GI - random topics

Question 1

How often should patients with cirrhosis be screened for hepatocellular carcinoma? And with what modality?

Answer 1

Abdominal ultrasound +/- AFP testing every 6 months
(can use CT w/ contrast or MRI to further characterize lesions >1cm)

Question 2

Grade 1 internal hemorrhoids

Answer 2

do not prolapse

Question 3

Grade 2 internal hemorrhoids

Answer 3

prolapse with straining, spontaneous reduction

Question 4

Grade 3 internal hemorrhoids

Answer 4

require manual reduction of the prolapse

Question 5

Grade 4 internal hemorrhoids

Answer 5

not manually reducible

Question 6

management for grade 1 internal hemorrhoids

Answer 6

conservative management (high fiber diet, sitz bath, reducing time on toilet)

Question 7

management for grade 2 internal hemorrhoids

Answer 7

conservative management (high fiber diet, sitz bath, reducing time on toilet)

Question 8

management for grade 3 internal hemorrhoids

Answer 8

conservative management (high fiber diet, sitz bath, reducing time on toilet)

Question 9

Options for treatment of grade 1,2,3 internal hemorrhoids that are refractory to conservative management

Answer 9

sclerotherapy or rubber band ligation

Question 10

management for grade 4 internal hemorrhoids

Answer 10

surgical excision

Question 11

screening for dysplastic fundic polyps

Answer 11

first surveillance follow up endoscopy after 1 year (if not high grade dysplasia - then it would be 6 months)
followed by EGD every 3-5 years for continued follow up

Question 12

indications for adding albumin to antibiotic treatment of SBP

Answer 12

kidney dysfunction (Cr >1, BUN >30)
serum bilirubin >4

Question 13

outpatient SBP prophylaxis indications

Answer 13

1) Ascitic fluid protein <1.5, serum Cr >1.2, BUN >25, Na <130
or
2) Child pugh score >9, and bilirubin >3

Question 14

outpatient SBP prophylaxis antibiotic options

Answer 14

Bactrim
Ciprofloxacin
Norfloxacin

Question 15

inpatient SBP prophylaxis indications for a patient not admitted with SBP or GI bleed

Answer 15

Ascitic fluid protein <1
Hx SBP

Question 16

inpatient SBP prophylaxis antibiotic options (for a patient not admitted with SBP or GI bleed)

Answer 16

Bactrim
Ciprofloxacin
Norfloxacin

Question 17

inpatient SBP prophylaxis antibiotic of choice for a patient admitted with GI bleed

Answer 17

Ceftriaxone 1g daily

Question 18

Tests for confirmation of H pylori eradication

Answer 18

urea breath test
Stool antigen test

Question 19

Timing for follow up colonoscopy if 3-4 tubular adenomas <10mm

Answer 19

3-5 years

Question 19

Timing for follow up colonoscopy if 1-2 tubular adenomas <10mm

Answer 19

7-10 years

Question 20

Timing for follow up colonoscopy if the following are found:
5-10 tubular adenomas <10mm
Adenoma >10mm
Adenoma with villous component
Adenoma with high grade dysplasia

Answer 20

3 years

Question 21

Timing for follow up colonoscopy If >10 adenomas

Answer 21

1 year

Question 22

Timing for follow up colonoscopy If piecemeal resection of adenoma >20mm

Answer 22

6 months (and then again 1 year later)

Question 23

Timing for follow up colonoscopy if <20 hyperplastic polyps <10mm

Answer 23

10 years

Question 24

Timing for follow up colonoscopy If 1-2 sessile serrated polyps <10mm

Answer 24

5-10 years

Question 25

Timing for follow up colonoscopy if 3-4 sessile serrated polyps <10mm or if hyperplastic polyp >10mm

Answer 25

3-5 years

Question 26

Timing for follow up colonoscopy if the following are found:
5-10 sessile serrated polyps <10mm
Sessile serrated polyps >10mm
Sessile serrated polyps with dysplasia

Answer 26

3 years

Question 27

Timing for follow up colonoscopy If patient has sessile serrated polyposis syndrome

Answer 27

1 year