GI 6 + GI 7 treatments

Question 1

CRC: What is the treatment of choice for almost all patients who have resectable lesions & can tolerate general anesthesia?

Answer 1

Resection of the primary colonic or rectal cancer

Question 2

CRC:
1) What is the Tx for colon cancer?
2) What is the Tx for rectal cancer?

Answer 2

1) Surgery & systemic chemotherapy
2) Surgery +/1 neoadjuvant & adjuvant therapy

Question 3

What is one thing you need to do for mgmt of CRC? Why?

Answer 3

1) Regional dissection of lymph nodes
-At least 12 to determine staging
-Guides decisions about adjuvant therapy

Question 4

You need at least _____ lymph nodes to be resected to determine staging of CRC

Answer 4

12

Question 5

How do you manage HCC?

Answer 5

1) Surgical resection
2) +/- Liver transplantation
3) Alcohol injection or radiofrequency ablation
4) Chemoembolization

Question 6

What is the standard screening/ surveillance approach for HCC?

Answer 6

U/S liver & AFP every 6 months

Question 7

Cavernous hemangioma: How do you manage it?

Answer 7

Observation & surveillance imaging (asymptomatic), possible surgical resection (symptomatic)

Question 8

Hepatocellular adenoma: How do you manage it?

Answer 8

Surgery recommended, ligate hepatic artery, discontinue OCPs

Question 9

Infantile hemangioendothelioma:
1) How do you Dx?
2) How do you manage?

Answer 9

1) U/S (do not biopsy)
2) Embolization, hepatic artery ligation, surgical resection, or liver transplantation

Question 10

What is an important part of treating Focal nodular hyperplasia (FNH)?

Answer 10

Stop OCPs

Question 11

Gastric adenocarcinoma:
1) How do you Dx?
2) How do you manage it?

Answer 11

1) Endoscopic biopsy
2) Surgical resection, perioperative chemotherapy or adjuvant chemoradiation, endoscopic mucosal resection for select patients, palliative surgery and/or chemotherapy for unresectable disease

Question 12

What is a key part of gastric adenocarcinoma management?

Answer 12

Surgical resection

Question 13

What is a key part of gastric lymphoma management?

Answer 13

Tx of H. pylori in positive patients

Question 14

Gastric lymphoma:
1) How do you Dx?
2) How do you manage?

Answer 14

1) Endoscopic biopsy
2) Depends on tumor histology, grade, & stage; radiation therapy, chemotherapy, and/or surgery; treatment for H. pylori in positive patients

Question 15

Gastrointestinal stromal tumor (GIST):
1) How do you Dx?
2) How do you manage?

Answer 15

1) Histopathology, immunohistochemistry, & identification of disease-specific mutations
2) Depends on confidence in preoperative diagnosis, tumor location & size, extent of spread, & clinical presentation
-Complete resection possible in most cases of localized GIST; high recurrence rate

Question 16

Adenocarcinoma as an enteric neoplasm:
1) What is unique abt Crohn’s pts?
2) What may management involve?

Answer 16

1) Most common in ileum
2) Wide resection

Question 17

How do you manage NET?

Answer 17

depends on extent of disease; wide resection, palliative procedures

Question 18

Pancreatic CA mgmt: Should do _________________ to relieve jaundice in unresectable cases

Answer 18

endoscopic stenting

Question 19

Pancreatic CA Dx/Tx:
1) What is indicated for cancers limited to the head of the pancreas?
2) What is used for surgically resectable tumors of body or tail?

Answer 19

1) Radical pancreaticoduodenal (Whipple) resection
2) Distal subtotal pancreatectomy

Question 20

How do you Tx STEC?

Answer 20

Supportive care. DO NOT GIVE ATBs, can increase risk of HUS.

Question 21

DO NOT GIVE ATBs for what condition?

(important)

Answer 21

STEC

Question 22

Describe treatment for traveler’s diarrhea

Answer 22

1) Most cases self-limited; treat with antidiarrheals & hydration (as with acute diarrhea)
2) Fever and/or bloody diarrhea in areas where toxin-producing bacteria is major cause (Latin America, Africa):
single PO dose ciprofloxacin 750 mg (or levofloxacin 500 mg, or ofloxacin 200 mg)
-Bloody diarrhea that persists despite single dose fluoroquinolone, take single dose azithromycin 1000 mg
-Pregnant women in areas of prevalent invasive bacteria, azithromycin is DOC
3) Rifaximin approved (except for invasive disease)

Question 23

What should you do for C. Diff patients? (before actual management)

Answer 23

1) Patients with suspectedC. difficileinfection should be placed on contact precautions preemptively pending diagnostic evaluation.
2) Hand sanitizer does not kill C. diff; must use soap & water
3) Send stool studies for GDH enzyme and toxin A & B testing (quick turnaround)

Question 24

Describe how to manage C. Diff

Answer 24

1) Management based on severity & episode type
-Non-severe, severe, fulminant colitis
-Initial, 1st/2nd/3rd or subsequent episode
2) Antibiotic agents used:
Metronidazole
Fidaxomicin $$$$
Rifaximin$$$
Oral vancomycin
3) **Fecal microbiota transplant (FMT) $$$