GI Treatment Planning & Management 3 — Questions and Answers
Question 1: Which medication is used for primary prophylaxis of spontaneous bacterial peritonitis (SBP) in cirrhotic patients with low-protein ascites?
- Vancomycin
- Norfloxacin or ciprofloxacin (Correct answer)
- Metronidazole
- Rifaximin
Correct answer: Norfloxacin or ciprofloxacin
Norfloxacin (or ciprofloxacin) is recommended for primary SBP prophylaxis in high-risk cirrhotic patients with ascites protein < 1.5 g/dL.
Question 2: A patient with Barrett's esophagus without dysplasia is found on endoscopy. What is the appropriate management?
- Immediate ablation therapy
- Esophagectomy
- Surveillance endoscopy every 3–5 years with PPI therapy (Correct answer)
- No further management needed
Correct answer: Surveillance endoscopy every 3–5 years with PPI therapy
Non-dysplastic Barrett's esophagus is managed with PPI therapy and surveillance endoscopy every 3–5 years per ACG guidelines.
Question 3: What is the treatment of choice for acute variceal hemorrhage in a cirrhotic patient?
- Emergent surgical shunt
- Endoscopic band ligation plus vasoactive drugs (e.g., octreotide) (Correct answer)
- PPI infusion alone
- Fresh frozen plasma transfusion only
Correct answer: Endoscopic band ligation plus vasoactive drugs (e.g., octreotide)
Combination of endoscopic variceal band ligation and vasoactive drugs like octreotide is the standard of care for acute variceal bleeding.
Question 4: A 55-year-old patient with chronic liver disease develops hepatic encephalopathy. Which medication reduces ammonia-producing colonic bacteria?
- Neomycin sulfate
- Rifaximin
- Lactulose
- Both lactulose and rifaximin are used (Correct answer)
Correct answer: Both lactulose and rifaximin are used
Both lactulose (reduces colonic pH and traps ammonia) and rifaximin (suppresses urease-producing bacteria) are used in hepatic encephalopathy management.
Question 5: Which therapy is appropriate for a patient with refractory gastroesophageal reflux disease (GERD) not responsive to twice-daily PPI?
- Add an H2 blocker only
- Perform esophageal manometry and pH testing, then consider surgical fundoplication (Correct answer)
- Start metoclopramide as monotherapy
- Increase PPI to three times daily indefinitely
Correct answer: Perform esophageal manometry and pH testing, then consider surgical fundoplication
Refractory GERD requires objective evaluation with pH monitoring/manometry before considering surgical options like laparoscopic Nissen fundoplication.
Question 6: What is the mainstay of treatment for mild-to-moderate ulcerative colitis limited to the left colon?
- Systemic corticosteroids
- Biologic therapy (anti-TNF)
- Topical and/or oral 5-aminosalicylic acid (5-ASA) (Correct answer)
- Immediate colectomy
Correct answer: Topical and/or oral 5-aminosalicylic acid (5-ASA)
5-ASA agents (oral and topical/suppository) are first-line therapy for mild-to-moderate left-sided ulcerative colitis.
Question 7: A patient on long-term PPI therapy is found to have low serum magnesium. What is the most appropriate intervention?
- Continue PPI and add magnesium supplementation indefinitely
- Discontinue PPI and reassess magnesium levels
- Switch to an H2 receptor antagonist and monitor magnesium
- Both B and C are appropriate options to consider (Correct answer)
Correct answer: Both B and C are appropriate options to consider
PPI-induced hypomagnesemia may require either PPI discontinuation or switching to H2 blockers, depending on clinical need and response.
GI Treatment Planning & Management 3
Which medication is used for primary prophylaxis of spontaneous bacterial peritonitis (SBP) in cirrhotic patients with low-protein ascites?