1 In a patient with blood in the stools who is hemodynamically stable, use history to differentiate upper vs. lower gastrointestinal (GI) bleed as the investigation differs. UGIB LGIB ClassificationSymptoms Above Ligament of Treitz Vomiting – BRB, coffee ground Meds:…
Dehydration XS intracellular fluid loss (from GI, skin, or kidney) usually due to hypovolemia Highest morbidity and mortality in peds Hypovolemia 1) Hypertonic/hypernatremic GI losses, fever, DM, renal dz Net loss of extracellular water, or gain of sodium 2) Isotonic…
3 categories Acute Diarrhea: presence of ≥ 3 loose, waterly stools within 24hr Dysentery: bloody diarrhea, visible blood and mucous present Persistent diarrhea: Episodes of diarrhea lasting >14 days Main symptoms Fever: common and associated with invasive pathogens Bloody stools: invasive…
1 In a patient presenting with hepatitis symptoms and/or abnormal liver function tests, take a focused history to assist in establishing the etiology (e.g., new drugs, alcohol, blood or body fluid exposure, viral hepatitis). S/Sx: HAV: lasting 2mo, fulminant illness <1%, 70%…
1) ULCERATIVE COLITIS- (sulfasalazine most effective to maintain remission) Well balanced diet Colectomy if refractory to medical Tx or if have cancerous changes Colonoscopy surveillance recommended starting 7 yrs from time of diagnosis Meds: mild-mod disease – sulfasalazine high dose…
Dyspepsia is a symptom 1 In a patient presenting with dyspepsia, include cardiovascular disease in the differential diagnosis. DDx: Cardiac: CAD/MI/PE/Pericarditis/Myocarditis/Aortic dissection/Tamponade Boerhaves Hepatobiliary, colonic, Celiac, Achalasia, MSK, esophageal stricture / scleroderma Dyspepsia: GERD, gastric cancer (Zollinger-Ellison), esophageal cancer, pancreatic…
1 Given a patient with abdominal pain, paying particular attention to its location and chronicity: a) Distinguish between acute and chronic pain: Arbitrary distinction, 6-12 wk for chronic pain b) Generate a complete differential diagnosis (ddx). Periumbilical – gastro, obstipation,…
