20 articles Gastroenterology

Chronic Diarrhea

Chronic Diarrhea: 3 main categories: Watery: Calculate the fecal osmotic gap: Distinguish: Osmotic subtype: Gap > 125 mOsm/kg Secretory subtype: Gap < 50 mOsm/kg Differential diagnosis: Diabetic autonomic neuropathy Microscopic colitis Need colonoscopy with random biopsies. Older female Younger pt with extensive NSAID use Hyperthyroidism Non-osmotic laxative abuse Hormone-producing tumors (carcinoid) Calculate gap: stool osmolarity…

Functional Gastrointestinal Disorders

ROME Criteria: Functional GastroIntestinal Disorders (FGIDs): disorders of the digestive system in which symptoms cannot be explained by the presence of structural or tissue abnormality, based on clinical symptoms. Examples of FGIDs: irritable bowel syndrome functional dyspepsia functional constipation functional heartburn. Rome III Diagnostic Criteria for Functional Gastrointestinal Disorders: http://romecriteria.org/assets/pdf/19_RomeIII_apA_885-898.pdf Comparison Table of Rome II…

Small Bowel Obstruction (SBO)

Small Bowel Obstruction: Partial small bowel obstruction: Abdominal series, flat and upright: mildly dilated small bowel loop with air fluid levels, that may be secondary to partial obstruction, enteritis/colitis, or ileus. Admit the patient to Dr.______. Keep the patient NPO. Give IV fluids. Begin pain medications with Dilaudid and taper off as symptoms improve. (Dilaudid,…

Inflammatory Bowel Disease: Crohn’s/Ulcerative Colitis

Crohn’s/UC: (Crohn’s: tender RLQ; UC: LLQ) flare possibly secondary to stress/pain elsewhere (ex: kidney stone) CT of abdomen and pelvis with contrast to look for abscess – May need to consult surgery if big abscess Cover bowel (GI) flora (Diverticulitis/Crohn’s abscess): Ciprofloxacin and Flagyl. And/or Zosyn, Levoquin (levofloxacin), or Rocephin 1g IV qd [Levoquin and…

Gastroenteritis

Gastroenteritis: IV fluids: NS @ 150cc/hr X 2L (why this specifically?) Zofran or Phenergan PRN for N/V. Lomotil PRN for Diarrhea Lomotil 2.5mg 1-2 tabs PO bid-qid PRN for Diarrhea [Take with food to decrease GI upset.] Mechanism of action: inhibits peristalsis of intestinal muscles Diet: Clear liquids and advance as tolerated. If diarrhea: Order…

Diverticulitis

Diverticulitis: CT of abdomen and pelvis with contrast Cover bowel (GI) flora (Diverticulitis): Ciprofloxacin and Flagyl. And/or Zosyn, Levoquin (levofloxacin), or Rocephin 1g IV qd [Levoquin and Flagyl] or Rocephin and Flagyl Levofloxacin 750mg/D5W 150ml IV qd Metronidazole (Flagyl) 500mg/NS 100ml IV q6-8hrs Meropenum 1g IV q8hr Carbapenums: ultra-broad spectrum (Gram POS, Gram NEG, and…

Acid reflux/GERD

Heartburn: GI cocktail: Maalox X-ST (ALOH/MGOH/Simet) 30ml PO X 1 dose Magnesium Hydroxide (MOM) oral suspension Lidocaine (Xylocaine) 2% viscous 15ml PO X 1 dose Maalox 30cc, Mylanta, Scheduled Protonix/Omepraxole Scheduled and/or PRN Ranitidine GERD: Encourage lifestyle changes: Do not eat large meals close to bedtime, prop up the head of the bed, eat multiple…