GI - Online MedEd

Question 1

What is the treatment if patient presents with acute cholecystitis?

How is acute cholecystitis managed in a non surgical candidate?

Answer 1

NPO, IV fluids and abx, then this should be followed by cholecystectomy, which has to be done urgently (NOT emergently, there are worse clinical outcomes if its not done within 48 hours)

Non surgical candidates are treated by cholecytotomy (percutaneous drainage of gall bladder)

Question 2

What are the symptoms of cholecystitis?

Answer 2

Pericholecystic fluid, thickening of the wall and gall stones

Question 3

Explain choleangitis, Charcot’s triad and Reynold’s pentad

What abx do we use?

Answer 3

Abx:

1. Ciprofloxacin + Metronidazole
2. Ampicillin + Gentamicin + Metronidazole

Pipercillin + Tazobactam is the wrong choice since we are over covering for Strep!

Question 4

What does scleroderma cause in terms of symptoms of the esophagus?

Answer 4

Relentless GERD since the LES muscle gets replaced by cartilage so it doesnt contract at all

Question 5

How does an esophageal stricture and esophageal cancer similar in presentation and what tests are done to differentiate the 2

Answer 5

Question 6

What are the steps in managing GERD?

Answer 6

1. First step is lifestyle modifications (diet modifications) + PPI
2. If the patient has persistent GERD we then do EGD + biopsy
3. If the patient has alarming symptoms (weight loss, hemoptysis etc) then we just straight to Step 2
4. If on EGD we see metaplasia, increase the dose of PPI
5. If on EGD we see dysplasia, we do cryoablation

Question 7

What is Nissen fundoplication and what is its use

Answer 7

Wrapping the stomach around itself, increases the tone for LES, this is used when patient does want to be on PPI for GERD

Question 8

Treatment algorithm for GERD

Answer 8

Question 9

Explain how do we diagnose and treat H. pylori infection, explain the different array of tests that are there for our use and when do we use each of these tests

Answer 9

1. The best test to dx H. pylori infection is EGD + biopsy
2. The 2nd best test is histology
3. Urea breath test can be used for initial diagnosis
4. Once the patient is treated a stool assay can be done to confirm eradication of H. pylori
5. Serology is a poor test since it will be +ve even after the infection has been treated, so it is only done when the patient has symptoms and has not been treated before for the disease

Question 10

Explain the treatment of Zollinger Ellison syndrome

Answer 10

1. If gastrin levels are between 250 and 1600 then we do a secretin skin test, administer secretin and if the gastrin levels go up then the patient has ZE syndrome
2. If more than 1600 pt has ZE, no need to do secretin skin test
3. Less than 250 are normal
4. Another test we can do is SRS, somatostatin recepor scintagraphy
5. Tx is resection of the tumor and follow up for malignancy

Question 11

Explain gastraparesis, gastric adenocarcinoma and cyclic vomiting syndrome

Answer 11

Question 12

What is the work up for acute diarrhea?

Answer 12

Main thing to know here is if the patient has severe diarrhea for which they get admitted, first thing to do C diff culture, if that comes back negative then we do stool culture and colonoscopy

Question 13

C. Diff dx and treatment

Answer 13

Question 14

Explain secretory, osmotic and inflammatory diarrhea and how do you find if its osmotic or secretive diarrhea?

Answer 14