Professional Documents
Culture Documents
גסטרו
גסטרו
-
-
35 sigmoidoscopy
50
-
10-15 50
poorly differentiated mucinous
pancriato-biliary GU -
HNPCC -
40 25
US
77 CRC screening
50 -
10
5
virtual colonoscopy
-
-
-
LGIB
Obscure GIB
- UGIB
50% PUD 1
visible vessel, active bleeding high risk ulcer 20% -
1/3
IV PPI
IV PPI
clean base Lower risk ulcers -
oral PPI
10-50% -
5% rebleeding H. Pylory
NSAIDs
1-7
10-15% Erosions 2
-
-
NSAIDS 50% NSAIDs
2-40% Varices 3
20-30% -
1/3 -
12 HVPG (Hepatic venous pressure gradient) -
EVL -
ABC -
90% Endoscopic Variceal Ligation 12 -
2-5 terlipressin somatostatin, octreotide IV Vasoconstricting agents -
-
TIPS -
child C
TIPS
EVL -
portal hypertensive gastropathy -
6
-
aorto-enteric fistula -
Osler weber rendu -
GAVE -
Dieulafoy's lesion -
hemosccus pancreaticus -
40
-
-
small intestine Meckel's diverticulum -
-
Diverticula -
Painless
15-40% 80-90%
-
radiation IBD Colitis -
Post-polypectomy bleeding -
NSAIDs -
Solitary rectal ulcer -
-
-
-
juvenile polyposis IBD -
GIB
LGIB UGIB
Hematemesis -
14 Melena -
90%
10%
maroon Hematochezia -
UGIB LGIB 85%
-
15-20% o
20% o
40% o
-
72 o
people bleed whole blood
chronic GIB o
-
UGIB 15% - o
50% UGIB o
o
GIB
UGIB
IV PPI -
terlipressin octreotide
uptodate -
7
o
8
9
UGIB 24 -
o
o
o
12 -
urgent endoscopy
70
5-10% rebleeding -
Coaptive coagulation
PPI -
LGIB
urgent colonoscopy -
yield -
-
o
Tc-pertechnetate Meckel s diverticulum
Occult GIB
-
-
-
-
30% -
colorectal cancer 10% -
-
-
-
mucosal vascular ectasia 50-70% -
MR enterography CT -
Deep enteroscopy -
0.1 -
0.1-0.3 CTA -
0.5 -
200 -
Acute -
2-4 Persistent -
4 Chronic -
-
IBS Pseudodiarrhea
Fecal incontinence
fecal impaction Overflow diarrhea -
90% -
norovirus Giardia E COLI
Vibrio A E COLI O157:H7
Cryptosporidium microsporida CMV
vibrio
cryptosporidium giardia rota virus
C. Difficile
-
Yersinia
reactive arthritis Yersinia
HUS E COLI
Postinfectious IBS
-
NSAIDS
sparing 50 Ischemic colitis
-
Profuse diarrhea
38.5
48
50
70
C difficile -
CT -
IBD
-
loperamide moderate-severe -
bismuth encephalopathy -
febrile dysentery moderate-severe -
3-5 500
7 250 giardia
-
4 -
-
3 -
1
2
3
1 -
Stimulant laxatives painless -
-
sprue like entropathy Olmesartan Osmotic gap<50 -
2
carcinoid syndrome primary bronchial carcinoid Metastatic carcinoid tumor
flushing
10% 1/3 gastrinoma
20 VIP VIPoma
pancreatic cholera
pellagra like
calcitonin Medullary carcinoma of thyroid
urticaria pigmentosa Systemic mastocytosis
NSAIDS Large colorectal villous adenoma
C4 FGF-19
lactase deficiency 1 -
GI 75% Osmotic gap 50 -
2
3
Fermentable Oligo-, Di-, Mono-saccharides And Polyols FODMAP Intolerance 4
1 -
pancreatic duct CF ADEK -
Bacterial overgrowth -
B12 7 -
billiary obstruction 14
2 15-25
32
IBD - -
Lymphocytic collitis, collagenous collitis - WBC -
Ischemic colitis - calprotectin -
Radiation enteritis - protein losing enteropathy -
-
charcot Leyden crystals 50-75% Eosinophilic gastroenteritis - colorectal cancer -
-
-
pyloric obstruction gastroparesis
rumination syndrome
gastric obstruction
Zenker's
-
pyloric obstruction gastroparesis Succussion splash
-
-
CT -
-
-
-
pseudo-obstruction -
-
-
-
-
hearburn, pyrosis -
GERD
retching -
rumination retching
GERD -
-
30%
oropharyngeal dysphagia
pill\infectious esophagitis -
GERD
Water brush -
barret metaplasia
Contrast radiography -
22-95% reflux esophagitis
13
TE Fistula
Zenker's cricopharyngeaous
video fluoroscopic rapid sequence
EUS -
barret
staging
24-96h ph monitoring -
GERD 5% 4 ph
GERD
impedance
Hiatal hernia
esophageal hiatus
sliding hernia Type I -
95
GE hiatus paraesophageal
gastric cardia junction
wear and tear
GERD
Paraesophageal hernia -
B ring -
squamocolumnar mucosal junction
10-15%
Schatzki ring 13
steakhouse syndrome
Diverticula
False diverticula -
Hypopharyngeal (Zenker's)
UES stenotic crycopharyngeaous muscle
Killian triangle
crycopharyngeal myotomy diverticulectomy
marsupialization
Epiphrenic
left recurrent
laryngeal
-
oropharyngeal dysphagia -
Esophageal dysphagia -
myenteric plexus NO -
100,000 1-3 -
25-60 -
LES -
LES + sigmoid espohagus -
HSV1 -
-
-
-
squeezing
chest pain equivalent
-
-
DD
DES -
Chaga's disease -
5% Pseudo-achalasia -
-
anti-neuronal ab.
-
beak like esophagus
epiphrenic diverticulum
sigmoid configuration
-
LES -
-
-
1
3-4
32-98%
0.5-5%
Laparoscopic Heller myotomy 2
Heller myotomy
62-100%
5 90% RCT
POEM - Per Oral Esophageal Myotomy LES myotomy
LES
-
CCB
LES
66%
-
stasis esophagitis
17 Squamous cell esophageal cancer
DES
short latency -
CCB -
anxiolytic -
-
20 2-6 -
10-15% -
-
Barret's esophagus -
GERD -
-
LES 1
LES hypotention 2
GEJ 3
50% ZES
-
-
-
-
-
GERD -
-
-
-
GEJ Erosive esophagitis
1/3
-
peptic stricture erosive esophaitis
PPI
Barret metaplasia -
PPI
Barret's screening 50 5
Barret metaplasia
GE Junction
columnar metaplasia
low and high grade 0.1-0.3%
dysplasia
6
barret PPI
2
PPI 3
H2 Receptor antagonist
PPI
interstital nephritis
B12
Clostridium difficile infection
PPI
PPI Laparoscopic Nissen fundoplication 4
CMV -
200 CD4<100 AIDS -
seroconversion
HAART
HSV - -
-
co oral trush - - -
infection - candida albicans
-
100-200 200-400 PO
14-21 -
voriconazole, posconazole -
IV Echinocandin
-
CMV
Pill esophagitis
-
mid esophagus -
-
Doxycycline
Tetracycline
NSAIDs
Bisphosphonates
Phenytoin
Quinidine
Potassium phosphate
Ferrous sulfate
-
-
CT -
-
PPI
-
schatzki ring -
Eosinophilic Esophagitis
100,000 4-6 -
30-40 -
GERD EoE -
-
HPF 15 food impaction -
PPI food aversion
50% -
-
-
-
PPI 30-50% GERD PPI
Elimination Diet
fibrostenosis
40/50/55 -
40 -
5 GERD
Test and treat
-
10% 12% -
-
90% -
-
5 -
-
OR 3.7
OR 3.3 NSAIDs
-
NSAIDS 30-60% - - -
-
- - -
- -
1
2
3 3 antral gastritis
4
NSAIDS -
chemical
gastropathy
Helicobacter Pylori
-
PUD
S shaped -
dormant cocoid -
CagA Vac A CO2 urease -
LPS -
-
10-15% -
30-60% 50-70% -
-
body
NSAIDs
50-60% -
15-30% PUD -
1.5% -
4-5% -
80% -
75 NSAIDs -
-
NSAIDs
NSAIDS
NSAIDS 87% -
coffee ground
20% -
succusion splash -
15-25% GI 1
NSAIDS 60
30 2.5-10%
50%
7% 2
NSAIDS
20% 30
2/3
GU DU
Gatro-colic fistula
IV PPI
1-2% 3
pylorospasm
7-10 PPI
DD
NUD Non Ulcer Dyspepsia -
essential dyspepsia
30% -
80% -
40 -
-
0.5 80-90%
PPI
1% Reinfection
-
-
8-12
70%
-
90%
8 12
NSAIDS
ZES
secretin stimulation test
High dose PPI 8 90
30-60 40
Eosinophilic gastroenteritis
TB CMV
NSAIDs HP -
-
Antacids -
PUD
CKD 1
CKD 2
4
H2 -
4 nizatidine famotidine ranitidine cimetidine
Abx 4-6
Cimetidine
CYP450
PPI H2
PPI -
H+K+ATPase
95% 72-96
18 2-5
1-2
ketoconazole
reinfection 2.5 74% C diff CAP
IF B12
40%
Interstitial nephritis
65
PPI
Tentoprazole PPI -
benzimidazole imidazopyridine
GERD
P-CABs -
venoprazan revaprazan potassium competitive acid pump antagonist
Cytoprotective Agents -
Sucralfate
sulfate aluminium hydroxyl
bezoar
flushing
misoprostol
HP
-
-
10-20% 70% 60%
documented PUD 1
NSAIDS
PUD
MALToma 2
60-90%
NSAIDs 3
PUD
PPI
4
15% 158
subtotal resection
Pan-gastritis, body-predominant
85-90% -
-
14 -
4-6 H2/PPI 14 -
sequential -
-
3-4 -
-
GI -
-
1-2% Pseudomembranous colitis
-
80% 30% -
1-2% 15%
-
-
15-20% -
in vitro -
-
-
-
-
14 2 PPI 1
500 2 clarithromycin
3 500 1 3 based
Prevac
10-14 4 PPI 1
2 Bismuth
500 3 quadruple
250-500 4 Helidac
5 2 PPI 1
1 2 Concomitant
10-14 500 3
500 Tinidazole 4
-
Rifabutin/Furazolidone/Levofloxacin+amoxi+PPI -
NSAIDS -
NSAIDS PPI -
NSAIDS -
NSAIDS
naproxen, ibuprofen GI NSAIDS -
-
PPI -
200 misoprostol 40 H2 -
Selective COX2 -
COX2 100 rofecoxib clecoxib -
COX2 Inhibitors
NSAIDS -
NSAIDS combination pills -
90
gastroduodenostomy\jejunostomy 1
Highly selective vagotomy 2
Bilroth I antrectomy 1
Roun-en-Y GEJ subtotal gastrectomy 2
ZES o
o
NSAIDS o
retained gastric antrum o
sham feeding gastric acid analysis
50% cephalic
sham feeding pancreatic polypeptide
PPI 70-90 H2
15-30 1
volume contraction shift
VIP GI
3 90 2
6
acrabose guar
3 10% 60% -
intake
PUD
90% o
o
NSAIDs H pylory
2/3
50%
MEN1
20-25%
5 6%
pernicious anemia
-
PPI -
12 PPI -
150 pg\ml -
PH 2
3 PH -
3 PH -
3
PPI -
90% ZES 15 120 pg\ml -
-
4
50% -
Ga-DOTATATE PET CT octreoscan MRI CT -
SSTR2 Sub type 2
US EUS -
selective arterial secretin injection -
EUS
PPI
o
5 10 Basal Acid Output BAO o
PPI
lanreotide octreotide o
o
90% 5-10
radiolabeled somatostatin analogue o
20 5 o
6% MEN1 o
o
o
PPI
5% PPI
-
-
Multi organ failure -
-
IV PPI
Menetrier s disease
sparing
40-60
CMV ZES
familial polyposis syndrome PPI
massive foveolar hyperplasia
CMV
20-100% GI
protein losing gastropathy
snare technique
CBC -
-
CMV -
PH -
EGFR pathway
EGF Cetuximab
-
IBD 0.6% -
-
African American -
-
2-4 1
UC 7-9 2
5-10% -
o
o
36% IBD 10% IBD -
IBD 2.9 -
IBD -
6 -
HR 2.82
13-26% Appendectomy
concordance 38-58% concordance 6-18%
concordance 4% concordance 0-2%
2-3 C DIFF
- -
- -
sparing -
skip areas -
30-40% 40-50% -
-
stellate - Sandpaper
Cobblestone inflammatory polyps
appearance
- toxic megacolon -
-
Creeping fat -
- -
crypt abcess - -
- -
UC -
skip areas -
1
bifid
2
Crypt Cryptitis 3
abscesses
-
Fibrostenotic obstructing pattern 1 -
Penetrating fistulous pattern 2 -
-
- -
-
Ileo-colitis
10-20% -
-
- -
-
- PR -
o toxic megacolon hepatic tympany -
enterocutaneus o
fecaluria pneumaturia entero-vesical o -
foul-smelling dyspareunia enterovaginal o
String sign - CRP
-
bulb -
-
30% -
-
IBS lactoferrin calprotectin -
10% o
-
MRE CTE o
o
5% 1% Capsule retention o
patency capsule o
30
MRE CT -
o
CTE MRE o
1-2% 1 UC 15% -
10-30% 2 1% 1
- -
CT - 24-48 6-8 -
-
- 5% Toxic megacolon 2
40% 3 6 -
4
5 -
6 50% -
-
15%
Toxic colitis -
5-10% 3
-
-
93% 55% ASCA - pANCA -
IPAA
indeterminate
colitis
-
40 -
-
TNF 3
1/3 MMF o
Etanercept o
Atypical colitis -
1
2
Diversion colitis o
SCFA
IBD 1/3 -
-
- o
UC 10% 15%
o
UC 1-12%
IV
neutrophilic dermatosis sweet syndrome o
o
5-10% o
80% perianal skin tags o
o
-
15-20% o
TNF
HLA B27 2/3
Sacroileitis o
UC
AS
1-10% -
anterior uveitis o
UC
3-4% Episcleritis o
-
o
IBD 50%
o
10-35%
Granulomatous hepatitis o
Hepatic amyloidosis o
PSC o
IBD PSC 50-75% PSC UC 5%
pANCA UC
IBD
ERCP GS
MRCP
5-10
-
10-20% o
o
ileal-bladder o
-
40% o
o
TPN budesonide MTX
60
1% o
o
MRI
-
o
o
o
o
-
o
5ASA o
o
5ASA - -
15 o
30 o
Sulfasalazine o -
2-4 - budesonide o
- o
o
acute severe colitis o -
- o
o
acute severe colitis Cyclosporine -
-
SONIC -
5-ASA
UC -
-
-
Sulfasalazine
-
G6PD -
-
30% -
o
o
-
o
o
o
hypersensitivity pneumonitis o
o
o
o
folic acid -
5-ASA
-
-
-
-
IPAA UC 20-50% UC -
-
o
disulfiram like-reaction o
o
-
tendon rupture tendinitis o
Azathioprine 6-Mercaptopurine
-
thioinosinic acid -
-
-
4-6 3-4 -
-
-
3-4% o
o
o
o
dose related
TMPT
CBC -
MTX
IL-1 DNA -
-
IM\SC -
-
-
o
PO o
o
o
o
100 -
integrity -
UC CD -
moderate-severe CD and UC -
AZA\MTX Top-down therapy -
o
o
TNF
infliximab -
o
IV o
adalimumab -
o
o
acute severe colitis o
infliximab o
o
cerolizumab pegol -
o
Fab2 o
o
o
human IgG 1 anti TNF Golimumab -
o
o
UC o
adalimumab o
anti TNF
-
serum sickness infusion reaction o
o
8
MTX 6MP AZA
o
Primary failure
NHL -
2:10,000 CD o
4:10,000 6MP AZA o
65 o
thiopurine TNF o
TNF adjustment o
Hepatosplenic T Cell lymphoma -
o
5% -
o
TNF o
Ustekinumab o
-
Anti integrins
Natalizumab -
maintanance alpha4 integrin IgG o
11:1000 PML o
50-55% JC Virus 1
2
3
seroconversion 1-2% JC virus o
o
Vedolizumab -
gut selective immunosuppression alpha4beta7 o
TNF o
JC Virus TNF CD UC o
Tofacitinib
2 JAK1,3 -
signaling -
UC -
Biosimilars
-
-
infliximab -
RCT -
Ozanimod
sphingosine-1-phosphate receptor subtypes 1,5 -
GI tract -
UC -
-
TPN bowel rest o
o
TPN EEN o
UC -
-
10 UC 50%
6-10
30-50%
urgency
CD
3-5%
-
o
o
o
80%
strictureplasties
50%
IPAA
MTX o
o
TNF o
Certolizumab
Infliximab, adalimumab
TNF
-
o
50% Total colectomy o
IBD
1.5-2 UC -
-
-
o
o
o
PSC
80% -
45 -
post infectious IBS -
IBS
shigella salmonella
crampy
200
-
Upper GI symptoms -
25-50%
48
200-300
40
IBS-D
microscopic colitis
-
Reassurance
IBS-D -
anti-diarrheals Anti-spasmosdics
Bile acid binders
5HT3 Alosetron Serotonin receptor modulators
Rifaximine
-
TCA
-
-
-
Atypical celiac disease -
Silent celiac disease -
-
-
-
steatorrhea -
GI -
Steatorrhea -
brush border Secondary lactase deficiency -
-
crypt hyperplasia -
gliadin -
IgA -
Anti tTG
90-95% Anti Endomysial
Antigliadin
-
10%
HLA-DQ8 HLA-DQ2
HLA
DQ2\DQ8
tTG -
eosinophilic
bacterial overgrowth milk intolerance enteritis
2
-
-
rechallange -
-
-
-
90% -
Refractory celiac disease -
-
Intestinal T cell lymphoma
Intestinal ulceration -
BM collagen like material Collagenous spure -
-
-
B12
ALK-P ADKE
-
72 gold standard
Sudan III
Tropical sprue
-
-
Intergrity -
-
-
-
6-12
-
-
MCTs -
bacterial overgrowth -
steatorrhea PPI -
B12 zinc fat soluble vitamins -
teduglutide GLP-2 -
Functional stasis -
ileocolonic resection -
B12 -
unconjugated Steaorrhea -
steatorrhea -
B12 -
jejunum -
Hydrogen breath test -
-
rifaximin
Whipple's Disease
PAS steatorrhea GI -
Migratory arthropathy -
-
CNS -
-
-
T. Whipplei
-
-
-
BBB
Pseudo-divericula -
muscularis propria
vasa recta
dysbiosis -
70% left sigmoid colon -
60 60% -
20% -
Westerenized societies -
-
-
60 -
20% -
NSAIDS
-
-
25%
RBC CT
80% coil embolization
sub-total colectomy segmental resection 24 6
LLQ pain -
25% LLQ -
-
CT -
4
Complicated diverticulitis -
-
30
Uncomplicated -
75%
Bowel rest
3
5
Complicated -
low surgical risk
6 -
-
review
Rifaximin
30%
- CT - - - - Non-occlusive
- - - mesenteric
- ischemic colitis - - ischemia
Cardiogenic \septic -
shock
Cocaine overdose -
IV - CT - - - Mesenteric
- SMV - Protein C\S - venous
- deficiency thrombosis
Anti thrombin III -
deficiency
Polycythemia vera -
-
- - Intestinal angina - - Chronic
- intestinal
GS - ischemia
- MRA -
80%
Ileus
ileus
IV -
-
-
mu receptor antagonist -
IV 10
Gallstones 80-90% -
5 30-60% Gallstones
15-30%
100,000 5
5-10% Post ERCP -
ERCP prophylactic pancreatic duct stent rectal NSAIDs
-
-
-
10-20%
Cullen's sign
Turner's sign
3 -
7-14 3-7
3 2 -
1
3 2
3
US -
3-5 CT -
90-95% Interstitial pancreatitis
5-10% Necrotizing pancreatitis
peripancreatic necrosis
GCS<15
SIRS
60
Gallstone pancreatitits -
24-48 ERCP
4-6
-
-
organ failure
5-7
Sterile necrosis
step up approach necrosectomy pancreatic debridement Infected necrosis
Pseudo-cyst -
10% 6
MRCP ERCP
90% 6 bridging pancreatic stent
Perivascular complicantions -
Splenic vein thrombosis
20% -
Recurrent pancreatitis
25% -
-
microlithiasis
2-4%
Pancreas divisum
CF
-
stellate cells -
-
-
-
CF -
25% -
15%
20%
-
-
severe pancreatic exocrine insufficency 100 fecal 1 elastase -
-
CT -
MRI
60%
FP EUS -
10 -
AIP
IgG related disease -
IgG-associated cholangitis
UC RA
Mediastinal fibrosis and adenopathy
TIN
Chronic perioaortitis
Sialadenitis
Mikulicz's disease
-
2/3
-
2/3 IgG4
ALP
CT -
1/3 ERCP -
-
lymphoplasmacytic
Storiform fibrosis
IgG4
1 HISORt -
H
I
S
other organ involvment O
response R
-
tapering 4 40
2-4
2-4
99%
30% relapse
Rituximab 6MP AZA relapse
Pregabalin
dominant stricture