Liver, Cirrhosis, Pancrease

Question 1

1. What is the concern for over transfusion with active esophageal bleeding?
2. How should esophageal bleeding patients be managed when they have evidence of coagulopathy ? (INR > 1.5 or Platelets < 50,000) and why ?

Answer 1

1. Overtransfusion Hgb > 10mg//dl —-> more bleeding (more of a concern if they cant get a EGD done within 5 hrs….if not transfuse!!!!)
2. Transfuse with Platelets or FFP because the target INR needs to be < 3 prior to Endoscopy (minimize further bleeding risk with procedure)

Question 2

Name the diagnosis:

1. Jaundice, fever, anorexia, abdominal distention, encephalopathy, muscle weakness AST > ALT ratio > 2, Elevated GTT, Bilirubin, INR but low albumin, fatty liver on US. Dx?
2. Fever, RUQ pain, Nausea, vomiting, Diarrhea? Rx?
3. Fever, RUQ pain, JAUNDICE, Nausea, Vomiting, Diarrhea. Dx? Management?
4. Jaundice, diffuse abdominal pain, AST and ALT > 500 U/L ?

Answer 2

1. Alcoholic Hepatitis
2. Acute Cholecystitis - IVF, Pain medication, Abx, Surgery
3. Acute Cholangitis - IVF, Pain medication, Abx ERCP to retrieve stone.
4. Tylenol Toxicity

Question 3

This is a concern after an attack for Resolved Pancreatitis in patients with persistently Elevated Lipase, Abdominal fullness. Dx? Imaging test Rx?

What if they come infected ?

Answer 3

Pancreatic Pseudocyst

Abdominal CT

Resolve without intervention.

Drain via Percutaneous, Surgical or Endoscopic procedures.

Question 4

Associated with Elevated ALK Phos levels and Pruritus?

Dx?
Rx?

Answer 4

PBC

Ursodeoxycholic Acid

Question 5

Whats the Platelet Transfusion Threshold for Variceal bleeding?

What is important prescribe upon discharge?

What is the Platelet and INR threshold for Paracentesis?

Answer 5

if <50,000 —> Transfuse

Antibiotics for up to 7 days. —-> to prevent SBP

It can be done with INR > 8 and plt count < 19,000

Question 6

What is the management of a Pancreatic Mass?

Answer 6

Question 7

What is the next imaging test to order if a pancreatic mass is not seen on CT scan when a patient presents with Extrahepatic Cholestasis?

Answer 7

ERCP gives better visualization for diagnostic and therapeutic purposes.

Question 8

What is the next step in management when a patient with H. pylori from East Asia/Latin America presents with peptic ulcer disease?

Answer 8

Endoscopy with biopsies to R/O cancer.

They are at risk for gastric mucosa associated lymphoid tissue lymphomas (MALT Lymphoma).

Question 9

What is concerning for a patient with a history of celiac disease presenting with fevers, chronic abdominal pain, diarrhea, melena?

Answer 9

They may have a serious complication related to celiac disease.

Question 10

Who else should be tested for this condition?

Answer 10

Family members may also need to be tested for celiac disease.

Question 11

What does it indicate if a patient with a history of celiac disease has persistent pathological symptoms despite a gluten-free diet?

Answer 11

It suggests possible non-compliance or other complications.

Question 12

In what 3 conditions is ERCP beneficial?

Answer 12

1. Acute Cholangitis
2. Gallstone Pancreatitis with evidence of bile duct obstruction.

Question 13

When should a cholecystectomy be performed during a bout of gallstone pancreatitis?

Answer 13

After recovery to prevent recurrence.

Question 14

What is the role of cholestyramine in Crohn’s disease?

Answer 14

It helps bind to bile acids that reach the colon because they were not reabsorbed in the colon.