GI

Question 1

Treatment of Autoimmune Hepatitis (meds and duration)

Answer 1

The mainstay of treatment of autoimmune hepatitis is immunosuppression with prednisone or a combination of prednisone and azathioprine.

Because autoimmune hepatitis has a high rate of relapse, therapy is recommended for at least 2 to 3 years before discontinuation of the medications.

Question 2

60 yo woman p/w LLQ abdominal pain and hematochezia, most likely dx?

Answer 2

Colonic ischemia
(acute diverticulitis does not present with rectal bleeding, making this diagnosis unlikely)
(risk factors for colonic ischemia include age (>60 years), female sex, vasoconstrictive and antihypertension medications, constipation, and thrombophilia)

Question 3

How do you diagnose hereditary hemochromatosis?

Answer 3

Diagnosis is suspected by finding elevated transferrin saturation greater than 45% and an elevated serum ferritin level
Diagnosis is confirmed through genetic testing (HFE gene)

Question 4

What do you need to rule out before diagnosing someone with IBS? (p/w classic symptoms & diarrhea)

Answer 4

Fecal calprotectin testing to assess for inflammatory bowel disease
Stool testing for giardiasis and celiac disease

Question 5

Best next step in a patient with active lower GI bleed and hemodynamic instability?

Answer 5

CT angiography is the study of choice.

Catheter angiography and possible embolization should be performed as soon as possible after positive results

Question 6

Treatment of bleeding gastric varices

Answer 6

Depends on the anatomy of the abdominal vasculature. Need CT abd with contrast to decide. Potentially splenectomy, balloon-occluded retrograde transvenous obliteration of varices, TIPS.
Gastric varices are not amenable to banding - too deep!

Question 7

First line therapy for HCC?

Answer 7

Surgical resection for pts with no liver dysfunction or liver transplant for patients with portal HTN or liver dysfunction
Cytoreductive therapies (including TACE, TARE, and external radiation) are considered when patients are not candidates for either of the above

Question 8

Treatment of asymptomatic pancreatic pseudocysts

Answer 8

Observation; they do not require drainage unless the patient is symptomatic or they become infected.

Question 9

How to calculate stool osmolar gap

Answer 9

Fecal osmotic gap is calculated as follows: 290 – (2 × [stool sodium + stool potassium])
Calculated osmotic gap of greater than 100 mOsm/kg suggests osmotic diarrhea (there’s an unmeasured, osmotically active substance)

Question 10

Management of hepatic adenoma in a man

Answer 10

Surgical resection
(increased risk for malignant transformation of hepatic adenomas when >5 cm or β-catenin activation, which men usually have)

Question 11

When to treat hepatitis B

Answer 11

When patients have acute liver failure, chronic infection in the immune-active phase or reactivation phase, or cirrhosis and for selected immunosuppressed patients.

Patients in the immune-active phase or reactivation phase have elevated ALT, presence of hepatitis B core antibody, and an elevated HBV DNA level