Transcript Document

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
• 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
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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
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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
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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
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>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
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Red blood
Minimal
No vital sign change
Mostly with perennial problems
Mostly in constipated cases
Mostly low-risk