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Mksap GI

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abcdefgh's version from 2017-06-14 01:59

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Occult GI bleeding first colonoscopy >>> then endoscopy>>> again repeat endoscopy and/or colonoscopy>>>Pill cam
For patients with obscure active GIBinitial imaging studies may include nuclear studies followed by angiography to localize the bleeding>>>>> next steps in patients with active bleeding are push enteroscopy, balloon-assisted enteroscopy (deep enteroscopy), or surgery and intraoperative enteroscopy as a last diagnostic option.
Prophylactic cholecystectoymy recommendation1.anomalous pancreaticobiliary duct junction 2. gallbladder polyps 1 cm or larger, 3. gallbladder polyp(s) with concomitant gallstones, or 4. polyps of any size in the setting of primary sclerosing cholangitis., 5.Prophylactic cholecystectomy can also be considered in patients with a porcelain gallbladder or with gallstones larger than 3 cm.
Prognosis of GB cancerLess than 10% of patients with symptoms and less than 20% of patients with incidentally discovered cancer are found to have early-stage tumors.
next step Mx for acalculous cholecytitisHIDA Scan or cholecystostomy tube
hepatocellular adenoma...when is resection indicatedTreatment with surgical resection or radiofrequency ablation is advised for lesions that are larger than 5 cm (or larger than 3 cm when pregnancy is anticipated) or that exhibit β-catenin nuclear reactivity.
hepatocellular adenoma ...if on OCPdiscontinue OCP
surveillance for all patient with cirrhosishepatic ultrasounf every 6 months to monitor for HCC........2.lesions < 1 cm
epeat USG in 3 months.>>>>>>>>>>lasions larger than 1 cm>>>four phase CT scan
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when you do a four-phase CT how to identify hepatocellular carcinomaA diagnosis of HCC can be made in lesions larger than 1 cm that enhance in the arterial phase and have washout of contrast in the venous phase.
hepatocelluar carcinoma staging systemchild pugh staging or barcelona classification
how many stages does child pugh ( CP)stagin system for HCC have?CP A , CP A-B, CP and CP -C
how many stages does Barcelona stagin system for HCC have?Stage 0 , Stage a - C and Stage D
what is HCC stage 0 or Child pugh stage A?very early HCC < 2cm , Carcinoma in situ, single, no evidence of portal pressure, no elevated bili then RESECTION!!!
IF the patient has lesion < 2cm , with increased protal pressure however has evidence of associated disease??then Mx?per-cutaneous alcohol injection or radio-frequency ablation
HCC single or three nodules <= 3 cm with no disease but increased portal pressureliver transplantation
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