Digestive System Diseases Commons^™

Rare Obscure Cause Of Upper Gastrointestinal Bleeding: Bleeding Duodenal Lymphangiectasia, Sufian Sorathia, Rulz Cantave, Vivek Choksi, Kairavee D. Dave, Steven Kaplan

Gastroenterology

Introduction: While ulcerative and erosive mucosal changes are more commonly the culprit lesion of upper gastrointestinal bleeding, bleeding can also occur from traumatic, malignant or vascular lesions. An unusual and infrequent vascular cause of bleeding is from a focal intestinal lymphangiectasia (IL). We describe a patient who presented with bleeding from a duodenal IL.

Case Description/Methods: A 94-year-old female was sent by her nursing home for witnessed melena and new onset normocytic anemia with a hemoglobin of 7 g/dl. She was unable to provide a reliable history due to her advanced dementia. Her medical history was unknown. She was hypotensive …

A Scary Case Of Gastroenteritis, Kairavee D. Dave, Vivek Choksi, Sufian Sorathia, Rulz Cantave, Steven Kaplan

Gastroenterology

No abstract provided.

A Hiatal Hernia Causing Atrial Fibrillation Through Direct Mechanical Irritation, Kirolus Sourial, Zaid Yaqoob, Anthony Chahin, Saif Borgan, Ernesto S. Robalino Gonzaga, Aamir Javaid, Olga Karasik

Gastroenterology

Introduction: Hiatal hernia (HH) is anatomically classified into four types according to herniated structures. Giant HH refers to a herniation of > 50% of the stomach. Atrial fibrillation (AF) is a common arrhythmia, frequently seen in association with cardiovascular diseases. We report a case of AF caused by a giant HH compressing the left atrium.

Case Description/Methods: A 90+ year-old female with a past medical history of gastroesophageal reflux disease (GERD), was admitted for surgical evaluation of symptomatic HH. During hospital stay the patient developed AF with rapid ventricular response, became hypotensive and lightheaded. EKG (Figure 1) confirmed new onset AF …

Iron Pill-Induced Gastropathy In Elderly Patients: A Case Series Report, Isin Y. Comba Md, Richard Henriquez, Sundeep Kumar, Ruthvik Srinvasa-Murthy, Maria Wallis-Crespo, Lakhinder Bhatia Md, Joshua Shultz

Gastroenterology

Introduction: Iron deficiency anemia is a global health problem with an estimated two billion cases worldwide. Oral iron supplementation is considered the first line treatment. However, recent studies favor the use of short-term IV iron especially in patients with drug tolerance and efficacy concerns. In this report, we present three cases of iron pill gastropathy in patient's whose clinical courses were complicated by gastric erosion, ulcer or gastrointestinal (GI) bleeding. All of our patients had a history of iron deficiency anemia and were being treated with oral ferrous sulfate.

Case Description/Methods: The first case involved a 72-year-old male with multiple …

Doxycycline-Induced Acute Pancreatitis: A Likely Source Rarely Seen, Paul Hoffman Do, Wilco Civil Sr, Jung Yoon Do, Gurjeet Kang Do, Christopher Lozano Orpiano Do, Michael Quinn Do, Joseph Staffetti Md, Dilip Ghanekar Md, Lakshminarasimhan Venu Md, Lily N. Jones Do, Ji Kwon Do, Shaival Thakore Md

Gastroenterology

No abstract provided.

Pancreatic Cancer: Leading To Failure Of Rivaroxaban As An Anticoagulant, Pratikkumar Vekaria Md, Chandrika Raiyani, Daniel Robitshek Md, Tejas Raiyani Md

Internal Medicine

Vascular Thromboembolism (VTE) is seen with hypercoagulable state and it can be a reason of significant morbidity and mortality. Cancer is considered as one of the most common causes of hypercoagulability and developing VTE. Since novel oral anticoagulants (NOAC) have been introduced in market for VTE prophylaxis and treatment, their use have been increased significantly as they are easy to use without episodic monitoring. Rivaroxaban is one of the commonly used NOACs and some of studies have shown its good efficacy for VTE.

Nasal Crohn's: Rare But Real Possibility, Pratikkumar Vekaria Md, Johnnie Mao Md, Ravis Patel Md, Devin Vaishnani Md, Tejas Raiyani Md

Internal Medicine

Crohn’s disease(CD) is an autoimmune IBD that can occur anywhere along GI tract. Its pathology show transmural granulomatous inflammation that can include all layers of GI lining. Extra-intestinal manifestations can be seen in multiple organ systems like skin, joints, eyes, and mouth. These symptoms are common in patient involving large intestine compare to involving only small-intestine. Nasal involvement is rare with CD and very few cases have been reported so far.

Female Predominance In Metronidazole-Induced Acute Pancreatitis: A Case Report And Review Of Literature, Eileen Chang Do, Marvin Vaishnani Md, Ian Chang Do, Whitney Jennings Md

Internal Medicine

Acute pancreatitis is a relatively common condition in the hospital. About 75% of cases are associated with excessive alcohol use or gallstones, and only 0.1 to 2% are drug-induced. The clinical and pathologic findings are similar regardless of the inciting cause. We have suspicion that metronidazole-induced pancreatitis occurs at a significantly higher incidence, or maybe exclusively, in females.

Spontaneous Fungal Peritonitis: A Rare Complication Of Ascites Secondary To Right Heart Failure: A Case Report, Saaah Siddiqui Md, Dharti R. Patel Md, Arshad M. Iqbal Md, Ateeq Mubarik Md, Salman Muddassir Md, Fahad Zafar Md

Internal Medicine

•Spontaneous fungal peritonitis (SFP) is an infection defined as a neutrophil count (> 250 cells/mL) in the ascitic fluid with the evidence of positive fungal culture (1) while excluding other intra-abdominal infections. SFP is not as common as spontaneous bacterial peritonitis and has higher mortality rates due to late recognition and difficulty in differentiation between SFP and SBP. (1,2). The common risk factors that have shown to increase the mortality for SFP include hepatorenal syndrome, patient on SBP prophylaxis, elevated APACHE II scores on admission, and elevated lactate levels (2,3). Candida albicans and Candida glabrata are the two …

Non-Incarcerated Inguinal Hernia With Sigmoidal Diverticulitis, Umair J. Khan, Ali Hassan, Kingsley Dah, M Lambing, P Mathew

Internal Medicine

Introduction: Abdominal wall hernia is defined as a protrusion of a part or whole organ through the wall of a cavity. Inguinal hernias account for 75% of abdominal wall hernias, with a lifetime risk of 27% in men and 3% in women. Indirect inguinal hernia account for 80% of total inguinal hernias. A wide variety of pathological processes can present as inguinal hernias however, large reducible inguinal hernias are quite rare. Recent studies have associated abdominal wall hernia with colonic diverticulosis, a term referred to as herniosis. This association suggests that an underlying connective tissue disorder could be a common …

Amoxicillin-Clavulanate Related Liver Injury, Devin Vaishnani Md, Pratikkumar Vekaria Md, Ravish Patel Md, Megan White Md, Marvin Vaishnani Md

Gastroenterology

Introduction: Recognition of Drug-induced Liver Injury (DILI) may be challenging as it is often diagnosis of exclusion, unavailability of diagnostic test and variability in presentation. Many antibiotics can cause DILI but Amoxicillin-Clavulanate has rare adverse reaction causing mixed cholestatic-hepatocellular injury. Since amoxicillin alone does not induce liver injury, combination of amoxicillin and clavulanic acid could be responsible for this adverse reaction. It can be due to metabolic idiosyncrasy or hypersensitivity mechanism. Case Report: 64-year-old female with no pertinent PMH presented to ER with abdominal pain and jaundice. She had abdominal pain for 4-5 days. Abdominal pain was constant and located …

Evaluating The Role Of Fecal Microbiota Transplant In The Treatment Of Clostridium Difficile Infection, Anh Dao Le, Olivia Henton, Shane Bogusz, Brian Heilbronner, Jessica Hinson

Pharmacy and Wellness Review

Fecal microbiota transplant (FMT) therapy is an increasingly prevalent treatment option for Clostridium difficile infection (CDI). Clostridium difficile infection is an aggressive and potentially fatal disease state, and antibiotic therapy often fails to resolve the disease state effectively. Clostridium difficile infection occurs most commonly subsequent to the use of antimicrobial agents that disrupt the natural bacterial flora of the gastrointestinal (GI) tract. Since disease state pathophysiology operates in this way, researchers have experimented with ways to restore GI flora to a natural state in which nonpathogenic bacteria can proliferate. Probiotic agents do not impose an acute enough response to recreate …

The Effect Of Cyp3a5 Polymorphism On Kidney Transplant Recipients Given Tacrolimus, Samia Alam, Sunitha Johns, Haval Norman, Brian Heilbronner, Yousif Rojeab

Pharmacy and Wellness Review

Tacrolimus, an immunosuppressant agent indicated for organ transplants, is commonly administered to reduce the risk of renal graft rejection in patients with chronic kidney disease (CKD) and end stage renal disease (ESRD). Due to its narrow therapeutic index and high inter-patient variability, studies have suggested that CYP3A5-based dosing provides specialized regimens which may significantly improve the chances of achieving therapeutic concentrations. According to the Clinical Pharmacogenetics Implementation Consortium (CPIC) recommendations, extensive (CYP3A5*1/*1) and intermediate metabolizers (CYP3A5*1/*3) require a higher initial dose while poor metabolizers (CYP3A5*3/*3) require a lower initial dose in order to achieve target tacrolimus concentrations. Studies concluded that …

Choking On Adenocarcinoma, Andre Sahakian Md, Rajesh Gulati Md

Internal Medicine

No abstract provided.

What Is The Smartpill®?, Christina Ciccone, Pul Lee, Kimberly Loughlin, David Koh

Pharmacy and Wellness Review

The SmartPill® is a new, noninvasive technology to evaluate the gastrointestinal tract. It is a nondigestible capsule that migrates through the gastrointestinal tract to measure pH, pressure, and temperature. It was approved by the FDA in 2006 for the evaluation of colonic transit time in patients with chronic constipation and to evaluate gastric transit time in patients with suspected gastroparesis. Other currently used gastrointestinal monitoring systems have some disadvantages, and the SmartPill® is suggested as an alternative. The SmartPill® has also been used for research purposes in various studies and has the potential to be used in diagnosis and monitoring …

A Cost-Benefit Analysis Of Choosing Non-Instrumental Bedside Screenings In Patients With Low Risk Factors For Ped Not Meeting The Cms Criteria Of Pmv (Prolonged Mechanical Ventilation), Kyle Barjon Do, Giselle Falconi, Bharat Upadhyay Md

Family Medicine

No abstract provided.

Prediction Of Anal Cancer Recurrence After Chemoradiotherapy Using Quantitative Image Features Extracted From Serial (18)F-Fdg Pet/Ct, Michael Chuong

All Publications

No abstract provided.

An Unusual Case Of Small Bowel Obstruction Secondary To Calcium Carbonate Use, Selsabeel Elyaman, Uma Gudur Md, Hady Khalifa, Alan Hamza, Andrew Seevaratnam Md

Gastroenterology

A Gastric Bezoar is defined as an accumulation of indigestible foreign material found in an individual’s GI tract. The incidence of gastric bezoar is 0.3% as reported by endoscopy studies. These formations usually consist of insoluble vegetable matter (phytobezoars), hair (trichobezoars), or medications (pharmacobezoar). In general, they can be asymptomatic for many years or cause nonspecific symptoms including abdominal pain, early satiety, and weight loss. However, in recent years, these have become increasingly problematic for the general population attributing to a variety of GI disturbances. We are reporting a case which revolves around a female patient with no history of …

Weighing Harms, Benefits, And Alternatives For A Young Man With A Recent Flare Of Ulcerative Colitis, Louise B. Welsh

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Sandborn WJ, Su C, Sands B, et al. Tofacitinib as Induction and Maintenance Therapy for Ulcerative Colitis. N Engl J Med. 2017 May 4;376(18):1723-1736. doi: 10.1056/NEJMoa1606910

Influence Of Gut Microbiome On Obesity In Western-Style Dietary Practices Versus Other Diets: A Systematic Review, Keely A. Niemeyer, Doris I. Buezo, Loren Landeros, Karina Corral

OSRI Journal of Student Research and Innovation

BACKGROUND: The human gut is home to a microbiome that has a complex relationship to human health. Like the human genome project, microbiome is catching the attention of researchers who seek new methods to combat obesity and negative health outcomes associated with it.

OBJECTIVES: This systematic review aims to distinguish the impact of a Western diet on gut health verses a plant-based diet.

DATA SOURCES: EBSCOHost library databases inclusive of CINAHL plus, ScienceDirect, and PubMed using keywords to better understand the correlation of dietary practices and microbiome balance.

STUDY ELIGIBILITY: Criteria that include diet, current research, and scholarly peer reviewed …