Gastroenterology

Question 1

Low fecal elastase and Low fecal chymotrypsin

Answer 1

Pancreatic insufficiency

Question 2

Serum lipase

Answer 2

MORE sensitive and specific than serum amylase for ACUTE PANCREATITIS.

Also note: serum amylase is 3x the upper limit in acute pancreatitis.

Question 3

Patient in palliative care with esophageal cancer presents with progressive dysphasia for solids

Answer 3

do esophageal stenting to help expand the esophagus and thereby make it possible for the person to eat.

***PEG tube and TPN can deny the patient the ability to eat which is necessary for their social connection, feeling better, etc.,. Also TPN requires intensive monitoring.

Question 4

WORSENS with Cold Fluids

Answer 4

& IMPROVES with Hot Fluids

•Achalasia Cardia & other Esophageal Motility Disorders

Question 5

WORSENS with Hot Fluids

Answer 5

•Benign esophageal strictures

• benign esophageal strictures are usually due to scarring from acid reflux in severe and persistent GERD.
• It may also follow ingestion of CORROSIVES.
• While the area heals, a scar forms, causing the tissue to pull and tighten, leading to difficulty in swallowing.

Question 6

Best investigation to diagnose intermittent episodes of chest pain with dysphagia

Answer 6

MANOMETRY

• The condition is diffuse esophageal spasm.
• crushing chest pain in the lower substernal area.
• Pain is so severe that often clinicians would first rule out a cardiac cause like MI.

Question 7

End stage cancer with liver metastases - low urine output - lab work low albumin. What Rx?

Answer 7

Intravenous albumin to correct hypoalbuminemia
- this increases colloid osmotic pressure to draw fluid back into the intravascular compartment to reduce edema and ascites.
- only produces a transient effect but useful in cases like these where surgery may not be an option
- also helps obtain diuresis in hypoalbuminemic patients

Question 8

Hepatoma a.k.a

Answer 8

Hepatocellular carcinoma