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G.I. – Awesome

Random GI problems

QuestionAnswer
Rome Criteria (4) for IBS IBS require recurrent abd pain or discomfort at least 3d/mo in last 3mo assoc w >=2 of the following: (1) improvement with defecation, (2) onset associated with a change in frequency of stool, and (3) onset associated with a change in form of stool.
chronic painless, watery diarrhea in a 67-year-old woman who does not fulfill Rome Criteria for IBS microscopic colitis
How to diagnose microscopic colitis? random colon biopsies to look for a thickened subepithelial collagen band (collagenous colitis) or a subepithelial lymphocytic infiltrate (lymphocytic colitis). Can't r/o with nl colonoscopy.
how to treat acute Wilson disease refer for liver transplantation
fusiform dilatation of the common bile duct with smooth tapering at the distal common bile duct, absence of obstruction or stones type I Biliary cyst; A biliary cyst should be suspected when dilatation of the bile duct is found without evidence of an obstructing lesion.
why do you have to recognize biliary cysts? biliary cyst confers a risk for recurrent bouts of cholangitis and a high risk for biliary cancer
all patients with cirrhosis screened for what? screened for esophageal varices with EGD
esophageal varices that flatten with air insufflation during endoscopy Small varices that are usually less than 5 mm in diameter
esophageal varices that persist despite air insufflation during endoscopy Large varices are larger than 5 mm
red wale markings (longitudinal red streaks on varices) indicates what? what to do for these pts? varices at inc risk of rupturing; next step - nonselective β-blockers or ligation as ppx to prevent variceal hemorrhage. If ligation doesn't work->balloon tamponade->TIPS (portal decompression by placement of transjugular intrahepatic portosystemic shunt)
recently acute diverticulitis - how to treat? what to do once resolved? Uncomplicated, acute diverticulitis should be treated 7-10 days using broad-spectrum abx; Following resolution, the entire colorectum should be evaluated to rule out other disorders that may mimic diverticulitis, such as adenocarcinoma or Crohn disease.
how to diagnose small intestinal bacterial overgrowth high folate, low B12 are clues; dx with hydrogen breath testing or upper endoscopy with small-intestinal cultures
does IBS diarrhea happen at night? no
diarrhea + fat malabsorption and vitamin deficiencies problem with the small bowel - NOT colon problem
In severely ill patients with hypotension and sepsis and a high clinical suspicion for acute cholangitis - wtd next ERCP. ERCP also provides immediate biliary decompression with stone extraction and/or stent placement if a biliary stricture is also found.
intravenous albumin at 1.5 g/kg on admission and 1 g/kg on day 3 give albumin with 3rd gen (cefotaxime) cephalosporin for spontaneous bacterial peritonitis - improved survival. Give this is Cr >1.5 with cirrhosis or tBili > 4 with cirrhosis.
who should be considered for liver transplantation The major indications are acute liver failure, hepatic decompensation from chronic liver dz (ascites, hepatic encephalopathy, jaundice, or portal-hypertension-related bleeding), primary liver ca, & inborn errors of metabolism.
when to do PPX cholecystectomy patients with gallbladder polyps larger than 10 mm, gallstones larger than 3 cm, or porcelain gallbladder (calcified gallbladder) to prevent gallbladder cancer
wtd for gallbladder polyps smaller than 10 mm serial imaging q6mo
What to do if on EGD, if a non-bleeding visible vessel is found in an ulcer? An ulcer with a visible vessel has an approximately 50% risk of rebleeding. These ulcers can be effectively treated with injection of sclerosants, thermal coagulation via endoscopic probes, or mechanical modalities such as hemostatic clips.
What to do it on EGD a clean based also is found? Clean-based ulcers rebleed in less than 5% of cases and do not require endoscopic therapy.
Created by: christinapham