Gastroenterology

Question 1

UC pt with toxic megacolon - 1 week of bloody diarrhea refractory to medical therapy

Answer 1

immediate surgery if hemodynamically unstable (tachy, fever, hypotension) - if stable consider IV steroids

Question 2

Hepatitis B

Answer 2

a/w polyarteritis nodosa

Question 3

How to treat achalasia

Answer 3

surgical/lap myotomy in good candidates - only botulism inj or pneumatic balloon dilation if poor candidate for surgery

Question 4

Dermatitis herpetiformis

Answer 4

a/w celiac dz - IgA dep in skin bx - tx with gluten free diet and dapsone (does not tx intestinal manifestation) - itchy papulovesicles - no relation to HSV - non infectious, dx with TTG/IgA titers

Question 5

IBD-D - pt with painless watery diarrhea

Answer 5

ROME III criteria needs diarrhea AND abd pain - if no pain then need colonoscopy with biopsies to r/o microscopic colitis

Question 6

H. Pylori serology

Answer 6

only test NOT affected by recent GIB or PPI use

Question 7

Short bowel syndrome post op

Answer 7

need PPI - pt with acid hypersecretion in post op period - acid inactivates pancreatic lipase - causes diarrhea - don’t give cholestyramine - will bind little remaining bile salts and worsen diarrhea

Question 8

Autoimmune Pancreatitis

Answer 8

Painless jaundice, diffusely enlarged pancreas, r/o’d for mass lesion, narrowed pancreatic duct, normal CA 19-9 and +IgG4 - trial of corticosteroids then immunomodulators (azathroprine) - if not then ERCP with stent

Question 9

Acute uncomplicated diverticulitis

Answer 9

+WBC, abd pain, inflammation in colon on CT - if tolerating oral - oral flagyl and cipro ok - avoid colonoscopy in this setting (r/o perf)

Question 10

Acute complicated divierticulitis

Answer 10

a/w abscess, fistula, obstruction, perforation, stricuture - needs surgery