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This document presents five clinical gastroenterology and hepatology cases, discussing their history, diagnosis, management, and treatment through a question-and-answer format with expert discussion.<br /><br />Case 1 involves a 58-year-old man with upper gastrointestinal (GI) bleeding. Initial management includes placing two large bore IVs, starting IV fluids, and proton pump inhibitors. Peptic ulcer disease, mainly caused by NSAIDs and Helicobacter pylori, is identified as the most common cause of upper GI bleeding in the US. Esophagogastroduodenoscopy (EGD) is the best initial test for diagnosis and therapy, allowing treatments such as epinephrine injection, clipping, and cautery. NSAIDs (ibuprofen and aspirin) are the likely ulcer cause.<br /><br />Case 2 describes a 54-year-old woman with severe epigastric pain diagnosed with acute pancreatitis, confirmed by elevated lipase and clinical signs. Common causes of pancreatitis in the US are gallstones and alcohol. In this patient without typical risk factors, triglyceride and calcium levels should be checked. She had markedly elevated triglycerides (1573 mg/dL), indicating hypertriglyceridemia-induced pancreatitis. Treatment includes triglyceride lowering (preferably fenofibrate), aggressive hydration, and monitoring hemoglobin and BUN.<br /><br />Case 3 concerns a 67-year-old woman with a large cecal polyp. Endoscopic mucosal resection (EMR) with submucosal injection (dye-based) is recommended to lift the lesion to allow safe removal and reduce complications, avoiding surgery if benign.<br /><br />Case 4 presents a 54-year-old man with pancreatic mass causing biliary obstruction and diagnosis of pancreatic cancer. Endoscopic ultrasound (EUS) with fine needle aspiration is used for tissue diagnosis. ERCP is deployed to place a biliary stent to relieve obstruction and jaundice. Metal stents are preferred for palliative care due to longer patency.<br /><br />Case 5 involves a young woman with moderate to severe Crohn’s ileitis refractory to standard therapy. Biologic anti-TNF therapy (adalimumab) was initiated after appropriate pre-treatment work-up (TB, hepatitis, chest X-ray). Cyclosporine is not used for mild-moderate Crohn’s. Cardiac echo is not required before starting biologic therapy.<br /><br />Overall, the cases emphasize appropriate diagnostic approaches and evidence-based management strategies in common GI conditions, integrating laboratory and imaging studies with endoscopic techniques and pharmacologic therapies.

Asset Subtitle

Sushovan Guha, MD, PhD and Faculty

Keywords

upper gastrointestinal bleeding

peptic ulcer disease

NSAIDs

Helicobacter pylori

acute pancreatitis

hypertriglyceridemia

endoscopic mucosal resection

pancreatic cancer

biliary stent

Crohn's disease