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Clinical Nutrition in Gastrointestinal Disease
1 related chapter
Chapter 50: Gastrointestinal Complications Of Bariatric Surgery
Complicated Cases in GI
10 related chapters
Chapter 1: Endoscopic Therapy Foran Esophageal Dissection
Chapter 4: A Benign Form Of Progressive Dysphagia
Chapter 6: Diffuse Squamous Cell Dysplasiaof The Esophagus
Chapter 16: A Rare Cause Of Gastrointestinalbleeding In An Adult
Chapter 20: Small Bowelarterio-Venous Malformation
Chapter 21: Capsule Retentionin Small Bowel Diverticulosis
Chapter 35: An Unusual Cause Ofre Current Acute Pancreatitis
Chapter 37: Diarrhea, Abdominal Pain, And A Dilated Biliary Tree
Chapter 39: Elevated Serum Alkaline Phosphatase in an Asymptomatic Patient
Chapter 54: Gastrointestinal Bleeding and a Purpuric Rash
Core Concepts in Colonoscopy
11 related chapters
Chapter 1: The Structure And Function Of The Modern Colonoscope
Chapter 2: Enhanced Imaging Techniques
Chapter 3: Air Versus Carbon Dioxide Insufflation Versus Water Immersion During Colonoscopy
Chapter 4: External Pressure During Colonoscopy
Chapter 5: Endoscopic Loops During Colonoscopy
Chapter 6: Endoscopic Polypectomy Techniques
Chapter 8: Colonoscopy Perforations
Chapter 9: Colon Decompression
Chapter 10: Colonic Stenting
Chapter 11: Lower Gastrointestinal Bleeding
Chapter 12: Colonoscopy Quality Indicators In Training And Beyond
Curbside Consultation in Endoscopy: 49 Clinical Questions, Second Edition
48 related chapters
Question 1: An 81-Year-Old Healthy Male Is Found To Have A 12-Cm Long Segment Barrett’S Esophagus And Several Tiny Raised Lesions, With Moderate To High Grade Dysplasia In One Location. What Do I Tell The Patient? What Therapy Is Appropriate?
Question 2: A 46-Year-Old Female With Cirrhosis Came In With Severe Upper Gi Bleeding. Her Proximal Stomach Is Filled With Large Clots And Gastric Varices Are Suspected. How Can I Tell For Certain Endoscopically, And What Is The Treatment?
Question 3: What Are The Essential Tools For Removing Esophagogastric Foreign Bodies, And When Should I Apply These Devices?
Question 4: You Were Called By The Er Physician Regarding A Female Who Attempted To Commit Suicide By Drinking Toilet Cleaning Solution. There Were Obvious Burns Around The Mouth And Tongue. What Would You Do Next?
Question 5: What Is The Current Recommendation For Endoscopic Surveillance Of Barrett’S Esophagus, And How Can We Improve The Results With The Current Technologies?
Question 6: What Should I Do If I Have Inadvertently Perforated The Viscus During An Endoscopy?
Question 7: What Is The Current Expert Opinion On What Hemostasis Technique To Use In Treating A Visible Vessel Or Dieulafoy Lesion? When Should I Involve A Surgeon?
Question 8: What Do People Do For The Treatment Of Achalasia These Days? Does It Matter If The Symptoms Are Severe Or If The Patient Is Elderly?
Question 9: A 65-Year-Old Male With Long-Standing Gerd Complained Of Recent Onset Of Progressive Difficulty Swallowing (Especially Solids) And Subjective Weight Loss. How Should I Evaluate The Patient?
Question 10: Several Trips To The Er For A 56-Year-Old Mechanic For Sob And Iron Deficient Anemia Revealed Positive Fobt, But Egd And Colonoscopies Did Not Identify The Bleeding Source. He Takes Nsaids Regularly For Arthritis Pain. Is There A Role For Enteroscopy?
Question 11: A 59-Year-Old Professor Had Dyspepsia And Subjective Weight Loss. He Was Treated Previously For H Pylori Infection. Egd And Biopsies Showed Chronic Inflammation With Intestinal Metaplasia And One Focal Area Of Low-Grade Dysplasia. What Do I Do?
Question 13: A 35-Year-Old Female Presented With Epigastric Pain, Difficulty Swallowing, And Subjective Fever 1 Month After Gastric Bypass Surgery. She Was Seen In The Er Because Of Recent Hematemesis. What Do I Do?
Question 14: A 45-Year-Old Alcoholic Was Admitted With Abdominal Pain, Coffee Ground Emesis, And Mild Anemia. Upper Endoscopy Shows A Few Polypoid Masses In The Gastric Body And Pigmentations In The Antrum. What Should I Do?
Question 15: A 45-Year-Old Patient With Known Hepatitis C Was Admitted Because Of Massive Upper Gi Bleeding. What Should I Do?
Question 16: Bougienage, Balloon Dilation, Cautery Cutting, Stenting, And Steroid Injection Have All Been Described To Treat Benign Strictures Of The Gi Tract. Is There A Right Way Of Doing This?
Question 17: Which Of My Patients With Ulcerative Colitis Need “Surveillance” Colonoscopy? How Should The Procedure Be Performed?
Question 18: I Had A Difficult Colonoscopy And No Matter What I Tried, I Just Could Not Reach The Cecum. I Maxed Out On Iv Sedations And Have No Anesthesiology Support. Can You Help Me?
Question 19: A 68-Year-Old Male With Significant Comorbidities Presented With Weight Loss And New Onset Vomiting. Investigation Showed Colonic Obstruction With Poorly Differentiated Adenocarcinoma Involving The Sigmoid Colon. Do I Consider Stenting?
Question 20: A 58-Year-Old Female Underwent A Screening Colonoscopy That Showed A 2.5-Cm Flat Polyp In The Proximal Ascending Colon. I Tattooed The Area And Biopsied The Polyp, Which Was Initially Reported As Hyperplastic. What Should I Do?
Question 21: What Is The Role Of Chromoendoscopy In Screening Colonoscopy? Will It Help To Differentiate Different Types Of Polyps, And Is It Useful For Proximal Serrated Polyps?
Question 22: I Have Trouble Doing A Complete Colonoscopy In Some Of My Patients Because Of Poor Bowel Preparation. What Should I Do To Insure A Properly Prepared Colon?
Question 23: A 55-Year-Old Veteran Had A Ruptured Gallbladder And A Difficult Cholecystectomy. Postoperatively, The Patient Had Persistent Bile Leakage Despite Months Of Multiple Biliary Stenting. What Can I Do?
Question 24: A 65-Year-Old Male On Plavix Following A Recent Mi And Coronary Stenting Was Seen In The Er With Fever, Pain, Jaundice, And A Wbc Of 18,000. Us Showed A Dilated Bile Duct Of 15 Mm And A Gallbladder Full Of Stones. Mrcp Revealed A 15-Mm Stone In The Distal Cbd. What Would You Do?
Question 25: What Is The Best Endoscopic Method To Diagnose Pancreatic Cancer? What Is The Best Way To Sample Tissue To Diagnose Suspected Bile Duct Cancer?
Question 26: A 68-Year-Old Man With A Klatskin’S Tumor Was Referred For Consideration Of Ercp And Palliative Drainage. How Should I Manage The Patient?
Question 27: An Elderly Patient With Multiple Medical Problems Presents With Acute Pancreatitis And Stones In The Gallbladder. Lfts Show Ast Of 90 And Alt Of 95, Both Declining. Mrcp Shows No Cbd Stones Or Ductal Dilation. Is Ercp Indicated?
Question 28: I Have A Patient With Biliary-Type Pain, But No Other Evidence Of Bile Duct Disease (Normal Diameter Duct On Ultrasound, Normal Liver Function Tests). How Should Such A Patient Be Managed?
Question 29: How Can We Accurately Determine The Appropriate Length Of The Stent To Use In A Patient With A Bile Duct Stricture?
Question 30: A 56-Year-Old Female Presents With Recurrent Ruq Pain, Impaired Lfts, Elevated Alkp, And Transaminases. She Had A Prior Ercp And Possible Biliary Papillotomy For Similar Complaints But She Does Not Recall The Diagnosis. What Should I Do?
Question 31: My Accountant, Whose Ulcerative Colitis Is In Good Control On Maintenance 5 Asa Therapy, Called Because His Lfts Were Elevated. He Had No History Of Jaundice, But New Onset Of Itching. What Should I Do?
Question 32: My 35-Year-Old Patient Who Had A Cholecystectomy 5 Years Ago During Her Gastric Bypass Surgery Presents With Abdominal Pain And Impaired Lfts. Ct Showed A 15-Mm Cbd With A Distal Cbd Stone. Ercp Was Unsuccessful Using A Pediatric Scope. Can You Help?
Question 33: A 48-Year-Old Male Had Liver Transplantation 9 Months Ago For Chronic Hep C Cirrhosis. He Presented Recently With Recurrence Of Jaundice And Impaired Lfts. How Should I Manage This Patient?
Question 34: A 68-Year-Old Banker Who Had A Prior Whipple For Periampullary Cancer Had Recurrent Abdominal Pain And Fever For 3 Years. Each Resolved With Antibiotics. Lfts Are Impaired And Ct Scan Shows Dilated Intrahepatic Ducts And A Tubular Structure In The Pancreas. What Should I Do?
Question 35: A 78-Year-Old Vietnamese Woman Who Collapsed At Home Was Found To Be Febrile And In Shock With A Systolic Bp Of 80 Mm Hg. She Is Mildly Jaundiced With Abdominal Guarding. How Would You Manage Her?
Question 36: My 68-Year-Old Patient With Ms Presents With Dyspeptic Symptoms And Loose Stools. Imaging Showed A Dilated Pancreatic Duct And Extensive Calcification In The Head Of The Pancreas. Symptoms Responded Partly To Pancreatic Enzyme Supplement. What Should I Do Next?
Question 37: A 12-Year-Old Patient Has A 5-Year History Of Recurrent “Acute Pancreatitis,” Managed Conservatively With Pancreatic Enzymes Supplement. Ct Reveals Mildly Dilated Pancreatic Duct With A Possible Stone In The Head Of The Pancreas. What Else Can I Do?
Question 38: A 25-Year-Old Female Presents With Recurrent Abdominal Pain And Mildly Elevated Serum Amylase And Lipase Levels, Normal Lfts. Abdominal Imaging Shows Normal Size Cbd, Pd, And No Obvious Stones In The Gallbladder. What Should I Do Next?
Question 39: What Is The Best Treatment For Duodenal Or Ampullary Adenoma, And What Is The Current Recommendation For Surveillance After Treatment?
Question 40: What Should Be The Sequence Of Investigations For A Patient With Recurrent, Unexplained Pancreatitis?
Question 41: A 56-Year-Old Female With Nausea And Vomiting Has A Mildly Elevated Bilirubin But Normal Amylase And Lipase. Ct Shows Thickening Of The Duodenum And Mildly Dilated Cbd. Attempted Ercp Shows A Tight Ulcerative Stenosis Of 1St/2Nd Part Of The Duodenum. What Should I Do?
Question 42: How Do We Manage A Patient With A 10-Cm Pseudocyst Who Is Currently Asymptomatic?
Question 43: Do All Pancreatic Cysts Need Eus Imaging, And Do They All Need To Be Aspirated For Analysis? Are There Even Standard Criteria To Determine Their Origins?
Question 44: Our Endosonographer Frequently Detects Vague Hypoechoic Pancreatic Lesions, But Does Not Perform Fine Needle Aspiration—He Recommends Follow Up Eus In 3 Months. How Many Follow Up Exams Are Needed? Are Fine Needle Aspirations Unsafe?
Question 45: When Is Eus Necessary For A Newly Diagnosed Cancer Of The Esophagus, Stomach, Colon, Or Pancreas?
Question 46: A 35-Year-Old Mechanic Is Complaining Of New Onset Epigastric Pain After Taking Motrin. Egd Shows Mild, Nonerosive Antral Gastritis, And A 1-Cm Submucosal Mass In The Proximal Antrum. Biopsies Showed Chronic Inflammation. What Should I Do?
Question 47: In True Obscure Gi Bleeding, What Should I Do If A Capsule Endoscopy And Upper And Lower Endoscopies Are Unrevealing?
Question 48: What Is A Reliable Method To Estimate The Location Of A Lesion Found On Capsule Endoscopy?
Question 49: If I Suspect A Small Bowel Lesion, How Do I Choose Among Small-Bowel Series, Capsule Endoscopy, Ct Enterography, And Double-Balloon Enteroscopy As The Diagnostic Test?
Curbside Consultation in GI Cancer for the Gastroenterologist: 49 Clinical Questions
27 related chapters
Question 2: Do All Patients With Esophageal Cancer Require Surgery Or Can Some Be Managed With Nonsurgical (Endoscopic, Oncologic, Etc) Methods Alone?
Question 4: An 81-Year-Old Man Is Found To Have Unresectable Esophageal Cancer And Malignant Dysphagia. Should He Have A Stent? A Nasogastric Feeding Tube? A Percutaneous Endoscopic Gastrostomy Tube?
Question 5: How Should Malignant Tracheoesophageal Fistulae Be Managed In Patients With Esophageal Cancer?
Question 6: A 55-Year-Old Man Undergoes An Esophagectomy For Esophageal Cancer. Two Years Later, He Develops Dysphagia And A Contrast Study Discloses A Narrowing At His Anastomosis. How Should This Be Investigated And Treated?
Question 9: What Options Exist For Patients With Gastric Outlet Obstruction From Gastric Cancer?
Question 10: What Is The Role Of Endoscopic Ultrasound In Staging Gastric Cancers?
Question 11: How Is Tumor-Related Bleeding From Gastric Cancers Best Approached?
Question 13: A 42-Year-Old Woman Has An Esophagogastroduodenoscopy For Dyspepsia. A 2-Cm Submucosal Lesion In The Proximal Stomach Is Seen. How Should This Lesion Be Further Evaluated And Treated?
Question 14: A 54-Year-Old Woman Has Weight Loss And Back Pain. An Ultrasound Is Suggestive Of A Solid Mass In Her Pancreas. How Should Her Evaluation Best Proceed With Regards To Diagnosis And Staging?
Question 15: Do Patients With Pancreatic Cancer And Jaundice Need To Have An Endoscopic Retrograde Cholangiopancreatography Preoperatively?
Question 16: A 43-Year-Old Woman Has Syncope Due To Hypoglycemia. An Insulinoma Is Suspected. Computed Tomography And Magnetic Resonance Imaging Of Her Abdomen Are Negative. How Should This Patient Be Further Evaluated?
Question 17: How Should A Cystic Pancreatic Lesion Be Evaluated Prior To Treatment? Which Cystic Lesions In The Pancreas Require Resection And Which Can Be Followed Conservatively?
Question 18: What Is The Role Of Metal Biliary Stents In Patients With Unresectable Pancreatic Cancer And Jaundice?
Question 21: A 70-Year-Old Man With Pancreatic And Liver Cancers Develops Gastric Outlet Obstruction Due To A Mass Compressing The Mass Proximal Duodenum. What Treatment Options Exist For This Situation?
Question 23: A 68-Year-Old Man Develops Painless Jaundice. Endoscopic Retrograde Cholangiopancreatography Demonstrates A Large Ampullary Mass. Biopsies Demonstrate Adenocarcinoma. How Should This Patient Be Managed?
Question 25: What Is The Role Of Endoscopic Retrograde Cholangiopancreatography And Endoscopic Ultrasound In Patients With Suspected Cholangiocarcinoma?
Question 27: What Oncologic Treatment Options Exist For Patients With Cholangiocarcinoma Who Are Not Considered Surgical Candidates?
Question 28: Should Patients With Unresectable Cholangiocarcinoma And Jaundice Be Managed Via Endoscopy With Stents, Interventional Radiologists With Drains, Or Both?
Question 29: What Is The Role Of Photodynamic Therapy And Brachytherapy In Patients With Cholangiocarcinoma?
Question 33: In Nonsurgical Patients With Hepatocellular Cancer, What Treatment Options Exist, And How Effective Are They?
Question 37: What Are The Current Guidelines For Screening For Colorectal Cancer?
Question 39: What Surgical Options Are Available For Patients With Colon Cancer, Including Those Who Present With Acute Obstruction?
Question 41: Which Patients With Colorectal Cancer Should Be Considered For A Colonic Stent?
Question 43: A 78-Year-Old Man With Metastatic Colon Cancer Had A Colonic Stent Placed 16 Months Ago. He Has Developed Recurrent Obstruction At The Site Of The Tumor. How Should This Patient Be Evaluated And Managed?
Question 46: What Is The Role Of Endorectal Ultrasound In Patients With Rectal Cancer? Do All Patients With Rectal Cancer Need To Have An Endorectal Ultrasound?
Question 48: How Should Patients Be Followed After Successful Treatment For Rectal Cancer?
Question 49: How Low In The Rectum Can A Colonic Stent Be Safely Placed? What Happens If The Stent Is Deployed Too Far Distally?
Curbside Consultation in IBD: 49 Clinical Questions, Second Edition
5 related chapters
Question 2: How Can I Clarify The Diagnosis In My Patient With Indeterminate Colitis?
Question 3: How Do You Evaluate Small Bowel Crohn’S Disease? How Do You Assess Response To Therapy?
Question 5: What Is The Updated Role Of Capsule Endoscopy In Crohn’S Disease?
Question 10: My Patient With An Ileo Pouch-Anal Anastomosis Has Developed Diarrhea And Urgency. What Is The Differential Diagnosis, And How Should I Evaluate Him? What Is The Significance Of Pre-Pouch Ileitis?
Question 12: What Endpoints Should We Aim For In Inflammatory Bowel Disease Medical Therapy?
Curbside Consultation in IBS: 49 Clinical Questions
1 related chapter
Question 7: What is the Value of Performing a Colonoscopy in Patients with IBS?
Curbside Consultation of the Colon: 49 Clinical Questions
7 related chapters
Question 1: A 46-Year-Old African American Man Who Has No Alarm Features Or Symptoms Requests A Screening Colonoscopy. Is This Appropriate?
Question 5: The Board Of Directors Of My Hospital Wants To Know The Current Colorectal Cancer Screening Options And Will Go With Whatever I Recommend. What Does The Evidence Say Is The Best Colorectal Cancer Screening Regimen?
Question 6: My Patient Had A 13-Mm Tubular Adenoma Removed From Her Colon. What Kind Of Surveillance Do I Need To Recommend? Would It Change Things If She Were 80 Years Old Without Co-Morbidities?
Question 30: What Are The Treatment Options For A Patient With Metastatic Colon Cancer Who Has A Malignant Sigmoid Stricture?
Question 36: A 74-Year-Old Man Who Is Status Post External Radiation Therapy For Prostate Cancer Now Presents With Hematochezia. What Should I Do Next? Can I Keep This From Recurring?
Question 43: What Should Be My Response To Patients Who Ask About Antibiotic Prophylaxis For Their Colonoscopies? If They Are Persistent, And Do Not Have An Indication, Is It Ok To Acquiesce?
Question 46: When Do I Need To Refer A Patient With Diverticular Bleeding For A Colectomy And What Tests Should Be Done Before This Happens?