Medical Specialties Commons^™

Predicting And Managing Hepatocellular Carcinoma Recurrence After Liver Transplant: A Single-Center Experience 2012-2024, Jesse Civan, Madison Force, Ali Raza Shaikh, Adam Bodzin, Daniel Lin

Division of Gastroenterology and Hepatology Faculty Papers

Background: Hepatocellular carcinoma (HCC) is a major cause of mortality in the United States, but it can be cured with orthotopic liver transplant (OLT) in selected patients. Despite curative intent, post-OLT recurrence can occur in up to 15% of patients. The need for a program of post-OLT surveillance is widely accepted but the specifics of an optimal program have not been established. There is interest in identifying lower-risk cohorts of patients in whom an abbreviated strategy of surveillance may prove adequate, utilizing tools such as the RETREAT score. Unique challenges are posed in the post-transplant population regarding safety and …

Mapping The Unexpected: Aberrant Celiac Trunk Origination With Atypical Splenic Artery Bifurcation, David A. Delano, Fernando D. Gonzalez, Franco R. Ramos, Parker J. Ballard

Annual Research Symposium

No abstract provided.

Successful Rituximab Therapy In Igg4-Related Sclerosing Mesenteritis, Sanjana L. Thimmannagari, Shiamak Cooper, Annie H. Yang, Abdullah M. Firoze Ahmed

Advances in Clinical Medical Research and Healthcare Delivery

Immunoglobulin G4-related disease (IgG4-RD) is an increasingly common autoimmune, multiorgan fibro-inflammatory disorder. Its involvement of organs like the pancreas, lacrimal glands, salivary glands and kidneys is well known but IgG4RD presenting as sclerosing mesenteritis is a rare entity. On imaging, it presents as a mesenteric mass and biopsy is the gold standard for confirmation as elevated serum IgG4 levels are unreliable to establish the diagnosis. Here we report a previously healthy 33-year-old African American female who presented with one week history of generalized abdominal pain. Imaging studies revealed a mass within the mesentery and post-operative biopsy of the mass confirmed …

Idiosyncratic Drug Induced Liver Injury Secondary To Ciprofloxacin: A Reminder To Always Check Medication History, Xavier Zonna, Conor Banta, Erika Anson Md

Advances in Clinical Medical Research and Healthcare Delivery

A 38-year-old Caucasian male with no significant past medical history presented to the emergency department with complaints of nausea, vomiting, abdominal pain, and jaundice of 2 days duration. He noticed this in addition to pruritus, fever, and malaise. He had severe transaminitis and hyperbilirubinemia on laboratory evaluation. He was admitted for acute liver injury of an unknown etiology. He had taken a course of ciprofloxacin days prior to presentation for UTI at an outlying facility. Serologies were also concerning possible autoimmune liver disease with elevated Anti-Nuclear Antibody and equivocal Anti Smooth Muscle Antibody. Liver biopsy was negative for any autoimmune …

Literally Heartburn: A Case Report Exploring Potential Preventive Measures Of Esophageal Injury After Radiofrequency Ablation For Atrial Fibrillation, Venkat Arutla, Chengu Niu, Prajjwol Bhatta, Basil George Verghese

Advances in Clinical Medical Research and Healthcare Delivery

Esophageal injury (EI) after radiofrequency ablation (RF) for atrial fibrillation (AF) is a feared complication due to its extreme variability in presentation and very high mortality rate. The incidence of EI after RF ablation also varies widely among the literature. The diagnosis and management of EI is a combination of swift clinical recognition, confirmatory computed tomography (CT) imaging, and prompt surgical repair. This case discusses a 56-year-old male with past medical history of AF who presented to the hospital with complaints of chest pain, shortness of breath and nausea after undergoing recent RF ablation for AF. Imaging revealed an esophageal …

Ensuring Successful H. Pylori Test Of Cure: A Quality Improvement Initiative Focused On Post-Treatment Testing, Prajjwol D. Bhatta, Smriti Bhetuwal, Asim Pandey, Ahmed Shehadah, John Shrestha, Venkat Arutla, Chengu Niu, Himal Kharel, Abdullah Ahmed

Advances in Clinical Medical Research and Healthcare Delivery

Background

Eradication of Helicobacter. Pylori (HP) infection is crucial for preventing serious sequelae, such as peptic ulcer disease and gastric malignancies. The ACG guideline recommends mandatory re-testing to ensure HP eradication. However, studies have shown that only less than 25% of patients undergo eradication testing.

Objectives:

The main objective of this study is to evaluate the effectiveness of a simple educational intervention on test of cure compliance rate. Our target population includes patients with confirmed HP infection who were treated with HP eradication therapy.

Design: Quality improvement pre-post intervention

Participants: Internal Medicine residents

Intervention: Educational training on the importance …

Hidden Malignancy: Ileocecal Intussusception As An Atypical First Presentation Of Diffuse Large B-Cell Lymphoma In Adulthood, Komal Harisinghani, Parth Adrejiya, Mohammad Abubaker, Oluchi Idenyi, Raman Babayeuski, Noor Qureshi, Ashok Kanugula, Sara Assaf, Daniel Assaf, Srikanth Maddika

Journal of Community Hospital Internal Medicine Perspectives

Intussusception is predominantly a pediatric condition, with only about 5% of all intussusception cases occurring in adults with primary intestinal lymphomas comprising 1%–4% of gastrointestinal malignancies, 90% of which are B-cell non-Hodgkin lymphomas (NHL). Diffuse large B-cell lymphoma (DLBCL), the most common subtype of NHL, often leads to intussusception without classical B symptoms. We present the case of a 33-year-old male with ileocolonic intussusception caused by a 4.8 × 5.3 × 5.5 cm enhancing mass. Histopathology and FISH confirmed DLBCL without MYC, BCL2, or BCL6 rearrangements, ruling out double- or triple-hit lymphoma. Following a right ileo-colectomy, R-CHOP(rituximab, cyclophosphamide, doxorubicin, vincristine, …

A Case Of Listeria Monocytogenes Bacteremia In A Middle-Aged Woman With A History Of Primary Biliary Cholangitis, Caleb Smack, Jared T. Lausen, Aaron Mills

Eastern Virginia Medical Journal

In this report, we discuss the case of a patient with Listeria monocytogenes bacteremia likely resulting from primary biliary cholangitis (PBC) induced cirrhosis. We aim to bolster the body of literature on Listeria bacteremia and establish PBC as a risk factor for this rare complication. Our patient, who presented with sepsis, was subsequently found to have Listeria bacteremia and received intravenous antibiotic treatment of ampicillin for 3 total weeks with complete resolution of her disease. This is the first case suggesting that cirrhosis as a result of PBC may be an independent risk factor for Listeria bacteremia. In patients at …

Inflammatory Bowel Disease, Children's Health School Services

School Guides

Educator guide about how to support students with inflammatory bowel disease.

Oral N-Acetylcysteine In Hepatitis C - Induced Acute Liver Injury: A Case Report, Mohammed Irfan Khan, Shuchita Jhaveri, Renu Thomas, Kevin Garnepudi, Galvin Dhaliwal, Ahmed Ouni, Shane P. Sweeney, Julian Nguyen

Gulf Coast Division GME Research Day 2026

No abstract provided.

Colonic Perforation In A Patient On Glp-1 Agonist Therapy: A Case Report, Mohammed Irfan Khan, Shuchita Jhaveri, Azad Patel, Bilal Ashraf, Ahmed Ouni, John Paek, Sivatej Sarva

Gulf Coast Division GME Research Day 2026

No abstract provided.

Potassium Competitive Acid Blockade After Gastric Esd: Does Vonoprazan Outperform Ppis: A Systematic Review And Meta-Analysis, Shavya R. Ginnaram, Pradeep Yarra, Gnanashree Dharmarpandi, Rajat Garg, Sreekanth Chandrupatla

West Florida Division GME Research Day 2026

No abstract provided.

Resurgence Of Liver Cirrhosis And Variceal Hemorrhage Mortality In Us Adults: Trends And Disparities In A 20-Year Analysis, Chandur Bhan, Nimarta Bheesham, Shravya Ginnaram, Gananshree Dharmarpandi, Melvin Joy, Chenyu Sun, Sreekanth Chandrupatla

West Florida Division GME Research Day 2026

No abstract provided.

Negative Imaging, Ongoing Hemorrhage: An Ulcerated Jejunal Avm Requiring Advanced Endoscopic Intervention, Joel Mathews, Trina Lewis, John Mathew, Long Hoang

North Texas GME Research Forum 2026

Small bowel bleeding is relatively uncommon, accounting for less than 10% of all gastrointestinal (GI) bleeds. Small bowel angiodysplasias are the most common cause of small bowel bleeding. These lesions can often be difficult to identify on radiographic imaging or endoscopy and tend to rebleed after intervention. Our case centers on an 86-year-old patient who presented with an acute GI bleed from an obscure ulcerated jejunal arteriovenous malformation (AVM); his past medical history includes an undisclosed prior upper GI bleed treated with endoscopic clipping, paroxysmal atrial fibrillation, type 2 diabetes, prostate cancer with prostatectomy, and other chronic conditions. He presented …

Salvage Percutaneous Spyglass-Assisted Lithotripsy Via A Cholecystostomy Tract After Failed Ercp: A Case Report, Nicholas Gerden, Tiffany Hong, Asad Rehman, Long Hoang

North Texas GME Research Forum 2026

IR-driven percutaneous cholangioscopy with SpyGlass-assisted lithotripsy is an emerging salvage technique for biliary stone disease in patients with failed or contraindicated endoscopic retrograde cholangiopancreatography (ERCP) due to complex anatomy. We report an 85-year-old patient with an indwelling cholecystostomy tube and biliary stent who presented with recurrent obstructive jaundice, with cholangiography demonstrating occlusion of the common bile duct stent due to choledocholithiasis. Conventional ERCP was unsuccessful because of complex biliary and gastrointestinal anatomy. A multidisciplinary interventional radiology–gastroenterology approach was therefore pursued, utilizing antegrade percutaneous choledochoscopy through an existing cholecystostomy tract with SpyGlass-assisted lithotripsy, followed by cholecystostomy tube exchange. The procedure resulted …

Extra-Intestinal Clostridioides Difficile Abscess In A Small Bowel Gist: A Rare Tumor-Associated Complication, Nicholas Gerden, Pradip Gautam, Asad Rehman, Long Hoang

North Texas GME Research Forum 2026

Extra-intestinal infections caused by Clostridioides difficile are exceedingly rare and typically occur in settings that disrupt the gastrointestinal barrier, including recent gastrointestinal surgery, bowel perforation or microperforation, and severe colonic disease.

We present the case of a 75-year-old man with abdominal pain and hemoperitoneum in the setting of a suspected small bowel leak secondary to an intestinal mass. Computed tomography angiography revealed an 11.0 × 9.6 cm pelvic fluid collection, prompting exploratory laparotomy with drainage of a pelvic abscess and evacuation of hemoperitoneum. Intraoperatively, a small bowel perforation caused by a 4.4 cm gastrointestinal stromal tumor (GIST) was identified. Operative …

Sudden Onset Idiopathic Necrotizing Pancreatitis Unmasking Undiagnosed Advanced Cirrhosis, Maikel Tawadrous, Mohammad Mahfouz, Aradhana Pandey, Namin Farid

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

Multifocal Gastrointestinal Diffuse Large B-Cell Lymphoma Initially Resembling Crohn’S Disease, Mary Moussa, Durga A. Kumar, Vikas Sethi, Alvin Boyd Newman-Caro, Christopher Halleman, Michael Schulman

West Florida Division GME Research Day 2026

No abstract provided.

Human Milk Feeding And Its Impact On The Incidence Of Necrotizing Enterocolitis, Maya C. Kern

Nursing | Senior Theses

One of the leading causes of morbidity and death for preterm and very low birth weight (VLBW) newborns is still necrotizing enterocolitis (NEC). Existing literature consistently shows that the bioactive, anti-inflammatory, and microbiome-supporting components of human breast milk, including donor human milk, significantly lower the incidence of NEC. However, a lot of infants are forced to rely on formula and nutrient fortifiers because they cannot obtain maternal or donor milk. A critical gap persists regarding whether human milk derived fortifiers offer greater NEC protection than bovine derived fortifiers in infants who must receive formula. This thesis examines three interconnected themes; …

Gastrointestinal Ebv In Immunosuppressed Hosts: A Case Of Ptld After Kidney Transplant, Mary Moussa, Baylen Shoemaker, Vikas Sethi, Alvin Boyd Newman-Caro, Rakhee Shah, Patricia Chun, Michael Schulman

West Florida Division GME Research Day 2026

No abstract provided.

A Lethal Connection Uncovered: Direct Endoscopic Evidence Of A Primary Aortoenteric Fistula, Joel Mathews, Trina Lewis, Munazzah Kaleem, Long Hoang

North Texas GME Research Forum 2026

BACKGROUND: Primary Aortoenteric Fistulas (PAEFs) are a rare condition that occurs when the native aorta develops an abnormal connection with the gastrointestinal lumen. PAEFs tend to develop within the duodenum, specifically the distal region of the third part of the duodenum, which is retroperitoneal and is anterior to the aorta. Duodenal PAEFs can be difficult to diagnose and are often lethal, given their non-specific presenting symptoms and rapid progression to hemorrhagic shock.

CASE PRESENTATION: This case focuses on a 70-year-old male with a history of T4N2 colon adenocarcinoma with hemicolectomy, active smoking, and abdominal aortic aneurysm (AAA) who was transferred …

A Not So Typical Case Of Alcoholic Pancreatitis, Wendy Phillips, Kaleem Munazzah, Asad Rehman, Robert Keller

North Texas GME Research Forum 2026

BACKGROUND Acute pancreatitis (AP) has become one of the leading gastrointestinal diagnoses resulting in inpatient hospitalization¹. AP is diagnosed by meeting two of three criteria: characteristic clinical presentation, biochemical evidence (elevated lipase or amylase levels), and imaging findings with pancreatic inflammation. Gallstones and heavy alcohol use account for most cases (40%–70% and 25%–35%, respectively). Hypertriglyceride induced AP (HTG-AP) accounts for only about 7-10% of AP cases³ and often tends to present in younger, male, obese, patients with a higher rate of diabetes¹. Below we present a unique case of a coinciding alcoholic and HTG - AP in an otherwise healthy …

The Impact Of Gastric Sleeve And Roux-En-Y Gastric Bypass On Chief Cell Function And Protein Digestion In Obese Patients, Garikoitz Mikel Gainza

Honors Undergraduate Theses

Obesity has become one of the largest global health concerns of the 21^st century, correlating with numerous associated diseases. To help address the growing prevalence and burden of obesity, sleeve gastrectomy and Roux-en-Y gastric bypass have become two commonly performed surgical procedures done to promote weight loss by altering the anatomical structure of the stomach and surrounding organs of the gastrointestinal system. Although the benefits of improved metabolism linked to these surgical procedures are well studied, their impact on the physiology of gastric cells, and more specifically chief cells as they relate to protein digestion post-surgery, is yet to …

Associations Between Oral Hormonal Contraceptive Use, Digestive And Other Health Symptoms In Young Women, Silviana E. Buzatu

Honors Undergraduate Theses

Oral hormonal contraceptives (OHCs) are widely used among reproductive-age women; however, their gastrointestinal (GI) side effects remain understudied. The present study examined associations between OHC use, GI, physical, and psychological symptom burden in a large sample of undergraduate women. Participants (N = 669) aged 18 to 25 years were recruited from UCF’s SONA system and classified into three groups based on self-reported contraceptive status: no birth control, combined estrogen–progestin OHC, and progestin-only OHC. Participants completed GI questionnaires, as well as physical and mental health symptoms ones.

Multivariate analyses indicated that overall GI symptom profiles did not differ significantly by birth …

Gastrointestinal Symptoms Associated With Sodium Bicarbonate Supplementation Protocols: A Systematic Review, Ian P. Winter, Paul Sarac, Patrick B. Wilson

Exercise Science Faculty Publications

Sodium bicarbonate positively impacts performance, but its associated gastrointestinal symptoms (GIS) may limit use. This systematic review synthesized literature that has evaluated GIS with sodium bicarbonate supplementation. Literature searches were performed from February 2024-March 2026. Eligible studies provided ≥ 5 g of sodium bicarbonate within a 24-h period or, if a multi-day protocol, at least one day involving ≥ 5 g. Included studies had a placebo group/condition or a comparison group/condition that created a contrast related to delivery method, form, or dose. In total, 101 investigations were summarized in six categories: acute single dosing (n = 35); acute spread dosing …

Upadacitinib For Recalcitrant Extraintestinal Crohn Disease, Avery H. Seward, Jeffrey P. Callen

Department of Medicine Faculty Publications

[Introduction] Crohn disease is a chronic inflammatory bowel disease that affects the gastrointestinal tract from the mouth to the anus. Extra-intestinal manifestations of Crohn disease are common, with the skin being the most commonly involved site.¹ Cutaneous manifestations of Crohn include lesions that directly extend from the bowel to the skin, whereas extraintestinal Crohn disease involves sites that do not directly extend from the bowel.¹ Extraintestinal Crohn disease is often resistant to treatments and often does not parallel the activity of the bowel disease.¹ There have only been 3 documented cases of extraintestinal Crohn disease responding to upadacitinib.²,³ We describe …

Micro- And Nanoplastics: A Paradigm Shift In The Pathogenesis Of Inflammatory Bowel Disease, Michael Saadeh, Priyata Dutta, Gordon Hong, Edward Oldfield, David A. Johnson

Department of Medicine Faculty Publications

Micro- and nanoplastics (MNPs) are pervasive environmental contaminants with growing recognition as potential contributors to human disease. Widespread human exposure occurs primarily through ingestion of contaminated food and water, and MNPs have been detected in multiple human tissues, including the gastrointestinal tract. Experimental evidence provides a plausible biological basis for disease associations, including impairment of intestinal barrier integrity, activation of mucosal immune pathways, and alteration of gut microbial communities caused by MNP exposure. Although human data remain limited, early studies demonstrate MNP detection in stool and suggest potential correlations with inflammatory biomarkers such as fecal calprotectin. These findings, together with …

Wilson’S Disease Psychosis In A Young Man With Autism Spectrum Disorder: A Case Report And Focus On Management, Landon C. Sowell, Barbara L. Gracious

HCA Healthcare Journal of Medicine

Introduction

Wilson's disease is a rare autosomal recessive disorder, affecting approximately 1 in 30 000 individuals and is characterized by abnormal copper accumulation in the body, primarily affecting the liver and brain. Psychiatric manifestations as a first presentation, particularly psychosis, are less commonly recognized resulting in failure to begin treatment early in the course of the disease. This case report highlights a patient that presented to the hospital with psychosis, who was later diagnosed with Wilson’s disease. This case underscores the importance of considering organic causes in first-episode psychosis.

Case Presentation

An 18-year-old man with a history of autism spectrum …

Masld-Induced Hyperammonemia With Atypical, Restricted Diffusion Pattern Suggesting Mixed Metabolic And Hypoxic-Anoxic Injury, Renu Thomas, Nhuchau Tiffany Nguyen, Daniel Bao, Jonathan Tang, Uzma Ali, Damon Cao

HCA Healthcare Journal of Medicine

Background

Hepatic encephalopathy is a common cause of altered mental status for patients with decompensated cirrhosis. Their conditions typically improve with high-dose laxatives; if not optimally treated, can develop neurologic sequelae like cerebral edema and herniation. In severe cases, despite normal systemic oxygenation, hyperammonemia may result in mixed restricted diffusion patterns that partially resemble those seen in hypoxic-anoxic brain injury.

Case Presentation

A 61-year-old woman with cirrhosis secondary to metabolic dysfunction-associated steatotic liver disease, scleroderma, and rheumatoid arthritis presented to the emergency room with altered mental status. She was admitted to the intensive care unit (ICU) and was intubated due …

A Pouch Of Trouble For The Pancreas: Unmasking A Case Of Lemmel Syndrome, Aravindharaj Tamilselvan, Sabari Ramesh

Manipal Journal of Medical Sciences

Lemmel syndrome is a rare cause of biliary and pancreatic obstruction arising from periampullary duodenal diverticula. We report a 72-year-old woman presenting with acute pancreatitis, biliary dilation, and a periampullary diverticulum causing distal CBD compression. Multimodality imaging, including CT and MRCP, established the diagnosis. Although ERCP was advised, the patient declined and improved with conservative management. Early recognition of this uncommon entity is essential to prevent recurrent pancreatobiliary complications.