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GI on HADJ. Payman Adibi,MD Professor, GI section, Dept. of Medicine, IUMS. Scope of problems. Acute complaints Chronic diseases Emergencies. Acute dyspepsia. Recent discomfort in epigatrum Pain Fullness Early satiety Pressure sensation Nausea. ER referral.
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GI onHADJ PaymanAdibi,MD Professor, GI section, Dept. of Medicine, IUMS
Scope of problems • Acute complaints • Chronic diseases • Emergencies
Acute dyspepsia • Recent discomfort in epigatrum • Pain • Fullness • Early satiety • Pressure sensation • Nausea
ER referral • Look for alarms that necessitate ER referral • Hematemesis or melena • Urine color darkening • Severe pain • Hx of CAD or high risk for CAD • Unstable vital signs
Symptom relief • Pyrosis Antacid 5 spf • Pain Antacid 5 spf + Lidocaine PPI + Antispasmodic • Nausea PPI + prokinetic
Acute Diarrhea • Mild symptoms • No fever • No blood • < 3 pass • No urgency • Bismuth • Antidiarrheal
Severe symptoms • Fever >37.8 • Pass >4 • Urgency • Dysentery • Antibiotics • Antidiarrheal
Bismuth • Two tab/ hr up to 8 doses • May be continued for longer time • Not in pregnancy ,milking • Stool color turns dark • Make ASA effect stronger (Salcylte form) • May cause neurotoxicity
Antibiotics • Ciprofloxacin 500 mg bid for 3 days • Azithromycin 1000 mg STAT
Antidiarrheal • Loperamide
Acute Constipation • Prevent • Liquids 8 glass/day • Fiber-containing portions 5 servings • Reduce tea < 4 cups • Move
ER referral • Obstipation • Real fever • Tender abdomen • Fecal impaction
Treat • Osmotic agents • Lactulose • May cause gas and bloat • MOM • Not in renal failure • Short-term use in elderly cases • PEG • Rapid acting • May cause dyspepsia
Stimulants • Senna • May cause colic • Safe to use in long-term • On-off use may be preferred
FGID • Change in • Sleep pattern • Meal intake • Composition • Habit • Stressors • Loneliness • Mobility
Limited amount of fluid in one time • Never over feed • Low tea consumption • Reduce speed of intake • Reduce liquids with meals • Consider botanicals • Consider Metronidazol/Bismuth in bloating
IBD • Before travel • Travelers' diarrhea chemoprophylaxis • Ciprofloxacin 500 mg bid • Increase maintenance dose if symptomatic • Start steroids if fully symptomatic • Transfuse if anemic
IBD • On-trip Flare-up • Clinical • >6 pass • >2 nocturnal pass • Fever • Colic • Anemia • S/E • WBC>5 • RBC>5
Flare-up control • 5-ASA • Increase to full dose • Reduce gradually • Metronidazol • 250 tds for 1-2 weeks • Steroid • Step down prednisolone 50 > 25 > 12.5
CHD • HBV • Health precautions to reduce transmission • Provide HBIG if possible for post-exposure control • No contraindication for activity • Do not use steroids • On treatment cases are as normal subjects
HCV • Health precautions to reduce transmission • No contraindication for activity • No contraindication for drug • On treatment cases • May face infection if neutropenic on IFN • May face fatigue if anemic on Ribaverin
Cirrhosis • On diuretic case may face dehydration • A case with history of encephalopathy must continue Lactulose forever • Any infection may increase encephalopathy • Any significant esophageal varix must be eradicated before flight
NSAID • May cause complication more in : • Elder patients • Those with past history of ulcer • Cases using steroids • Cases using anticoagulants PPI as preventive mean and early treatment
MPBPR • Red blood • Minimal • No vital sign change • Mostly with perennial problems • Mostly in constipated cases • Mostly low-risk