GiT Updates and More

❇️ How to clear the fundus from blood to examine it well for gastric varices ? 1- Pre-Medicate: IV Erythromycin and IV Octreotide. 2- Secure Airway: If high risk, intubate. 3- Initial Suction: Rapidly suction fluid blood from the gastric body. 4- Irrigate: Use water jet to wash the fundic folds. 5- Reposition: Turn patient to right lateral decubitus position and elevate the bed head 45-90 degree. 6- Remove Clots Cautiously: Suction non-adherent clots. Leave adherent clots alone. 7- Use Underwater View: Fill the fundus with water to improve visualization. 8- Inspect in Retroflexion: Systematically examine the cleared fundus for varices and stigmata of bleeding. 🔆 Crucial Warning: This is a high-risk procedure that should be performed by an experienced therapeutic endoscopist. The primary goal is to identify and treat the bleeding source, but the act of clearing the blood can itself cause bleeding.

❇️ Meckel's diverticulum is a small, pouch-like bulge in the wall of the small intestine, present at birth. ❇️ Key Facts: The Rule of 2 : ▫️Found in 2% of the population. ▫️Located about 2 feet (60 cm) from the end of the small intestine (the ileocecal valve). ▫️Is often 2 inches (5 cm) long. ▫️2:1 male-to-female ratio for those who develop symptoms. ❇️ Symptoms often appear before age 2 (though can occur at any age). ❇️ May contain gastric or pancreatic tissue ❇️ Complications: The vast majority of people with it have no symptoms. However, it can cause problems: ▫️Bleeding: The most common complication in children. Stomach tissue inside the pouch secretes acid, leading to ulcers in the adjacent normal intestine. ▫️Bowel Obstruction: The diverticulum can cause a blockage. ▫️Inflammation (Diverticulitis): Similar to appendicitis, but on the right side. ❇️ Treatment: Only treated if it causes symptoms, typically with surgical removal.

Management of high INR ( warfarin )

Algorithm for pharmacological management of MASLD/MASH in Indian patients

🔸With pedunculated polyps, cut LOW on stalk (C Arrow) to increase chance of R0 resection! 🔸Up to 1/3rd of malignant pedunculated polyps are Haggitt Level 3 (cancer in stalk), so you have to get low to increase chance of cure.

🔅Positive developments are on the horizon for Hepatitis B patients. Latest developments in chronic Hepatitis B treatment as of 2025: - Therapeutic vaccines like TherVacB are in clinical trials, aiming to stimulate the immune system to eliminate the virus and achieve a functional cure. - Gene editing therapies have begun trials (e.g., FDA-approved PBGENE-HBV) to directly disrupt the viral DNA inside infected liver cells. - New direct-acting antivirals and immunomodulatorsare being developed to improve virus suppression and immune response, often used in combination with existing drugs. - Experimental treatments targeting viral reservoirs in the liver (such as Hepalatide combined with interferon) show early promise in eliminating the virus.

In SBP (Spontaneous Bacterial Peritonitis), the benefit of albumin is not only due to its oncotic effect (increasing plasma oncotic pressure and shifting fluid into the circulation). The non-oncotic properties of albumin also play a major role: 1.Antioxidant effect → scavenges free radicals and reduces oxidative stress. 2.Binding & detoxification → binds endotoxins and harmful substances. 3.Immunomodulation → modulates the inflammatory response. 4.Endothelial stabilization → reduces capillary permeability and leakage. 5.Renal protection → lowers the risk of hepatorenal syndrome after SBP. So, Albumin is not just a “plasma expander,” its protective effects in SBP come largely from these non-oncotic properties, which explain why it reduces renal impairment and mortality.

Proposed clinical decision pathway/algorithm for EUS-guided coil injection therapy for gastric varices.

Proposed clinical decision pathway/algorithm for EUS-guided coil injection therapy for gastric varices.