Misc

Question 1

treatment for:

laxative-refractory opioid-induced constipation

Answer 1

oral naldemedine or
subcutaneous methylnaltrexone and
naloxegol, a pegylated form of naloxone

Question 2

what is the most appropriate next diagnostic testing in a patient with high suspicion for antimitochondrial antibody–negative PBC?

Answer 2

sp100 and gp210 antibodies

*Liver biopsy is not necessary in patients with compatible symptoms, elevation of serum ALP more than 1.5 times normal, and positive antibody test results.

Question 3

Type 1 autoimmune pancreatitis is a frequent manifestation of?

Answer 3

IgG4 disease. Tx is GLUCOCORTICOIDS

Question 4

chronic watery diarrhea, colonoscopy results showing normal-appearing mucosa, and biopsy results revealing lymphocytic infiltration and a subepithelial collagen band are diagnostic for?

Answer 4

collagenous colitis, which is a subtype of microscopic colitis

Question 5

treatment of microscopic colitis

Answer 5

discontinue a potentially causative medication, supportive treatment with antidiarrheal agents such loperamide, budesonide for refractory symptoms

Question 6

Indications for liver transplantation

Answer 6

MELD score of at least 15 or decompensated cirrhosis.
The MELD score is an equation that incorporates 1. bilirubin, 2. INR, and 3. serum creatinine levels, and it accurately predicts 3-month survival.

Question 7

What is the recommended initial diagnostic test after hemodynamic resuscitation in most patients with significant lower gastrointestinal bleeding?

Answer 7

Colonoscopy.
Almost 80% of lower gastrointestinal bleeding (LGIB) is due to diverticulosis, colitis, hemorrhoids, or postpolypectomy bleeding

Question 8

Primary prophylactic antibiotic therapy is indicated for patients at high risk for the development of spontaneous bacterial peritonitis, including?

Answer 8

patients with very low ascitic-fluid protein levels and those with advanced liver failure

Question 9

Patients with newly diagnosed pernicious anemia should be evaluated for? with?

Answer 9

gastric adenocarcinoma and gastric carcinoid with upper endoscopy and gastric biopsy.
- The serum gastrin level is elevated in patients with any form of atrophic gastritis and has no diagnostic or prognostic value in this setting.

Question 10

In patients requiring NSAIDs, an evidence-based treatment strategy to prevent recurrent NSAID-induced peptic ulcers is the use of?

Answer 10

a cyclooxygenase-2 selective NSAID plus a proton pump inhibitor

Question 11

Patients who have cholangitis with evidence of biliary obstruction should be treated with?

Answer 11

antibiotic therapy and biliary decompression with endoscopic retrograde cholangiopancreatography. Charcot’s triad = RUQ pain, fever, jaundice

Question 12

Management of esophageal variceal bleeding (in order)

Answer 12

• placement of two large-bore intravenous lines, fluid resuscitation, and erythrocyte transfusion to a goal hemoglobin level of 7 g/dL (70 g/L) or greater
• prophylactic ABX to improve mortality rates, since up to 50% of patients with cirrhosis and gastrointestinal bleeding develop infections within 1 week
• A splanchnic vasoconstrictor such as octreotide is recommended for 3 to 5 days
• Upper endoscopy with band ligation should be performed urgently after the patient is stabilized, followed by addition of a nonselective β-blocker.
• For the 10% to 20% of patients with uncontrolled bleeding and those with early rebleeding, a transjugular intrahepatic portosystemic shunt (TIPS) should be placed. - - Early airway management to prevent aspiration is essential when a patient cannot protect the airway or is otherwise at risk for aspiration of blood or gastric contents.

Question 13

In patients with ascites, what medications should be discontinued?

Answer 13

Medications that decrease kidney perfusion, including NSAIDs, ACE inhibitors, and angiotensin receptor blockers, should be discontinued in patients with ascites.
- Furthermore, in some patients with ascites that is refractory to medical management, β-blockers may worsen clinical outcomes, including survival.

Question 14

Patients whose Barrett esophagus is INDEFINITE for dysplasia should begin?

Answer 14

optimized antisecretory medical therapy and undergo a repeat endoscopy
- Endoscopic ablation therapy is indicated for patients with Barrett esophagus with low-grade or high-grade dysplasia

Question 15

What is the most appropriate test to evaluate patients for causes of small-bowel bleeding after negative upper endoscopy and colonoscopy?

Answer 15

Capsule endoscopy

Question 16

Gastrointestinal bleeding occurring in patients following aortic graft surgery should raise the possibility of aortoenteric fistula; what is the initial test in appropriate patients?

Answer 16

CT with contrast

Question 17

Patients with achalasia who are at high surgical risk should be treated with?

Answer 17

endoscopic botulinum toxin injection