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Line 103: − + − + − + − + − + − + − + − − =Missed Concepts= − *Food protein-induced allergic proctocolitis shows up at 1-4 weeks of age with blood and mucus streaked stools. Treat by eliminating dairy from the maternal diet. It is benign and self-limited. − *The shortest interval for repeat colonoscopy is for '''large adenomas (>2 cm) removed piecemeal'''. Second shortest interval is '''1 year for > 10 adenomas'''.
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=Missed Concepts=
*Food protein-induced allergic proctocolitis shows up at 1-4 weeks of age with blood and mucus streaked stools. Treat by eliminating dairy from the maternal diet. It is benign and self-limited.
*The shortest interval for repeat colonoscopy is for '''large adenomas (>2 cm) removed piecemeal'''. Second shortest interval is '''1 year for > 10 adenomas'''.
*Initial evaluation for gastroparesis is '''EGD to evaluate for mechanical obstruction'''.
=Esophageal Pathology=
=Esophageal Pathology=
*H&P:
*H&P:
*Dx: '''Adenocarcinoma''' is more common in the mid to distal esophagus, while '''squamous cell carcinoma''' is found in the upper 1/3.
*Dx: '''Adenocarcinoma''' is more common in the distal 2/3 esophagus (smooth muscle), while '''squamous cell carcinoma''' is found in the upper 1/3 (skeletal muscle).
*Tx:
*Tx:
=LGIB=
=LGIB=
*H&P:
*H&P:
*Dx: Angiodysplasias (e.g. AVMs) are associated with '''AS, vWD, and ESRD'''. Workup for hematochezia is '''colonoscopy''' if HDS, '''resuscitate, ± surgery/IR consult, EGD''' if HDUS.
*Dx: Workup for hematochezia is '''colonoscopy''' if HDS, '''resuscitate, ± surgery/IR consult, EGD''' if HDUS. Angiodysplasias (e.g. AVMs) are associated with '''AS, vWD, and ESRD'''.
*Tx:
*Tx:
{| class="wikitable"
{| class="wikitable"
|-
|-
| rowspan="3" | Cholestasis (ALK + TBili) || rowspan="2" | No Obstruction || Hepatitis, Cirrhosis
| rowspan="3" | Cholestasis (ALK + TBili) || rowspan="2" | No Obstruction || '''Indirect''' bili: Hepatitis, Cirrhosis
|-
|-
|| PBC, Drug-induced, Post-op, Sepsis
|| '''Direct''' bili: PBC, Drug-induced, Post-op, Sepsis
|-
|-
|| Obstruction || Choledocholithiasis, Cholangiocarcinoma, Pancreatic cancer, Sclerosing cholangitis, Pancreatitis
|| Obstruction || PSC, Choledocholithiasis, Cholangiocarcinoma, Pancreatic cancer, Pancreatitis
|-
|-
| rowspan="3" | Hepatocellular Injury (AST + ALT) || Viral || Hepatitis Virus (A-E), EBV, CMV, HSV, VZV
| rowspan="3" | Hepatocellular Injury (AST + ALT) || Viral || Hepatitis Virus (A-E), EBV, CMV, HSV, VZV
==Gallstone Disease==
==Gallstone Disease==
*H&P:
*H&P: Female, Fat, Forty, Fair, Fertile
*Dx: Cholestatic pattern of '''elevated bilirubin and alk phos''', Charcot triad for '''ascending cholangitis includes RUQ pain, fever, jaundice'''. When clinical suspicion for acute cholecystitis is high, but US is negative or inconclusive, '''get HIDA scan.'''
*Dx: Cholestatic pattern of '''elevated bilirubin and alk phos''', Charcot triad for '''ascending cholangitis includes RUQ pain, fever, jaundice'''. When clinical suspicion for acute cholecystitis is high, but US is negative or inconclusive, '''get HIDA scan.'''
*Tx: For acute/ascending cholangitis, treat with '''ERCP within 24-48 hrs'''
*Tx: For acute/ascending cholangitis, treat with '''ERCP within 24-48 hrs'''
==Heredity Hemochromatosis==
==Heredity Hemochromatosis==
*H&P: Males present young (30s), Females present late (60s), '''hyperpigmentation''', arthritis, cardiomyopathy, diabetes
*H&P: Males present young (30s), Females present late (60s); '''hyperpigmentation''', arthritis, cardiomyopathy, diabetes
*Dx: Elevated AST and ALT, serum ferritin and transferrin saturation, HFE gene mutation
*Dx: Elevated AST and ALT; increased serum ferritin and transferrin saturation; HFE gene mutation
*Tx: Therapeutic phlebotomy
*Tx: Therapeutic phlebotomy
==α1-Antitrypsin Disease==
==α1-Antitrypsin Disease==
*H&P: Associated with emphysema, young non-smokers
*H&P: Associated with emphysema in young non-smokers
*Dx: Elevated AST and ALT, serum AAT levels, genotyping
*Dx: Elevated AST and ALT; serum AAT levels, genotyping
*Tx: Transplant, AAT augmentation
*Tx: Transplant, AAT augmentation
==Autoimmune Hepatitis==
==Autoimmune Hepatitis==
*H&P: Young to middle-aged; F>M; painless hepatomegaly
*H&P: Young to middle-aged; F>M; painless hepatomegaly
*Dx: Elevated AST and ALT, normal ALK and TBili. '''ANA, anti smooth muscle, LKMA''' antibodies are positive. Biopsy.
*Dx: Elevated AST and ALT; '''ANA, anti smooth muscle, and LKMA''' antibodies are positive. Biopsy.
*Tx: Corticosteroids and azathioprine
*Tx: Corticosteroids and azathioprine
==PBC==
==PBC==
*H&P: Age 30-65; F>M; Fatigue and jaundice; pruritis and osteoporosis; associated with hypothyroid and arthritis
*H&P: '''Intrahepatic''' bile duct '''destruction'''; Age 30-65; F>M; Fatigue and jaundice; pruritis and osteoporosis; associated with hypothyroid and arthritis
*Dx: Elevated ALK + bili, positive AMA
*Dx: Elevated ALK + bili; '''positive AMA'''; no bile duct dilation on imaging
*Tx: Ursodeoxycholic acid, cholestyramine, fat-soluble vitamins; transplant in rare cases
*Tx: Ursodeoxycholic acid, cholestyramine, fat-soluble vitamins; transplant in rare cases
==PSC==
==PSC==
*H&P: Age 30-40; M>F; associated with IBD (UC>Crohn's); asymptomatic or presenting with fatigue, pruritic, RUQ pain
*H&P: '''Intra and extra hepatic''' bile duct '''fibrosis'''; Age 30-40; M>F; associated with IBD (UC>Crohn's); asymptomatic or presenting with fatigue, pruritic, RUQ pain
*Dx: Elevated ALK + bili; '''ANA, anti smooth muscle, and anti pANCA''' antibodies.
*Dx: Elevated ALK + bili; '''ANA, anti smooth muscle, and anti pANCA''' antibodies; bile duct dilation on imaging
*Tx: Ursodeoxycholic acid, cholestyramine, fat-soluble vitamins; transplant '''frequently''' required
*Tx: Ursodeoxycholic acid, cholestyramine, fat-soluble vitamins; transplant '''frequently''' required