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GI on HADJ

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.

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GI on HADJ

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  1. GI onHADJ PaymanAdibi,MD Professor, GI section, Dept. of Medicine, IUMS

  2. Scope of problems • Acute complaints • Chronic diseases • Emergencies

  3. Acute dyspepsia • Recent discomfort in epigatrum • Pain • Fullness • Early satiety • Pressure sensation • Nausea

  4. 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

  5. Symptom relief • Pyrosis Antacid 5 spf • Pain Antacid 5 spf + Lidocaine PPI + Antispasmodic • Nausea PPI + prokinetic

  6. Acute Diarrhea • Mild symptoms • No fever • No blood • < 3 pass • No urgency • Bismuth • Antidiarrheal

  7. Severe symptoms • Fever >37.8 • Pass >4 • Urgency • Dysentery • Antibiotics • Antidiarrheal

  8. 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

  9. Antibiotics • Ciprofloxacin 500 mg bid for 3 days • Azithromycin 1000 mg STAT

  10. Antidiarrheal • Loperamide

  11. Acute Constipation • Prevent • Liquids 8 glass/day • Fiber-containing portions 5 servings • Reduce tea < 4 cups • Move

  12. ER referral • Obstipation • Real fever • Tender abdomen • Fecal impaction

  13. 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

  14. Stimulants • Senna • May cause colic • Safe to use in long-term • On-off use may be preferred

  15. FGID • Change in • Sleep pattern • Meal intake • Composition • Habit • Stressors • Loneliness • Mobility

  16. 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

  17. IBD • Before travel • Travelers' diarrhea chemoprophylaxis • Ciprofloxacin 500 mg bid • Increase maintenance dose if symptomatic • Start steroids if fully symptomatic • Transfuse if anemic

  18. IBD • On-trip Flare-up • Clinical • >6 pass • >2 nocturnal pass • Fever • Colic • Anemia • S/E • WBC>5 • RBC>5

  19. 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

  20. 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

  21. 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

  22. 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

  23. 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

  24. MPBPR • Red blood • Minimal • No vital sign change • Mostly with perennial problems • Mostly in constipated cases • Mostly low-risk

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