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GI on
HADJPayman 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
• 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