A 70-year-old man presents for a colonoscopy due to chronic diarrhea. During the procedure, a polyp is discovered on the right side of his colon and removed via snare polypectomy. Six hours later, while in the Recovery Ward, he becomes lethargic and begins experiencing intense abdominal pain and vomiting. What is the best course of action for managing his symptoms?
A 21-year-old woman is brought to the emergency room after a night of heavy drinking with friends. She consumed a significant amount of tequila and beer and then began vomiting profusely. On the third episode of vomiting, her vomit was noted to have bright red blood.
The next morning, endoscopy showed no abnormalities.
What is the most appropriate next step in management?
A 73-year-old man presents with a prolonged history of dysphagia for both liquids and solids. Occasionally, food gets stuck, but this is relieved by drinking large amounts of fluid.
On a chest X-ray, a dilated lower oesophagus with a fluid level behind the heart is observed. Barium swallow shows gradual narrowing of the distal end of the oesophagus, ‘swan-necking’. Endoscopy reveals food residue in the distal oesophagus. Routine bloods are entirely unremarkable.
His blood pressure is 130/80 mmHg, with a pulse of 64/min and regular.
What would be the most appropriate initial medical treatment for this patient?
A 42-year-old health worker discovers that he has acquired hepatitis C infection from a needle-stick injury that occurred 8 weeks ago. What is the most suitable course of action for managing this situation?
A 45-year-old woman with no significant medical history presents to the Emergency Department with a 4-hour history of vomiting blood. She reports having gone mushroom foraging five days prior and consuming some of the mushrooms she found. On examination, she appears jaundiced and experiences tenderness in the epigastrium and right upper quadrant of her abdomen. There is evidence of bruising on her arms and legs, as well as dried blood around her lips. Her blood pressure is 110/72 mmHg, heart rate is 92 bpm and regular. The following abnormal laboratory results were obtained: Hb 101 g/l, WCC 10.5 × 109/l, PLT 121 × 109/l, INR 3.6, Na+ 138 mmol/l, K+ 4.2 mmol/l, Cr 255 µmol/l, bilirubin 182 µmol/l, alanine aminotransferase 290 u/l, alkaline phosphatase 99 u/l, and glucose 3.8 mmol/l. What is the next step in managing this patient?
A 45-year-old male presents for an elective ERCP for a common bile duct stone. Post-ERCP he develops acute septicaemia.
Pre-ERCP results:
Serum sodium 136 mmol/L (137-144)
Serum potassium 4 mmol/L (3.5-4.9)
Serum chloride 100 mmol/L (95-107)
Serum bicarbonate 28 mmol/L (20-28)
Serum urea 4 mmol/L (2.5-7.5)
Serum creatinine 96 µmol/L (60-110)
Post-ERCP results:
Serum sodium 140 mmol/L (137-144)
Serum potassium 4 mmol/L (3.5-4.9)
Serum chloride 100 mmol/L (95-107)
Serum bicarbonate 16 mmol/L (20-28)
Serum urea 40 mmol/L (2.5-7.5)
Serum creatinine 720 µmol/L (60-110)
All physical findings are normal and his chest is clinically clear. He is producing 40 ml of urine per hour.
What is the evidence-based recommendation based on recent clinical trials for the management of acute septicaemia in a patient post-ERCP?
A 56 year old man with a history of heavy alcohol consumption presents with hematemesis. What is the most effective treatment approach for esophageal varices during endoscopy?
A 54-year-old man with a six-month history of reflux attends your follow-up Gastroenterology Outpatient Clinic after being referred by his General Practitioner (GP) for a direct access upper gastrointestinal (GI) endoscopy. Despite stopping smoking, reducing and then stopping alcohol consumption, and trying proton pump inhibitors (PPIs) without success with the help of his GP, he has not lost any weight and has a body mass index (BMI) of 33 kg/m2. On examination, his blood pressure is 124/76 mmHg lying down, heart rate is 80 beats per minute and regular, and GI examination is unremarkable. Investigations performed by the GP reveal normal values for haemoglobin (Hb), white cell count (WCC), platelets (PLT), sodium (Na+), potassium (K+), creatinine (Cr), albumin, and alanine aminotransferase (ALT). However, upper GI endoscopy reveals 4 cm of columnar-lined oesophageal epithelium, appearances consistent with Barrett’s oesophagus, and biopsy indicating low-grade dysplasia. What is the most appropriate management regarding the endoscopy findings?
A 35-year-old woman has been diagnosed with hepatitis B surface antigen positivity that has persisted for over six months. Her hepatitis B envelope antigen (HBeAg) is negative, and HBV DNA is also negative. Additionally, all her liver function tests are normal. What would be the most appropriate course of action for further management?
A 32-year-old woman presents with symptoms of iron deficiency anaemia. She has a history of Crohn’s disease and took azathioprine for up to 2 years during her late 20s, but her symptoms have been stable over the past few years on no regular medication. Her bowels are open 3-4 times per day with loose motion. She has no regular periods as she currently uses the progesterone-releasing IUD for contraception.
The only other history of note is epigastric pain for which her GP has prescribed a PPI. On examination, her BP is 112/80 mmHg, pulse is 75/min and regular. She looks pale. Abdomen is soft and non-tender and her BMI is 22.
Investigations reveal a haemoglobin level of 94 g/l (normal range 135 – 175 g/l) and a mean corpuscular volume of 76 fl (normal range 80 – 100 fl). Her barium follow-through shows a gastroduodenal stricture, confirmed to be ulcerated on endoscopy, with biopsy appearance typical of active Crohn’s disease.
What is the most important step in managing this patient?