.

Merck Manual Professional Edition, Appendicitis

Pyloric stenosis

Projectile nonbilious vomiting at 3 to 6 weeks, an olive mass, and hypochloremic hypokalemic alkalosis; ultrasound confirms.

Merck Manual Professional Edition, Hypertrophic Pyloric Stenosis

Intussusception

Intermittent colicky pain with lethargy, a sausage-shaped mass and bloody stool; ultrasound diagnoses and air enema reduces.

Merck Manual Professional Edition, Intussusception

Luminal and liver disease

Upper GI questions ask for the right test, whether serology, a breath test or manometry. Tests for active infection differ from tests that stay positive after cure. Variceal bleeding in cirrhosis is treated with a bundle of drug, antibiotic and endoscopic therapy.

Celiac disease

IgA tissue transglutaminase with total IgA while eating gluten, confirmed by small-bowel biopsy.

American Family Physician 2022, Celiac Disease

H. pylori

Urea breath test or stool antigen detects active infection; serology does not confirm cure.

Merck Manual Professional Edition, Helicobacter pylori Infection

Variceal bleeding

Resuscitation, octreotide, antibiotic prophylaxis in cirrhosis and endoscopic banding, with TIPS for failure.

Merck Manual Professional Edition, Varices

Achalasia

Dysphagia to solids and liquids with regurgitation; manometry confirms.

Merck Manual Professional Edition, Achalasia

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