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