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29 Cards in this Set
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H. Pylori Regimen. STANDARD |
* Lansoprazole/Omeprazole 20 + Amoxicillin 1gm + clarithromycin 500 All twice daily * Lansoprazole/Omeprazole 20 + Clarithromycin 500 + Metronidazole 400 All twice daily |
For 10 to 14 days |
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H. Pylori eradication. Sequential regimen |
5 days of Lansoprazole 20 + Amoxicillin 1g. All bid 5 days of Lansoprazole 20 + Metronidazole 500 + Clarithromycin 500. All bid |
Not better than the standard according to studies |
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Eradication failure |
Moxifloxacin/quinolone once + amoxicillin 1g bid + Esmoprazole 20 bid
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For 7 days Repeat the test after 4 wks after the end of the regimen to make sure of the eradication |
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Most sensitive Most specific. Test for H. Pylori |
Serology. Sensitive Biopsy. Specific |
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Epigastric pain causes ?? |
Non-ulcer dyspepsia. Commonest GERD,,DU/GU,,Gastritis,,Cancer Biliary Cardiac |
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When to redo stool Ag or urea breath test after eradication of regimen? |
Persistence of symptoms Recurrence of symptoms Wait 4 wks after eradication regimen |
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Indications of endoscopy in pt with dyspepsia/epigastric pain ? |
Age >45 yrs GI bleeding; anemia,, occult blood +ve Dysphagia/Odynophagia Weight loss |
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Causes of epigastric pain?? |
Commonest nonulcer dyspepsia GI: GERD, Ulcer, Gastritis, Cancer Biliary Cardiac |
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A 27 yrs old man presented to you by sorethroat since 5 days cough, metalic taste in the mouth,,he reports epigastric pain esp. After heavy meals. He takes antibiotic for sorethroat and antitussive for cough and analgesic. How to manage? |
A case of GERD: Lifestyle modifications; wt loss,,caffeine,,alcohol,,smoking,,chocolate,,mint,,dinner,,bed PPI once daily, domperidone TID If no response to Rx surgery may be an option |
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Indications of endoscopy in a pt present by dyspepsia/epigadtric pain? |
Age >45 yrs Anemia, +ve occult blood, GI bleeding Dysphagia/ odynophagia Weight loss |
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The previous pt presented to you after 10 yrs asking about the risk of esophageal cancer and what can be done to be detected early?? |
Screening by endoscopy should be done for: Longstanding GERD > 5 Yrs Pts >50 yrs with hx of GERD |
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A 28yrs old man presented to you by sorethroat since 5 days not controlled by antibiotics but no fever, he reports epigastric pain, cough and metallic taste He takes amoxclav,bronchotec and novaldol How to manage? |
A case of GERD; lifestyle modifications' alcohol,chocolate, and mint, smoking, bed and dinner Motilium & PPI IF no response he may need surgery!! 24 hrs Ph monitoring only in case of planned surgery. |
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The pt had Barretts esophagus ,,what to be done???if No dysplasia Low grade dysplasia High grade dysplasia |
Give PPI Endoscopy after every 2 yrs Endiscopy after every 6 months Surgery/endoscopic ablation if high grade |
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Stress ulcer prophylaxis indications: |
Intubation Trauma Burn Sepsis Coagulopathy |
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A 48 yrs old man on PPI & Amoxicillin for H. Pylori infection and has high gastrin level,, your intern is concerned about zollinger Ellison ,,, what's your opinion? |
Stop PPI AND REMEASURE GASTRIN LEVEL OR MEASURE GASTRIC ACID OUTPUT essentially any pt with PPI has a high gastrin level |
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How to diagnose ZE???and mets dx??? |
Hx Large Recurrent ulcers Distal Multiple Inx High gastrin level High gastric acid output Dx mets by US, CT,MRI Endoscopic US Nuclear somatostatin |
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Your intern asks about MEn syndrome and when it's needed to be excluded |
Ca level 😋 |
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A 50 yrs old diabetic male complains of frequent bloating and sense of fullness after meals, disflatyl doesn't help so much. He has perpheral neuropathy, diabetic retinopathy and had a heart attack one yr ago. What do you prescribe? |
Gastroparesis: Metochlopromide. 1x3. 30min before meals Erythromycin. 250-500 mg TID before meals. |
Don't forget to ask about Wt loss, anemia, dys/odynophagia, N&V, dyspepsia If no response to Rx consider endoscopy. |
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A 60 yrs old female suffers from dizziness, diaphoresis, circumoral numbness, palpitation immediately after meals esp lunch. What's your dx & rx |
Ask about previous surgery in the stomach,,similar symptoms while fasting,if she is diabetic and takes insulin. It's probably dumping syndrome Rx: Eat frequent small meals,avoid large meals. |
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Ali is a 30 yrs old pt,presented to you by abdominal pain,,fever and diarrhea since a week,he visited a doctor and prescribed a spasmolytic, antibiotic and analgesic. Fever and pain responds partially but recurs and no response to diarrhea. He can't go to work any more than because of th diarrhea.. Deal with the pt?? |
Ask about nocturnal symptoms,does defecation decrease pain, wt loss, anemia the manifestation, blood mucous stool Order** stool analysis RBC/ leukocytes mucus **ANCA,ASCA Refer to gastroentrologist for colonoscopy |
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Ali told you tha he has CD,,What is his Rx options?? And pros and cins of each |
Mesalamine,,pentasa Sulfasalazine. Rash,hemolysis, nephropathy Steroid,enema,budesonide Ciprodiazole"only in perianal dz" |
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Ali says that he takes pentasa,ciprodiazole and prednisolone. He can't stop steroids as every time he tries to stop them symtoms recur. He read about adverse effects of steroids and wants to stop them?? |
Azathioprine can be used |
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Ali comes to you with a pain and an abdominal mass Deal & rx of choice |
US and CT can be done Probably it's a fistula and mass from adhesions between loops of intestine Infliximab is Rx |
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Ali comes to you asking about colectomy and whether it cures the dz and prevents developing cancer or not Advisehim when to screen for cancer and how? |
Only UC can be treated with colectomy Both UC and CD of the colon cause cancer after 8-10 yrs Advise him to do colonoscopy after 8 yrs of illness |
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A 45 yrs old lady comes to you complaining of severe diarrhea. Last week she had pneumonia and a course of antibiotic has been prescribed. What is the Rx |
Clostridium deficile infection "pseudomembranous colitis" Confirm by stool analysis and C.deficile toxin Rx Stop the offending antibiotic if possible Metronidazole 250 QID for 7 days Recurrence: repeat the course of antibiotics Persistence in spite of metronidazole: vancomycin |
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A 25 yrs old medical student complaining of abdominal pain relieved by defecation,sometimes she had episides of diarrhea but what bithers her is the pain Inx Rx |
Stool analysis free Rx Spasmolytic Antiflatulence SSRI & TCA Bulk forming agents/fibers |
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Intermittent Diarrhea, flushing, wheezes, murmur in tricuspid area Inx Rx |
Probable carcinoid 5HIAA in urine Rx Octreotide/surgery to remove the tumor. |
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Lactose intolerance Hx Inx Rx |
Chronic diarrhea, no fever no blood Inx; stool analysis,high osmolality Rx Avoid milk and milk products except youghurt |
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A 28 yrs old male had lunch at 3 pm and presented at 4 pm by diarrhea, fever and bloody stool, Mostlikely organism |
Campylobacter Salmonella |
Pain Tenderness Fever Bloody stool Are more important than duration of last meal and type of food |
