CrushingGIBoards
@CrushingGIBoard
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THE Go-To #Tweetorial 📄 to LEARN, ENGAGE, & EDUCATE in #Gastroenterology | ⭐️ New case qMonday | #MedEd | #GIBoards #GIRecert • Created by @AdvaniRashmiMD
Los Angeles, CA
Joined November 2022
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68M w/ T2DM, HTN, obesity with elevated LFTs.
💊Metformin and statin.
🍺2-3 beers per week, non smoker, no illicit drug use. 🧪AST 42, ALT 64, ALP 180.
🩸BP 143/85, Ht 5'11, 253Lbs.
🩻RUQ US: enlarged, echogenic liver w/o biliary ductal dilatation. ⬇️
1
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🌟CRUSHING THE GI BOARDS🌟 brings you exciting educational
#Tweetorials
brought to you by ➡️crew!
@taliafmalik
@SimoneJarrettMD
@abeljosephmd
@mattie_md
@CatherineWangMD
@DrGoodGuts
@hassamalii
@multani_monica
@mariaCfonseca2
@TanishaKalra14
STAY TUNED!
#GITwitter
4
22
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Check out the summary slide on Lemmel Syndrome - quite an interesting case!
Created by
@SanyaGoswami4
Follow us for more high-yield GI content!
#GITwitter
#MedEd
1
14
58
70 y/o man w/ intermittent dysphagia to liquids and solids and non exertional substernal chest pain for several months. EGD and cardiac work up was negative. Barium swallow test showed 📷 What is the diagnosis?
#GITwitter
#MedTwitter
#CrushingGIBoard
13
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35 Yr old M, with a hx of asthma, presents with 6 months of dysphagia and food impaction. EGD: Concentric rings in the distal esophagus, Bx: Increased eosinophilic infiltration. What is the diagnosis?
#GITwitter
#MedTwitter
#CrushingGIBoard
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Our growing family appreciates the 1000+ of you!
Want to be a
#contributor
for
@CrushingGIBoard
?
We are so excited that many of you have signed up until the summer ☀️!
There are still some spots remaining! DM us here or
@AdvaniRashmiMD
#GITwitter
#MedTwitter
#MedEd
21
9
57
Happy weekend! Let's wrap this week with this summary slide on Mirizzi syndrome by board member
@TanishaKalra14
Don't forget to save it for a quick review before boards!
#MedTwitter
#MedEd
#GITwitter
0
15
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It has been 1️⃣ month since
@CrushingGIBoard
took the
#GITwitter
stage and have got to say, we are so excited to bring you MORE content!
This past month, we heard from
@CatherineWangMD
@SimoneJarrettMD
@DrGoodGuts
and
@taliafmalik
!
Interested in being a contributor? DM us!
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32y/o man with severe chronic constipation, abd pain, N/V/D and CT below. Anorectal manometry showed absent rectal sensation and abnormal recto-anal inhibitory reflex. Which test would you use to make the diagnosis?
#GItwitter
#MedTwitter
#MedEd
#CrushingGIBoard
10
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A 19 y/o male p/w abd pain & intermittent rectal bleeding for 6 months. Colonoscopy revealed these findings. Which of the following tests is NOT recommended in the mgmt of these pts?🧐💩
⭕️C.Diff
⭕️Perinuclear ANCA Antibody
⭕️Fecal Calprotectin
⭕️CRP
#GITwitter
#CrushingGIBoards
14
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Patient with cirrhosis and esophageal varices undergoes an upper endoscopy. Biopsy shows dilated submucosal veins and capillaries. What is the diagnosis?
#MedEd
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Let's wrap up the week's case with our summary slide on EoE!
Brought to you by Board Member
@SanyaGoswami4
Don't forget to bookmark! 🔖
#GITwitter
#MedEd
0
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Wish to be a
@CrushingGIBoard
contributor? DM 📥 us!
This is an excellent opportunity for those of you looking to contribute to
#MedEd
on Twitter/X AND learn about commonly-tested GI diseases for the
#GIBoards
!
#MedTwitter
#GITwitter
13
5
47
Let's wrap up the week with a Summary Slide on Gastric Intestinal Metaplasia!
Brought to you by Board Member
@SanyaGoswami4
Bookmark this slide to review and help you crush the GI Boards!
#MedEd
#MedTwitter
#GITwitter
0
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Check out our summary for this week's topic
💥 Autoimmune Pancreatitis 💥
Thank you to our contributor
@DJDownsMD
for this awesome summary! 💩 💊
#GITwitter
#MedEd
#CrushingGips
#MedTwitter
0
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47 yo man presents w/ dyspepsia and weight loss. Pitting edema and epigastric tenderness on physical exam. EGD ⬇️ shows thickened folds without masses. Gastrin level 300 albumin 2.1 secretin stim ⬆️ gastrin level to 350. What is the diagnosis?
#medtwitter
#GItwitter
#boardsreview
16
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46 yo man w/ UC, PSC underwent a colonoscopy which showed 3 polyps(<1cm)⬇️. Biopsy findings⬇️. When should he f/u for repeat surveillance❓
A. Colonoscopy in 1 year
B. FIT testing in 3 years
C. Colonoscopy in 3 years
D. No further testing
#GITwitter
#MedTwitter
#CrushingGIBoard
10
12
44
Here's this week's summary on Barrett's Esophagus & surveillance algorithm
Remember to 🔖for review later to help you CRUSH 💪 the GI Boards!
Created by Board Member
@SanyaGoswami4
#GITwitter
#MedEd
#Boards
1
17
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Let's close out this week with a Summary Slide on our last case - Boerhaave Syndrome - brought to you by our very own Board Member
@SanyaGoswami4
!
Don't forget to bookmark this slide for reference later!
Check it out ⬇️!
#GITwitter
#MedEd
0
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Happy Monday!
A 56 y/o M w/ chronic hx of PUD came to the ED w/ epigastric pain. PE: + epigastric tenderness
Labs: LFTs w/ ALP 199, ALT 182, AST 245, TBili 2.6.
CT: double duct sig
EGD: Chronic duodenitis & duodenal outpouching.
What do you think is the ddx?
#GITwitter
💩
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1/ Gastroparesis = motility disorder which includes symptoms & objective evidence of delayed gastric emptying (GE)
Symptoms include:
-Nausea 🤢
-Vomiting 🤮
-Postprandial fullness
-Bloating 🫄
-Upper abdominal discomfort
2/ Major causes
• DM🍭🍬- Acute hyperglycemia delays GE.
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Happy Sunday! Let's wrap up the week with a summary on Ischemic Colitis - brought to you by Board Member
@SanyaGoswami4
Don't forget to save & bookmark! 📖
#GITwitter
#MedEd
0
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A 22 yo female with type 1 DM presents with abdominal bloating, fatigue, weight loss, and elbow rash (shown👇). Labs:
⬇️Hgb
⬆️ AST and ALT
Negative tTG Ab
Normal total IgA level
What’s the next step for the diagnosis?
#GITwitter
#MedTwitter
#MedEd
#CrushingGIBoard
13
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53 y/o woman w/ sudden-onset chest pain that started a couple of hours ago after eating sea food including fish. She was febrile and hypotensive.
CTA showed the following
What is the diagnosis?
#GITwitter
#MedTwitter
#CrushingGips
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🔥31 yo pregnant F (35 wks) with pruritus, excoriations on b/l arms, ALT 105, AST 90, ALP 240, plt 160k. Chronic liver disease w/up is neg. Total serum bile acids 42 µmol/L. RUQ US no biliary duct dilation.
Best next step❓
#GITwitter
#MedTwitter
#MedEd
Liver biopsy
38
Emergent delivery
227
Ursodiol, trend bile acid
380
MRCP
61
3
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In case your missed our last case, check out our weekly summary on Hirschsprung Disease ⬇️ created by
@SanyaGoswami4
!
Let's do a quick Friday review sesh!
Here's a breakdown on the
✅ Risk factors
✅ Pathophys
✅ Presentation
✅ Pathognomonic imaging
✅ Management
#GITwitter
1
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After a fun-filled weekend at DDW in Chicago, we're back with more GI content!
Here's another HY review on Menetrier's Disease brought to you by our very own Board Member
@SanyaGoswami4
!
Bookmark & save it to review for your boards!!!
#GITwitter
#MedEd
0
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🔥42/F w/ Crohn’s p/w abdominal pain, fever, diarrhea. Stopped adalimumab. Abdominal tenderness +, WBC 15k, CRP 44, calpro 1300, pancolitis on CT, active colitis on flex sig. IV steroids started. C. Diff PCR +. Next step❓
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Summary Series:
Check it out - summary of last week's case brought to you by
@SanyaGoswami4
!
Save and bookmark this slide⬇️!
Don't forget to follow us
@CrushingGIBoard
for more Board Review content!
#GITwitter
#MedTwitter
#MedEd
0
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A summary of the case posted last week!
Save and bookmark this slide ⬇️!
Brought to you by our newest board member
@SanyaGoswami4
who will be bringing you weekly summaries on our topic!
Don’t forget to follow
@CrushingGIBoard
for more content!
#GITwitter
#MedTwitter
0
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Here's a wrap on this week's case - please bookmark and save for review! Created by Board Member
@SanyaGoswami4
#GITwitter
#MedEd
0
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32
45 yo woman w/ 5 year h/o intermittent squeezing chest pain & dysphagia. Prior workup includes normal coronary angiogram and exercise stress test. Pt denies other PMH and meds. High-resolution manometry ⬇️ What is the *best* treatment option?
14
10
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High-yield summary on Sweet Syndrome - bookmark and save to review for the boards!
Brought to you by Board Member
@SanyaGoswami4
!
#GITwitter
#MedEd
0
12
31
🔥57 yo F p/w RUQ pain, fever, vomiting & jaundice. Hx of similar episodes in the past, but never felt this sick😢 or developed jaundice. Labs show leukocytosis, elevated liver enzymes, T. bil & D. bil. U/S is shown below in the comment. What is the diagnosis❓
#GITwitter
#MedEd
Ascending Cholangitis
195
Acute Cholecystitis
55
Mirizzi syndrome
181
Choledocholithiasis
36
5
14
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This Monday
@CrushingGIBoard
we would like to take a ⏸️ from our regular content for
#DDW2023
and highlight our appreciation for our board members and our contributors!
👏🏽 by contributors
@Ammusss
@fazlrahim2021
@SameerPrakashDO
@PSamikshaMD
DM us if interested!
#GITwitter
1
7
31
Happy Saturday! Check out the summary slide on this week's case!
Brought to you by our Board Member
@SanyaGoswami4
!
Don't forget to save and bookmark!
#MedEd
#GITwitter
1
9
28
46/F with SLE(on AZA), HTN(on valsartan) p/w ongoing diarrhea, nausea, vomiting🤮, abdominal pain for 3 wks. Nocturnal BMs +, >10 episodes/day. Diffuse abdominal tenderness +. CTAP (shown below in the comment) reveals changes in jejunum and ileum. What's the diagnosis❓
Celiac disease
15
Lupus enteritis
94
Enteropathy 2/2 valsartan
68
Tropical sprue
16
2
9
28
Happy Monday! 👻
21-yo F with bilious output from JP drain following laparoscopic cholecystectomy. ERCP ⬇️ s/p sphincterotomy & biliary stent However, she continued to drain copious bile despite endoscopic treatment.
1
6
29
Here's a wrap on this week's case by Board Member
@SanyaGoswami4
Bookmark 🔖and save!
#GITwitter
#MedEd
0
6
27
1\ Let's dive into Zenker's diverticulum (pun intended 😉)
🎯 Who does this happen to and why?
If symptomatic typically men, middle-aged and older adults in their 7th or 8th decade
🎯 Why does it happen?
Weakness in wall of hypopharynx known as Killian's triangle ⬇️
62 yo woman presents w/ regurgitation, new neck mass, and gurgling sensation after meals with the following ⬇️ imaging finding - what is the diagnosis? 🔍
12
7
17
1
9
28
Here's a summary on last week's case on
#acutepancreatitis
, created by Board Member
@SanyaGoswami4
!
Save & bookmark for review 🔖
#GITwitter
#MedEd
1
9
26
Here's a wrap on this week's case! Brought to you by Board Member
@SanyaGoswami4
and reviewed by
@AdvaniRashmiMD
Save & bookmark for review later! 📑
#GITwitter
#MedEd
0
6
25
Here's a wrap up on this week's case! Summary slide below created by Board Member
@SanyaGoswami4
Please bookmark and save for review! 🔖
#MedEd
#GITwitter
0
7
24
69 yo F p/w mild abdominal pain & bruises over her abdomen after an accident. CBC & liver enzymes normal, lipase 69. CTAP shown⬇️.
What's the diagnosis❓
#CrushingGIboards
#GITwitter
#MedTwitter
#MedEd
7
8
25
Did you get a chance to review last week's case on Dermatitis Herpetiformis?
Check out the summary slide created by
@SanyaGoswami4
to help you CRUSH the GI Boards!
Don't forget to save and bookmark 📖
#GITwitter
#MedEd
0
8
24
42 yo M w/ asthma, seasonal allergies presents w/ dysphagia for past 3 yrs. In the past 5 yrs has been to ED twice with food impaction. Thinks biopsies were taken during last EGD but doesn’t remember results. No weight loss. Reflux symptoms 3-4x weekly. What is best initial tx?
Antihistamine
16
Food elimination diet
48
Proton pump inhibitor
227
Swallowed topical steroid
60
3
5
24
68 yo M presents w IDA, Hgb 8.7, celiac disease negative. EGD & colonoscopy with good prep show no 🩸VCE is unrevealing. Pt is started on iron 💊 with ⛔ response. What is the next step?
#GITwitter
#MedEd
CT angio
29
Repeat EGD
82
CT enterography
94
Nuclear tagged RBC Scan
70
4
7
22
🔥30/M p/w jaundice, fatigue, hematemesis for 1 wk. Hx of alcohol use🍻. O/E drowsy, tachycardic, icterus +, hepatomegaly, asterixis +. Labs show Plt 72, Na 125, AST/ALT/ALP 284/113/18, T. bil 30, INR 1.7, Cr 1.08. CT shown below⬇️
Diagnosis❓
#MedTwitter
#GITwitter
#MedEd
Acute liver failure
103
Alcoholic hepatitis
137
Autoimmune hepatitis
3
Drug induced liver injury
0
2
11
24
Patient with leukemia on chemotherapy presents with incidental acute sigmoid diverticulitis. Exam is unremarkable. No pain. Vitals are normal. Normal WBC.
What do you want to do? 🤔
#GITwitter
#MedTwitter
#Tictok
3
8
23
1/ Esophageal Candidiasis
🔑 Most common cause of infectious esophagitis
Etiology🦠
🔸Candida species 🍄
🔸C. albicans (most common)
🔸C. glabrata and C. krusei
1
11
23
Uncomplicated diverticulitis in an immunocompromised patient should be treated with IV antibiotics and admission. Check out this high yield infographic on Diverticulitis
#CrushingGips
#MedEd
#GITwitter
1
5
23
32F w/ Crohn's Dx started on Azathioprine x 20 days.
🩺101.3°F🌡️, malaise 😓, painful erythematous lesions on arms, neck 🚨.
🔎 CRP 90, ESR 70, WBC 16🧫.
🔬 Skin Biopsy: Dense neutrophilic infiltration ⬇️.
1
11
22
Here's a wrap on last week's topic SIBO - bookmark and save to review for your boards! Brought to you by Board Member
@SanyaGoswami4
!
#GITwitter
#MedEd
0
10
19
Let’s review the answers!!
✅ Option 2 - Supportive Care. Typical of ischemic colitis which is a result of hypoperfusion to watershed regions in the colon.
What is the treatment of choice? 👇🏻
Courtesy of
@CrushingGIBoard
@Ansari_Zaid7
@mariaCfonseca2
@AdvaniRashmiMD
#GITwitter
#MedTwitter
@AmCollegeGastro
@AmerGastroAssn
1
0
2
2
6
19
1/ Peroral endoscopic myotomy (POEM) is recommended for type III (spastic) achalasia! How do we make this diagnosis?
📈presence of dysphagia, chest pain, nocturnal cough, regurgitation
📈integrated relaxation pressure (IRP) > 15
📈distal latency (DL) < 4.5 sec
45 yo woman w/ 5 year h/o intermittent squeezing chest pain & dysphagia. Prior workup includes normal coronary angiogram and exercise stress test. Pt denies other PMH and meds. High-resolution manometry ⬇️ What is the *best* treatment option?
14
10
33
1
10
20
36F with DM2, BMI 40 p/w postprandial fullness🤢, bloating😵💫, and epigastric discomfort. EGD reveals retained food in the stomach & biopsies are negative for H. pylori.
What do you do next?
Semaglutide
9
Metoclopramide
35
4hr gastric empyting scan
184
G-POEM referral
6
0
8
20
Quick overview of gallbladder polyp management:
• Large (>1cm) or SYMPTOMATIC polyps are managed with cholecystectomy.
• <1 cm and NO complicating factors (Age >50, stones, PSC) are likely non-neoplastic.
0
13
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Happy Monday!!
A 76 y/o M w/ Parkinson's dx & chronic constipation presents with worsened abd pain. He is febrile and nauseous🤢 but hemodynamically stable. On P/E he has a soft but distended abd. What do you think is the best initial tx⁉️ 💩
#CrushingGips
#QuestionOfTheWeek
A. Exploratory Laparotomy
10
B. Bowel Regimen
45
C. Colonoscopy
17
D. Bowel rest, NGT & Obs
97
2
6
19
Happy Monday! 🎄 let’s start the week!
🚨 55-yo man with severe epigastric pain, nausea, vomiting, fever, and jaundice x 3 days👨⚕️
✅ Elevated amylase, lipase, bilirubin, and alkaline phosphatase levels 📈
✅ CT scan (Figure ⬇️)
5
8
21
🕵️♂️ 52M c/o floating stools, joint pain, weight loss, memory problems with following PAS-positive duodenal biopsies. What is the culprit? 🧩🔍
#medtwitter
#GItwitter
#boardsreview
#medicaldiagnosis
5
9
20
Happy Monday! Check out our new question of the week thanks to our contributor
@EmilySeltzer4
! 💥
#GITwitter
#CrushingGips
A 70 y/o M w/ PMHx of sick sinus syndrome, uncontrolled DM (A1c 10), & newly dx compensated MASH-related cirrhosis 🍬🫤w/HVPG of 15 presented for his
A) Initiate Carvedilol
48
B) Initiate Nadolol
4
C) Band ligation
53
D) Surveillance EGD q6 mo
13
1
5
19
New case: 45yo Korean woman with postprandial pain, metaplasia, no dysplasia, no H. pylori on endoscopy. Family history of gastric cancer; on omeprazole.
👩⚕️Expert Opinion: Considering family history & metaplasia, next step is 🩺💡
Discontinue omeprazole
16
Retest stool H. pylori
21
Aspirin chemoprophylaxis
8
Surveillance endoscopy
147
1
6
19
75 yo M presents with painless jaundice. He is afebrile and hemodynamically stable. His TBili is 6.7, ALP 450, AST 56, ALT 72. His imaging is as below. In this patient, what is the best initial treatment?
#MedTwitter
#GITwitter
#GIboardsprep
#GIboardsreview
Chemotherapy
25
Steroids
66
Surgical Resection
53
Supportive management
23
1
5
19
46 year patient with episodic RUQ pain and tenderness for past 6 months. Murphy's negative. RUQ US reveals a 9mm polyp within the gallbladder. 🎥
What's the best next step?
1. EUS
2. CT scan of the abdomen with contrast
3. Monitor with repeat US in 6 months
4. Cholecystectomy
3
10
18
A 40 y/o man with abdominal fullness and U/S showing a 4.5 cm mass lesion in the left hepatic lobe. Contrast-enhanced CT ⬇️. What is the diagnosis? 🧐
#CrushingGIBoards
#MedTwitter
#GITwitter
2
6
18
When
@CrushingGIBoard
crushes the
#MedEd
game in its first weeks of going LIVE.
Knowledge is power. 💪
Study for your
#GIBoard
with us as we post weekly vignettes and answers!
Wish to be a collaborator/contributor? Please message us!
Peace, Love, & GI
#GITwitter
#MedTwitter
0
5
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It’s that time of the week‼️Are you ready ⁉️
#CrushingGips
⭕️ A 19y/o M pt presents w/ cc of difficulty swallowing. He has a hx of atopic dermatitis, asthma bt currently takes no medication. Which of the following are used in the long-term treatment for these patients?
Rituximab
22
Infliximab
25
Trastuzumab
15
Dupilumab
161
2
9
17
25🤰, first pregnancy at 34 weeks, with 3 days of N/V, pruritus and mild epigastric pain. BP 140/100 with icterus. WBC 12, plts 85, AST 250, ALT 160, ALP 140, T.bili 2.7, D.bili 1.6, Cr 2.1, PT, aPTT normal. Viral hepatitis and Tylenol negative. Best management option?
#GITwitter
RUQ US
24
Liver biopsy
0
Ursodiol, Trend bile acid
18
Delivery of fetus
73
2
8
18
26F w/ PMHx bipolar disorder. Presents with abdominal pain. Labs show AST 60, ALT 71, AlkP 22, T Bili 1.2, ALB 2.6, HGB 10.8, HCT 33, MCV 90, PLT 139, INR, 2.3, LDH 100, haptoglobin< 10, retic count 7. Abd US shows cirrhosis. Liver biopsy below:
2
8
17
62 yo woman presents w/ regurgitation, new neck mass, and gurgling sensation after meals with the following ⬇️ imaging finding - what is the diagnosis? 🔍
12
7
17
A 27M w/ (+) hepatitis B surface antigen 8 months ago. Retested and Hep B surface antigen was found positive again.
Further work-up shows Hb Core antibody positive, Hgb surface antibody negative. Liver function is unremarkable with normal AST/ALT.
Diagnosis?
Acute HBV infection
20
Resolved HBV infection
20
Inactive chronic infxn
109
Need further workup
39
2
4
17
👨⚕️ 21-year-old M with a h/o celiac disease presents with a week-long itchy rash on arms & legs. No relief from petroleum jelly. Reports mild GI issues: bloating/pain. PE shows red papules & vesicles on elbows & knees. What will be the treatment? 🤔
#Meded
#MedTwitter
8
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Happy Wednesday Everyone! Let’s get into Ulcerative Colitis, commonly referred to as UC!
@MondayNightIBD
What is UC? 🔍🧐
📌UC is a chronic idiopathic inflammatory condition that affects the large intestine! 💩
1
6
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Happy Friday! Is answer time ⏲️
Brought to you by
@CrushingGIBoard
Board Member
@mariaCfonseca2
and Contributor
@AliKhalifaMD
Hepatic Sarcoidosis!!
🔥Question
#1
: Test ▶️ EGD
🔥Question
#2
: Treatment ▶️ NSBB + UDCA
Explanations 👇
0
3
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Happy holiday Monday 😊!
52-yo F w hx of celiac disease presents w progressive severe malaise, nausea, AP x 10d. ➕hepatomeg, jaundice & AMS. No recents meds, ETOH, IVDU. AST 2352, ALT 2100, ALP 315, Tbili 12, INR 3.5, PLT 30. ➖Imaging. ➖ Tylenol, CLD workup & Utox. Liver BX👇🏻
2
6
16
35 yo M w/ 3 months of non-bloody, watery diarrhea. Denies travel🌍, weight loss & nocturnal symptoms. No family history of colon cancer. Normal TSH, fecal calprotectin, tTG IgG/IgA.
What should we do next? 🧐
#GITwitter
#MedTwitter
#MedEd
Stool ova and parasite
47
Abdominal ultrasound
4
Giardia antigen testing
36
Colonoscopy
42
1
5
15
Happy April! 🌷
A 65🧔♂️ w/ 4 mo of bloating, early satiety. Hg 10.5.
CT: 2.2cm, round, brightly enhancing in stomach.
EGD: round, smooth, submucosal mass.
EUS: muscular propia, hypoechoic, homogeneous.
FNA: spindle cells.
Best management option?
#GITwitter
#MedTwitter
Endoscopic surveillance
13
Imatinib
26
Surgical resection
90
Endoscopic resection
41
2
6
13
1/ Tricky question this week! Presentation is suspicious for EoE - can be treated with choices C/D/E but here we would say PPI
❗PPI response rate 30-50% in adults
❗PPI more efficacious if more eosinophilia in distal esophagus
❗PPI best choice if suspicion for concomitant GERD
42 yo M w/ asthma, seasonal allergies presents w/ dysphagia for past 3 yrs. In the past 5 yrs has been to ED twice with food impaction. Thinks biopsies were taken during last EGD but doesn’t remember results. No weight loss. Reflux symptoms 3-4x weekly. What is best initial tx?
3
5
24
1
2
15
Its Monday Funday!!
#GITwitter
💩
A 53 y/o M p/w a 6mo hx of abd pain in the RUQ. No prior endoscopy but endorses life long hx of alcohol use. He presents to the ER after waking in the night with large volume hematemesis🩸. CT Abd unremarkable . What's the likely ddx🤔?
Esophageal varies
61
Peptic Ulcer Disease
51
Angiodysplasia
3
Esophageal Tear
15
3
7
15
A 67 yo F 👵 w/ gastric bypass, chronic pancreatitis p/w abdominal fullness, bloating💨, diarrhea💩 for 6 mo. EGD/colonoscopy normal. Labs: normal lipase, elevated folic acid, and low B12 level.
Best next step❓
#MedTwitter
#GITwitter
#MedEd
Start probiotics
18
Start antibiotics
66
Hydrogen breath testing
115
Small bowel aspirate
23
4
4
14
Time for another Tweetorial! This Wednesday, let’s talk📢 about surveillance after colonoscopy and polypectomy
‼️45 is the new 50‼️ and screening colonoscopies for average-risk patients should begin at 45 yrs.
@AmCollegeGastro
@AmerGastroAssn
@ASGEendoscopy
2
4
13
A 56yo M w RUQ pain for many months. Exam: HSM. PLT 109, AP 450, ALT 105, AST 103. CXR: b/l hilar LAN. IGRA(-). US abd: enlarged nodular liver, bile ducts WNL, spleen 14cm. LBx ⬇️: (-) fungal, Brucella, C. Burnetii.
Next step ⁉️
A. CT abdomen
B.HIDA scan
C. MRCP
D. EGD
2
5
14
Repeat blood work : HBE antigen negative, anti HBE positive, HBV DNA undetectable. What would be the next step in management? Liver bx below:
A 27M w/ (+) hepatitis B surface antigen 8 months ago. Retested and Hep B surface antigen was found positive again.
Further work-up shows Hb Core antibody positive, Hgb surface antibody negative. Liver function is unremarkable with normal AST/ALT.
Diagnosis?
2
4
17
2
3
14
43 y/o F presents to the ED for jaundice & fatigue over a few months w occasionally dark urine. PE shows scleral icterus & jaundice, skin findings below. Labs w significant transaminitis, anti- smooth muscle antibodies negative. What is the next BEST step for definitive dx?
2
6
14
A 42yo F with had colonoscopy x hematochezia. BBPS3. Distal sigmoid edema and narrowing which cannot be traversed. Sigmoid biopsy 👇🏻.
What is the lesion identified on this path⁉️
📍Diverticulitis stricture
📍Crohn’s stricture
📍Colon cancer
📍Pseudomembranous colitis
7
8
13
Great job everyone 🌟
B) IPMN was the correct answer!!
Fukuoka guidelines (super HY for 📖day!!) 🚨🚨
1
8
12
1/ 42M with recurrent acute pancreatitis (AP)-unknown etiology, former alcohol use, active smoker, s/p CCY in clinic for f/u of AP 5w ago. Presented with abd pain, lipase 280, and CT with AP s/p Tx. Now with dull aching abd pain & nausea 2w & 20lbs wt loss.
#GITwitter
#MedEd
1
7
13
56 yo caucasian M w/Hx of 🚬, BMI of 35 p/w heartburn for 9yrs. EGD shows 5cm of abnormality shown📷. Biopsies revealed IM w/o dysplasia. What’s the next step in mgmt?
#MedTwitter
#GITwitter
#MedEd
EGD in 3 years
106
EGD in 1 year
30
EGD in 6 months
17
Refer for RFA or Cryo
15
1
4
13
Happy Monday!
Let’s 🏃🏼♀️ for this question
68 yo F with PMH of HTN, DM presents with crampy LLQ pain and diarrhea followed by bleeding per rectum. Vitals stable. WBC 12k and Hb 11. CT A/P 👇🏻

4
6
12
42 yo man w/ recently diagnosed PDAC presents to PCP for evaluation of numerous moles. FHx notable for father, paternal uncle diagnosed with melanoma and paternal aunt with breast cancer. What mutation best explains the patient’s predisposition to PDAC?
MLH1
18
STK11
11
PRSS1
13
CDKN2A
30
0
6
13
Happy Monday! Check out our new question of the week by our contributor
@DJDownsMD
💥
A 30 y/o male with PMH of alcohol and tobacco use disorder presents to the ED w/ epigastric discomfort 🤢dark urine, pale stools 💩 & weight loss.
Labs🧪 : Tbili 14 (D.Bili 9.5) mg/dL, lipase
A. Azathioprine
7
B. High dose prednisone
64
C. Rituximab
1
D. Pancreatectomy
10
1
1
13
#MondayFunday
🥳
Question by
@DrewfordMD
💩
#CrushingGips
56y/o F w/PMHx of celiac dx & tobacco use disorder presents w/ 6-mo hx of watery diarrhea. She reports compliance w/ gluten-free diet, & has not traveled in the past year. What next step would most likely reveal the ddx?
EGD w/ Small bowel biopsy
68
Trial of loperamide
4
C. diff & Giardia Assays
21
C-scope w/random biopsies
104
2
7
13
40 yo female presents with incidental CT finding of a solid-cystic lesion in pancreatic neck.
EUS-guided fine needle biopsy (FNB) 💉 revealed solid pseudopapilary neoplasm.
What is the next best step in the management of this patient?
Repeat EUS - FNB in 6 mo
22
MRI pancreas in 1 year
30
Surgical excision
148
No intervention indicated
29
0
9
12
A 👴🏻 p/w ⬇ appetite, & significant weight loss with h/o chronic pancreatitis, long-standing DM, chronic 🚬, & 🍺 abuse. CT scan is shown in the 💬 below. Labs show ⬆ CA19-9 & CEA levels.
2
2
12
Here's this week's exp🧵:
Diagnosis: Esophageal perforation in the setting of fish bone injury -Boerhaave syndrome
Presentation: excruciating retrosternal chest pain, hoarseness, dysphagia, odynophagia, dyspnea, subcutaneous emphysema, dyspnea, can even lead to sepsis & shock
1
7
12
75 yo M with AP, diarrhea and 35lb WL. + FOBT, IDA. IgG+. 18% plasma cell. CT w SBO & Colonoscopy 👇🏻 Tissue bx :+ CD138, lambda light chain
#GItwitter
#MedTwitter
@CrushingGIBoard
@AmCollegeGastro
@AmerGastroAssn
Lymphoma
25
Amyloidosis
49
Immune proliferation sb
18
Multiple myeloma
28
3
9
11