GiT Updates and More

Diagnostic tools for MASLD in the management of obesity.

✴️ Key Features of Underwater Mucosectomy: 🔅No Submucosal Injection Required - Unlike traditional EMR, 🔅UM uses water to create a cushion, eliminating the need for fluid injection. 🔅Underwater Environment - The colon is filled with water, which helps lift the mucosa away from the muscle layer, reducing the risk of perforation. 🔅Improved Visualization - Water immersion clears blood and debris, enhancing visibility during the procedure. 🔅Safer for Larger or Flat Lesions - Particularly useful for lesions >10 mm or laterally spreading tumors (LSTs). ✴️Advantages Over Traditional EMR: 🔅Faster - No time spent on submucosal injection. 🔅Lower Cost - Avoids expensive injection solutions. 🔅Reduced Risk of Bleeding/Perforation - Water provides a natural cushion. 🔅Better RO Resection Rates - Higher chance of complete removal. ✴️ Indications: 1- Colorectal polyps (especially flat or sessile lesions 10-20 mm). 2- Laterally spreading tumors (LSTs). 3- Benign or early malignant lesions (Ta).

🔅Colonoscopy in patient with Cardiac Resynchronization Therapy (CRT) device If a patient has a Cardiac Resynchronization Therapy (CRT) device (CRT-D or CRT-P), special precautions are needed before a colonoscopy, especially if electrocautery is planned. ✴️ Pre-Colonoscopy Precautions for CRT Devices: 🛑1. Pre-Procedural Evaluation Device Identification: Confirm whether the patient has a CRT-P (pacing only) or CRT-D (defibrillator function). Recent Device Check: Ensure a recent interrogation (within 3–6 months) to assess battery life and lead function. Cardiologist Consultation: If uncertain, consult the electrophysiologist before the procedure. 🛑 2. Bowel Preparation Considerations Fluid Balance: Patients with heart failure (common in CRT patients) are at risk of volume overload or dehydration. Use electrolyte-balanced solutions like PEG-based regimens (e.g., Golytely, MoviPrep) instead of sodium phosphate solutions. Medication Adjustments: Hold diuretics on the day before/during prep to prevent dehydration. Continue beta-blockers and other cardiac meds unless advised otherwise. 🛑 3. Electrocautery Considerations Bipolar Cautery Preferred: If polypectomy or hemostasis is required, use bipolar electrocautery or cold snare techniques to minimize EMI (electromagnetic interference). Monopolar Cautery Precautions: 🎈CRT-D: The defibrillator function may need temporary deactivation to prevent inappropriate shocks. 🎈CRT-P: No specific adjustments are usually needed, but minimize prolonged cautery. 🎈Use Short, Intermittent Bursts: If monopolar electrocautery is needed, use the lowest effective power and apply in short bursts (<5 seconds). 🎈Electrode Pad Placement: Ensure the grounding pad is positioned to direct current away from the device (typically on the thigh). 🛑 4. Post-Procedural Considerations Device Check if Deactivated: If the defibrillator function was turned off, ensure it is reactivated before discharge. Monitor for Arrhythmias: Watch for bradycardia or pacing dysfunction, though rare.

Diagnostic work-up of bile duct strictures: European Society of Gastrointestinal Endoscopy (ESGE) Guideline 2025

🔅Corticosteroids in acute liver injury : 1.Acute autoimmune hepatitis (AIH) 2.Alcohol-Associated Hepatitis (Severe) ✅ Indication: Maddrey’s Discriminant Function (DF) ≥ 32 or MELD > 21 3.Drug-Induced Liver Injury (DILI) – Hypersensitivity Reactions ✅ Indication: DILI with immune-allergic features (e.g., eosinophilia, rash, fever) 4.Severe Prolonged Cholestasis (>3 months) with Bile Duct Damage, but data is limited. 5.Liver Transplant Rejection (Acute) 6.Acute Liver Injury due to Severe COVID-19 ✅ Indication: ALI secondary to hyperinflammatory response in severe COVID-19

🔅Big news for MASH treatment ✅A phase 3 trial shows semaglutide 2.4 mg weekly may reverse liver damage in MASH with fibrosis.

EASL Clinical Practice Guidelines on the management of autoimmune hepatitis

✴️Urine analysis is simple, quick, and inexpensive for patients, yet it's a treasure that should be utilized well. About 19 diagnoses can be strongly suspected through careful examination of results (while considering medical history and clinical examination): 1️⃣ Dysmorphic RBCs + RBC casts → Glomerulonephritis 2️⃣ WBCs + WBC casts + fever + flank pain → Acute Pyelonephritis 3️⃣ Heavy proteinuria + fatty casts + oedema → Nephrotic Syndrome 4️⃣ Granular (muddy brown) casts + raised creatinine + hypotension → Acute Tubular Necrosis (ATN) 5️⃣ Positive nitrite + leukocyte esterase + bacteriuria → Uncomplicated UTI (Cystitis) 6️⃣ Leukocyte esterase + sterile pyuria + TB risk/travel → Genitourinary Tuberculosis 7️⃣ Ketones + glucose + acidic pH → Diabetic Ketoacidosis (DKA) 8️⃣ Positive dipstick blood + no RBCs on microscopy → Myoglobinuria or Hemoglobinuria (e.g. Rhabdomyolysis) 9️⃣ Alkaline urine + struvite crystals + recurrent UTI → Proteus-related Urolithiasis 🔟 Glycosuria with normal serum glucose → Fanconi Syndrome 1️⃣1️⃣ Low specific gravity (<1.005) + polyuria + dilute urine → Diabetes Insipidus 1️⃣2️⃣ High specific gravity (>1.030) + concentrated urine → Dehydration or SIADH 1️⃣3️⃣ Brown urine → Bile pigments (e.g. obstructive jaundice), Myoglobin (e.g. rhabdomyolysis) 1️⃣4️⃣ White urine → Chyluria or phosphate crystals (e.g. nephrotic syndrome, lymphatic fistula) 1️⃣5️⃣ Orange urine → Rifampicin therapy or phenazopyridine use 1️⃣6️⃣ ↑ Urobilinogen → Haemolysis or Hepatitis 1️⃣7️⃣ ↓ Urobilinogen → Cholestasis or obstructive jaundice 1️⃣8️⃣ Conjugated bilirubin in urine → Hepatic or obstructive jaundice 1️⃣9️⃣ Dark urine that fluoresces under Wood's lamp + blistering skin lesions → Porphyria Cutanea Tarda​​​​​​​​​​​​​​​​