Pearls_08

Question 1

Patient who has been fasting/overexerted/stressed and is asymptomatic aside from jaundice -> has an elevated indirect (unconjugated) bilirubin, normal AST/ALT, normal CBC, smear, and retic count:

Dx?
Tx?

Answer 1

think Gilbert’s Disease -> manage by doing nothing (no therapy).

Question 2

Patient presents with odynophagia, dysphagia, and retrosternal chest pain -> upper endoscopy with discrete ulcer, having relatively normal surrounding mucosa:

Dx? (two differentials)
Name some typical culprits?
Tx?

Answer 2

infectious vs pill induced esophagitis

If pill induced, culprits are:

• tetracyclines (Doxy)
• iron sulfate
• bisphosphonates
• potassium
• NSAIDs.

Tx
- stop the offending agent

Question 3

Patient presents with watery diarrhea without bleeding -> endoscopic biopsy shows predominance of intraepithelial lymphocytes in the colonic mucosa (lymphocytic colitis) or the addition of athickened subepithelial collagen band:

Dx?
Associated with?

Answer 3

Dx
Microscopic Colitis

Associated with

• Celiac dz
• NSAIDS
• PPIs
• Sertraline

Tx
-drug withdrawal or gluten-free diet

Question 4

Microscopic Colitis
- endoscopic biopsy shows predominance of ____ lymphocytes in the colonic mucosa (lymphocytic colitis) or the addition of a thickened ___ collagen band

Answer 4

intraepithelial

subepithelial

Question 5

What is associated with these?

• Celiac dz
• NSAIDS
• PPIs
• Sertraline

Answer 5

microscopic colitis

Question 6

What condition is assoc with the following:

• tetracyclines (Doxy)
• iron sulfate
• bisphosphonates
• potassium
• NSAIDs.

Answer 6

pill-induced esophagitis