GI

Question 1

4 phases of HBV infection

Answer 1

1. Immune Tolerant
2. Immune Active
3. Immune control (inactive
4. Reactivation

Question 2

When do you have to treat HBV infection

Answer 2

1. Immune active phase
2. HBeAg-positive and reactivation
3. HBeAg-negative phases require treatment if ALT is elevated
4. Acute liver failure, cirrhosis
5. People getting tx with immunosuppressive and chemo regimens

Question 3

Who should get hepatocellular carcinoma surveillance with US, and starting at what age

Answer 3

1. SE Asians 40 yo for men, 50 yo for women
2. Sub-Saharan Africa at age 20 years
3. People with HBV DNA level >10,000 IU/mL, family h/o HCC (+/- alpha-fetoprotein)

Question 4

Do you discontinue ASA prior to colonoscopy?

Answer 4

NO

Question 5

Causes of pseudoachalasia and when to suspect it

Answer 5

Causes:

1. Benign: amyloidosis, sarcoidosis, post-surgery
2. Tumor at the GE junction

Suspect in Older patients (>60 yo), and those with RAPID weight loss. Achalasia usually has an insidious onset.

Question 6

Definition of IBS

Answer 6

Symptoms of recurrent abdominal pain or discomfort at least 1 day a week for a period of 3 months,

+ 2 out of three below:

1. Pain relieved by defecation,
2. change in stool frequency, 3. change in bowel

Question 7

FDA approved medication for IBS-C

Answer 7

Linaclotide

Question 8

Colonoscopy schedule

Answer 8

10-years: if hyperplastic and <10 mm. If 2nd degree relative or further.

5-years: <2 adenomas (or sessile serrated polyps) + 1st degree relative with colon cancer diagnosed at <60 yo

3-years: 3+ adenomas (sessile serrated polyps), one adenoma >10 mm, or adenoma with villous or high grade dysplasia

1-year: >10 adenomas, those with polyposis syndrome, or those with Lynch syndrome

Question 9

Lynch syndrome

Answer 9

Amsterdam II criteria: hereditary nonpolyposis colorectal cancer and germline mutation in one of 4 mismached repair genes (MLH1, MSH2, MSH6, PMS2) or epithelial cell adhesion molecule gene EPCAM

Question 10

Charcot triad

Answer 10

fever
abdominal pain RUQ
jaundice

Question 11

Indication for urgent ERCP and when to do cholecystectomy when someone has Charcot’s triad

Answer 11

1. ongoing septic physiology (persistently elevated leukocyte count and temperature greater than 38.9 °C [102 °F]) despite resuscitative measures and antibiotics,
2. hyperbilirubinemia (>5 mg/dL [85.5 µmol/L])
3. altered mental status, which may also herald a worsened prognosis.

Elective cholecystectomy: within 2 weeks to reduce the risk for complications.

Question 12

Next step in refractory EoE after 8 weeks of oral fluticasone

Answer 12

EGD with dilation