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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 • 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
