GI

Question 1

Nonalcoholic fatty liver disease causes damage to the liver via what mechanism?

Answer 1

Increased transport of FFA from adipose to liver
Decreased oxidation of FFA in the liver
Decreased clearance of FFA from the liver
**Insulin resistance leads to increased peripheral lipolysis and subsequent hepatic uptake of fatty acids–> increased oxidative stress on liver

Question 2

Spontaneous bacterial peritonitis presentation (translocation of bacteria to ascitic fluid)

Answer 2

• cirrhosis/ascites w/ fever, abdominal pain/tenderness, altered mental status, hypotension
• ascitic fluid- >250 PMNs, positive culture

fluoroquinolones- trophy
tx= 3rd gen cephalosporin

Question 3

Chronic pancreatitis presentation

Answer 3

on CT: calcifications in pancreas, dilated ducts

• bloating, frequent bulky, foul smelling bowel movements consistent with steatorrhea (impaired secretion digestive enzymes)
• malabsorption- weight loss
• potential abdominal pain/diabetes mellitus (pancreatic endocrine insufficiency)
• *alcohol use

Question 4

Complications of Roux-en-Y gastric bypass

Answer 4

Early: anastomotic leak (sepsis), bowel ischemia (diffuse abdominal pain)

Late: anastomotic stricture (bowel obstruction)

• marginal ulcer
• Cholecystitis due to rapid weight loss encouraging stone formation
• dumping syndrome - diarrhea, crampy abdominal pain

Question 5

Tx of actively bleeding esophageal varices

Primary prophylaxis to prevent bleeding in moderate esophageal varices

Answer 5

• octreotide

- Beta blockers (propranolol, nadolol), or endoscopic variceal ligation