Upper GI
A cirrhotic patient with known varices presents with hematemesis and hypotension. Which two medications should be started before endoscopy
Octreotide & Ceftriaxone
72-year-old man with sudden, crampy left-sided abdominal pain followed by bloody diarrhea. Diagnosis
Ischemic colitis
HBsAg Negative, Anti-HBs Negative, Total anti-HBc Positive, IgM anti-HBc Positive.
What's the phase of hepatitis B infection?
Window period of acute hepatitis B
Which type of IBD is most strongly associated with PSC
UC
A 66-year-old develops painless jaundice, dark urine, and pale stools over several weeks; on exam the gallbladder is palpable and nontender
pancreatic head cancer
A 70-year-old man taking aspirin for secondary cardiovascular prevention is hospitalized with a bleeding duodenal ulcer. How should his aspirin be managed during the acute GI bleed.
Do not routinely stop aspirin
guidelines recommend against holding aspirin during acute GI bleeding because interruption increases cardiovascular risk. If aspirin was temporarily held, resume it on the day endoscopic hemostasis is confirmed.
A patient develops persistent watery diarrhea after terminal ileal resection for Crohn disease.
What mechanism is responsible?
Bile acid malabsorption causing secretory diarrhea in the colon
A patient with cirrhosis develops acute confusion and asterixis. Which precipitating event triggered hepatic encephalopathy?
Gastrointestinal bleeding / accumulation of hemoglobin in the intestine.
patient with ulcerative colitis receiving immunosuppressive therapy develops worsening bloody diarrhea despite corticosteroids. What infection should be suspected?
CMV colitis
This is the recommended hepatocellular carcinoma surveillance strategy and interval for a patient with compensated cirrhosis from chronic hepatitis B
US and AFP every 6 months
A patient with Child-Pugh C cirrhosis presents with acute variceal bleeding. After successful endoscopic banding, what intervention should be performed within 72 hours to reduce rebleeding and mortality?
TIPS
A patient undergoes extensive small-bowel resection including the terminal ileum. Months later, he develops recurrent calcium oxalate kidney stones.
What mechanism explains the nephrolithiasis?
Enteric hyperoxaluria.
Fat malabsorption causes calcium to bind fatty acids, leaving more free oxalate available for colonic absorption.
Anti-HCV antibody Positive, HCV RNA Negative
What are the two major explanations for this result?
Previously cleared/treated HCV infection or a false-positive HCV antibody.
Crohn disease pt presents with recurrent postprandial abdominal pain, distention, vomiting, and weight loss. increasing corticosteroids did not resolve symptoms. Cause?
fibrotic Crohn stricture
malignancy associated with primary sclerosing cholangitis
Cholangiocarcinoma
A 55-year-old man has chronic nocturnal reflux symptoms. EGD shows distal erosive esophagitis, and biopsy shows no Barrett metaplasia. If untreated, what complication is he most likely to develop?
Esophageal stricture
A hospitalized 74-year-old man develops marked abdominal distention after orthopedic surgery. Imaging shows substantial colonic dilation without a mechanical transition point.
What is the diagnosis?
Acute colonic pseudo-obstruction (Ogilvie syndrome)
A 35-year-old woman taking OCP develops abdominal pain, ascites, and hepatomegaly. Doppler ultrasound demonstrates absent flow in the hepatic veins.
What is the diagnosis?
Budd-Chiari syndrome
Name two interventions that should be avoided in Toxic Megacolon
Antidiarrheal/antimotility agents and colonoscopy
Surveillance ultrasound in cirrhotic pt reveals a new 2.4-cm hepatic lesion. Multiphasic CT demonstrates arterial-phase hyperenhancement followed by washout on delayed phase.
What is the next step to establish the diagnosis?
No biopsy is required; the characteristic imaging findings in an at-risk patient can establish HCC
EGD in a patient with chronic GERD shows a 2-cm segment of Barrett esophagus without dysplasia. When should surveillance EGD be repeated?
Every 3–5 years
A patient with acute colonic pseudo-obstruction continues to have significant colonic dilation despite correction of electrolytes, stopping offending medications, ambulation, and bowel rest. There is no perforation or mechanical obstruction.
What medication is used next?
Neostigmine
A patient with new ascites has: Serum albumin: 3.6 g/dL, Ascitic albumin: 1.8 g/dL, Ascitic total protein: 1.2 g/dL
Calculate the SAAG and identify the most likely underlying mechanism.
SAAG 1.8 g/dL, portal hypertension
Before starting anti-TNF therapy, patients must be screened for these two chronic infections that can reactivate
latent tuberculosis and hepatitis B
strongest modifiable risk factor for pancreatic adenocarcinoma
Cigerrete smoking