GI

Question 1

When to use budesonide?

Answer 1

systemic use in pregnant women with asthma, localized use in microscopic colitis

Question 2

Give an illness script for eosinophilic esophagitis.

What does it look like on EGD?

Answer 2

• mucosal inflammation caused by eosinophilic infiltration
• young men presenting with symptoms of dysphagia
• co-occurs in patients with food allergies, asthma, and eczema
• Rings and furrows in the esophagus are common findings on upper endoscopy
• diagnosis is confirmed with biopsies of the esophagus showing more than 15 eosinophils/hpf in the absence of other known causes of esophageal eosinophilia
• treatment includes restriction of dietary elements (elemental diet or targeted elimination diet) and swallowed aerosolized topical glucocorticoids or a proton pump inhibitor. Patients should also be counseled that the condition may recur.

Question 3

How is primary biliary cholangitis diagnosed?

Answer 3

Need liver biopsy for staging

Question 4

How is primary sclerosing cholangitis diagnosed?

Answer 4

MRCP

Question 5

How do you calculate stool osmotic gap? What is a significant stool osmotic gap?

Answer 5

290 mOsm/kg − 2 × (stool Na + stool K)
Gap <50 = secretory diarrhea, no gap
Gap >100 = osmotic diarrhea

Question 6

First line hep B treatment

Answer 6

Entecavir, Tenofovir

Question 7

Medications used to prevent vertical transmission of hep B

Answer 7

Lamivudine, Telbivudine, Tenofovir

Question 8

When should you start a non selective beta blocker for variceal bleed prophylaxis?

Answer 8

When the varices on EGD have red whale spots (visible vessels). We are referring to primary prophylaxis here!

Once a patient has SBP you stop beta blocker therapy permanently!