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G.I. – Awesome
Random GI problems
Question | Answer |
---|---|
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. |