GI and Hepatology

Question 1

Tx for esophagitis 2/2

(a) Candida albicans
(b) CMV
(c) HSV

Answer 1

Esophagitis

(a) Candida- PO fluconazole, or just nystatin wash for immunocompetent its
(b) CMV- ganciclovir IV x3-6 weeks
(c) Acyclovir 200mg PO 5 times a day
OR valacyclovir BID

Question 2

Endoscopic findings of CMV vs. HSV esophagitis

Answer 2

CMV- few large, superficial ulcerations

HSV- numerous small, deep ulcerations

Question 3

When is endoscopy needed for pill esophagitis?

Answer 3

Not needed immediately- only needed if symptoms don’t subside after stopping offending agent (and can add some PPI for good measure)

Clinical diagnosis (don’t need endoscopy for it)

Question 4

What is achalasia?

Answer 4

Achalasia = idiopathic functional decrease in esophageal motility

Bird beak narrowing on esophagram

Question 5

Otherwise healthy 29 y/oM w/ abd pain, CT shows inflamed diverticula around sigmoid colon with adjacent 1.2cm pericolic abscess

Best management?

Answer 5

IV antibiotics, bowel rest, and observe

Don’t need to drain pericolic abscesses unless over 4cm or associated peritonitis.
Would do colonoscopy 6 weeks out, not in acute setting