GI 6

Question 1

How do you diagnose Gastroparesis?

How do you TRX?

Answer 1

DX = Nuclear Gastric Emptying Test, but first do EGD to rule out mechanical obstruction.

TRX =

1) Small frequent meals low in fat and fiber
2) Promotility agents: Erythromycin, Metaclopramide

Question 2

Spontaneous bacterial Peritonitis is a complication of cirrhosis…can presents with fever, abd pain/tenderness +/- AMS and Sepsis…

Diagnosis involves a Paracentesis. What two findings, if present, are enough to make dx and empirically TRX?

Answer 2

1. PMNs > 250

2. SAAG > 1.1 (which suggest portal HTN)

Question 3

What is TRX for Spontanous Bacterial Peritonitis?

Answer 3

EMP ABX with 3rd Generation Cephalosporin (Cefotaxime)
+
ADD ALBUMIN IF renal dysfunction present (shown to decrease mortality and renal failure)

Question 4

MELD score is used to objectively measure 90 day mortality in End Stage Liver Disease…and is used to assess liver transplant patients.

What are the 4 components a MELD score uses?

Answer 4

• Bilirubin
• INR
• Cr
• Sodium

Question 5

What is post-cholecystectomy diarrhea?

TRX?

Answer 5

Form of bile salt induced diarrhea due to increased bile acids being dumped directly into intestine (where before it would be stored in gall bladder)

TRX = Cholestiramine (bile-salt binding resin)

Question 6

Primary Biliary Cirrhosis (PBC) and Primary Sclerosis Cholangitis (PSC) both autoimmune disorders that attack bile ducts and present with with fatigue, painless jaundice and generalized itching.

1. What is the gender differences between the two? What age does it usually present?
2. Between PBC and PSC which one will have higher Bilirubin levels and therefore more marked jaundice?
3. What physical exam findings is found in PBS that is characteristic?
4. Which one is associated with IBD, particularly UC?
5. Which is caused by intrahepatic ductal disease and which is caused by extra hepatic ductal disease?

Answer 6

1. PBC = women (middle aged)
   PSC = Men (middle aged)
2. PSC
3. Xanthalexmata (cholesterol deposit in eyes)
4. PSC
5. PBC = intrahepatic
   PSC = Extrahepatic

Question 7

How does one DX PBC?

How does one DX PSC?

Answer 7

PBC =
First –> get Anti-Mitochondrial Ab (highly sensitive and specific)
Confirm with BIOPSY (but not necessary if AMA positive and classic presentation)

PSC =
ERCP –> showing “beads on string” enough for dx.
- will also see elevated Antismooth muscle Ab

BX not necessary but will show onion skin fibrosis.

Question 8

What is the TRX for PBC and PSC?

Answer 8

Ursodeoxycholic Acid to slow progression,

Definitive trx will be Liver transplant.

Question 9

What are the three options for COLON CA screening?

Answer 9

1) GOLD STANDARD = Colonoscopy at 50 yo, then Q 10 years.
2) Sigmoidoscopy at 50 yo, then q5 years + q3 years hemoccult.
3) Sigmoidoscopy at 50 yo, then q 10 years + yearly hem occult.

(IF hem occult or sigmoid positive, then need to do full colonoscopy)

Question 10

When a patient presents with Hematochezia, first step in management is to deterring hemodynamic stability…

IF HD stable what is the steps in management?

IF HD Unstable what is the steps in management?

Answer 10

HD STABLE:

• Colonoscopy
• IF colonoscopy -ve, DO EGD
• IF EGD negative, do capsule vs repeat above steps.

HD UNSTABLE:

• Resuscitate +/- IR consult
• EGD first to r/o brisk upper GI bleed
• IF EGD negative and cont HD unstable –> Angiography
• IF EGD negative and HD stable –> Colonoscopy
• IF colonoscopy negative do capsule endoscopy.

Question 11

What is the most common complication for patients hospitalized for esophageal varices?

What can you do about this?

Answer 11

INFECTION –> Ppx with Fluoroquinolone 7-10 days (i.e. Cipro)

(also Hepatic encephalopathy and Renal failure, but less commonly than infection)

Question 12

New born’s first stool is call Meconium, a think black tarry stool…how long after birth should you have Meconium stool?

What is the typical stooling frequency for the first month of life?

After 1 month it is typical for stool frequency to decrease to what?

Answer 12

Meconium should pass within 48 hours of life.

First month 6-10X per day.

Can decrease to 1 stool every 1-2 days. No intervention needed.

Question 13

what are the thee main uses for Usodeoxycholic Acid?

Answer 13

1. Symptomatic Cholelithiasis but NOT a surgical candidate
2. PBC
3. PSC

Question 14

What do you do if a patient has biliary colic type pain, but RUQ US does not show any stones in gall bladder?

Answer 14

Cholecystokenin-Stim Cholecintigraphy –> Do cholecystectomy if decreased gall bladder ejection.

Question 15

Intussception (telescoping of intestines) is seen 3mth -6 years of age.

What is the classic presentation?

How do you DX?

How do you TRX?

Answer 15

• Sudden, severe and intermittent abdominal pain
• current jelly stool
• Sausage shaped abd mass
• +/- lethargy, AMS

DX = US with “Target sign”

TRX = AIR or SALINE enema

(NOT Barium enema bc risk of peritonitis if perforation occurs)