Endoscopic Management

Question 1

What are the forrest classifications? What lesions are treated and how?

Answer 1

Treat active bleeding, VV
Try to irrigate clot (no guidance beyond that)
Don’t treat pigmented spot or clean based ulcer

treat with:
vasoconstrictor + thermal/clips

alternatives:
Monopolar forceps
OTSC
hemospray

Question 2

Answer 2

Mallory Weiss Tear

Question 3

Answer 3

Mallory Weiss Tear

Question 4

Answer 4

GAVE
classic antral watermelon appearance
often seen in women with autoimmune conditions
presents with IDA

Rx- APC and tranexamic acid

Question 5

Answer 5

GAVE
punctate appearance
often seen in cirrhotics

not related to portal hypertension and only resolves with liver transplant

Rx- APC and tranexamic acid

Question 6

Answer 6

portal hypertensive gastropathy

Question 7

Answer 7

Dieulafoy lesion

Question 8

Answer 8

Dieulafoy lesion

Question 9

Answer 9

Dieulafoy lesion

Question 10

Answer 10

Cameron Lesion

manage with iron and PPI
HH repair if refractory

Question 11

Answer 11

Cameron Lesion

manage with iron and PPI
HH repair if refractory

Question 12

How do you manage presumed small bowel bleeding/ obscure GI bleeding?

What are common causes of small bowel bleeding?

Answer 12

Common causes of small bowel bleeding:
-AVMs
-tumors (lymphoma, carcinoid, GI stromal tumors)
-erosions - NSAIDS or Crohn’s
-Meckel’s
-radiation

Question 13

Answer 13

duodenal AVMs

Question 14

Answer 14

Aortoentertic fistula

Question 15

Answer 15

Caroli’s syndrome

Question 16

Answer 16

Type 1 choledochal cyst

Question 17

Answer 17

Type 1 choledochal cyst

Question 18

Answer 18

CBD stricture

Question 19

Answer 19

long CBD stricture

Question 20

Answer 20

CBD stricture

Question 21

Answer 21

CBD stricture

Question 22

Answer 22

GIST

Question 23

Answer 23

lipoma

Question 24

Answer 24

gastric duplication cyst

Question 25

When do you restart anticoagulation after EGD for PUD?

Answer 25

Don’t stop AC for longer than 5 to 7 days (increased risk of adverse thrombotic events).

If low risk lesion, ok to restart post procedure

if high risk lesion,
-restart after 3 days of PPI if low risk for TE events
-use heparin if high risk for TE event such as those with mechanical valves, atrial fibrillation with prior strokes, or significant pulmonary embolus.

Question 26

Answer 26

Whipworm or enterobius vermicularis
associated with anal pruritis
often passed from daycare workers
treat with albendazole