Gastroenterology an der RCSI-Medical University Of Bahrain | Karteikarten & Zusammenfassungen

Lernmaterialien für Gastroenterology an der RCSI-Medical University of Bahrain

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DIFFERENTIAL DIAGNOSIS OF
EPIGASTRIC PAIN

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• Peptic ulcer disease 
• Malignant ulcer (gastric cancer) 
• Esophagitis • GORD 
• Pancreatitis 
• Acute coronary syndrome (inferior MI) 
• Abdominal aortic aneurysm 
• Acute cholecystitis 
• Biliary colic

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MANAGEMENT of PUD

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1. Preventative   
• Do not smoke   
• Avoid alcohol   
2. Acute   
• Upper GI Haemorrhage   
   - (see Upper GI Bleeding Emergency)   
• Symptomatic Non-Bleeding Peptic Ulcer Management  

   - Proton Pump Inhibitors    
        - Eg Esomeprazsole 40mg OD, Omeprazole 40mg OD or Lansoprazole 30mg OD

        - SE: hyponatraemia, risk of C. diff,    

   - H2 antagonists 

        - If persistent symptoms or contraindication to PPI, Eg Ranitidine 150m.g.  OD      

   - Antacids        
        - Gaviscon PRN        
   - H. pylori Positive       

        - Eradicate bacteria with triple therapy (2 antibiotics and  PPI BD for 14 days        

                - Eg PPI (esomeprazole 40mg BD po) + amoxicillin  1g BD (or Metronidazole 400mg BD po if penicillin  allergy) + clarithromycin 500mg BD po all for 14 days          
3. Long-term management          
• Lifestyle         

   - Stop NSAIDs / medication rationalization 

   - Smoking Cessation  
   - Avoid Alcohol  
   - Weight loss  
• Monitoring  
   - If a gastric ulcer is Identified, patient should get a repeat OGD after PPI therapy to ensure gastric ulcer healing.

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TESTE DEIN WISSEN

RISK FACTORS of PUD

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• Previous PUD 
• Helicobacter pylori infection 
• Age> 60 
• Chronic kidney or liver disease 
• Drugs, especially polypharmacy: Anticoagulants, steroids, alendronate, NSAIDs 
• Smoking 
• Alcohol 
• Stress (Cushing's ulcers) 
• Burns (curling's ulcers)

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EPIDEMIOLOGY of gastroenteritis

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- Top 5 leading causes of death

- Increasing incidence in healthcare-associated setting (C. difficile 
and norovirus)

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TESTE DEIN WISSEN

AETIOLOGY of gastroenteritis 

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Major include:  
 Viruses (norovirus, rotavirus, adenovirus)  
 Bacteria (Clostridium difficile, Campylobacter spp, Salmonella, Shigella and E-coli)

 Protozoa (amoebiasis)  
• Enterotoxigenic  E. coli  (ETEC) is the commonest cause of  traveler's diarrhea  
• immunocompromised patients are vulnerable to thesis, in addition  to other pathogens: such as cytomegalovirus (CMV)

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TESTE DEIN WISSEN

GRADING SCALES (UPPER GI BLEEDING)

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• Glasgow Blatchford Score (see Non-variceal Upper GI bleeding chapter) 
• Rockall Score 
   - Scores are based on age, co-morbidities, findings on endoscopy, presentation, acting as prognostic indicators of rebleeding risk and mortality 

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SYMPTOMS of gastroenteritis 

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• Nausea +/- vomiting 
• Diarrhea (acute onset)

• Abdominal pain and cramps

• Red Flag Symptoms  
 Weight loss, intractable vomiting, severe dehydration, bloody stool, temp> 38.1,  incontinence, urgency,  nocturnal symptoms

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DEFINITION of Gastroenteritis

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Diarrhoeal disease (three or more loose stools per day) of rapid
onset that lasts less than two weeks and may be accompanied by
nausea, vomiting, fever, or abdominal pain
 Acute: ≦14 days
 Persistent: > 14 days but < 30 days duration
 Chronic: ≧30 days duration

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TESTE DEIN WISSEN

DEFINITION of PUD


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Defects in the gastric or duodenal mucosa

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EPIDEMIOLOGY of PUD

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- Duodenal ulcers> gastric ulcers

- Gastric ulcers: peak in 6th decade

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TESTE DEIN WISSEN

SYMPTOMS of PUD

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• Epigastric pain 

 Worsened by food

 Worsened when hungry     

• Waterbrash

• Heartburn     
• Alarm Symptoms  

   - Anemia

   - Loss of weight

   - Anorexia + early satiety

   - Recent onset

   - Malaena/Haematemesis


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TESTE DEIN WISSEN

MANAGEMENT of gastroenteritis

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1. Prevention 
• Hand hygiene 
• Avoid close contact with others 
2. Acute Management 
• Supportive Management 
 Give oral fluid repletion if mild dehydration and able to 
tolerate oral intake 
 iv fluids if severe dehydration or acute kidney injury 
• Pharmacological Management 
 In general, acute gastroenteritis does not require antibiotics which may actually increase risk of antibiotic-associated 
diarrhoea 
 Antibiotics recommended if: 
 Severe disease (fever,> 6 stools per day, 
immunocompromised patients) 
 Symptoms> 1 week 
• Surgical Management 
 Colectomy should be considered if toxic megacolon develops
3. Acute Clostridium Difficile Infection (positive toxin assay and symptoms) 
• Pharmacological Management 
 Moderate disease: Oral Metronidazole 400mg TDS 
 Severe disease, or elderly, or ↓ albumin: Vancomycin 125mg Q.DS 
 Relapse of C. diff. : Oral fidaxomicin 
• Procedural management 
 Faecal microbiome transplantation in relapse or recurrence 

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Beispielhafte Karteikarten für deinen Gastroenterology Kurs an der RCSI-Medical University of Bahrain - von Kommilitonen auf StudySmarter erstellt!

Q:

DIFFERENTIAL DIAGNOSIS OF
EPIGASTRIC PAIN

A:

• Peptic ulcer disease 
• Malignant ulcer (gastric cancer) 
• Esophagitis • GORD 
• Pancreatitis 
• Acute coronary syndrome (inferior MI) 
• Abdominal aortic aneurysm 
• Acute cholecystitis 
• Biliary colic

Q:

MANAGEMENT of PUD

A:

1. Preventative   
• Do not smoke   
• Avoid alcohol   
2. Acute   
• Upper GI Haemorrhage   
   - (see Upper GI Bleeding Emergency)   
• Symptomatic Non-Bleeding Peptic Ulcer Management  

   - Proton Pump Inhibitors    
        - Eg Esomeprazsole 40mg OD, Omeprazole 40mg OD or Lansoprazole 30mg OD

        - SE: hyponatraemia, risk of C. diff,    

   - H2 antagonists 

        - If persistent symptoms or contraindication to PPI, Eg Ranitidine 150m.g.  OD      

   - Antacids        
        - Gaviscon PRN        
   - H. pylori Positive       

        - Eradicate bacteria with triple therapy (2 antibiotics and  PPI BD for 14 days        

                - Eg PPI (esomeprazole 40mg BD po) + amoxicillin  1g BD (or Metronidazole 400mg BD po if penicillin  allergy) + clarithromycin 500mg BD po all for 14 days          
3. Long-term management          
• Lifestyle         

   - Stop NSAIDs / medication rationalization 

   - Smoking Cessation  
   - Avoid Alcohol  
   - Weight loss  
• Monitoring  
   - If a gastric ulcer is Identified, patient should get a repeat OGD after PPI therapy to ensure gastric ulcer healing.

Q:

RISK FACTORS of PUD

A:

• Previous PUD 
• Helicobacter pylori infection 
• Age> 60 
• Chronic kidney or liver disease 
• Drugs, especially polypharmacy: Anticoagulants, steroids, alendronate, NSAIDs 
• Smoking 
• Alcohol 
• Stress (Cushing's ulcers) 
• Burns (curling's ulcers)

Q:

EPIDEMIOLOGY of gastroenteritis

A:

- Top 5 leading causes of death

- Increasing incidence in healthcare-associated setting (C. difficile 
and norovirus)

Q:

AETIOLOGY of gastroenteritis 

A:

Major include:  
 Viruses (norovirus, rotavirus, adenovirus)  
 Bacteria (Clostridium difficile, Campylobacter spp, Salmonella, Shigella and E-coli)

 Protozoa (amoebiasis)  
• Enterotoxigenic  E. coli  (ETEC) is the commonest cause of  traveler's diarrhea  
• immunocompromised patients are vulnerable to thesis, in addition  to other pathogens: such as cytomegalovirus (CMV)

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Q:

GRADING SCALES (UPPER GI BLEEDING)

A:

• Glasgow Blatchford Score (see Non-variceal Upper GI bleeding chapter) 
• Rockall Score 
   - Scores are based on age, co-morbidities, findings on endoscopy, presentation, acting as prognostic indicators of rebleeding risk and mortality 

Q:

SYMPTOMS of gastroenteritis 

A:

• Nausea +/- vomiting 
• Diarrhea (acute onset)

• Abdominal pain and cramps

• Red Flag Symptoms  
 Weight loss, intractable vomiting, severe dehydration, bloody stool, temp> 38.1,  incontinence, urgency,  nocturnal symptoms

Q:

DEFINITION of Gastroenteritis

A:

Diarrhoeal disease (three or more loose stools per day) of rapid
onset that lasts less than two weeks and may be accompanied by
nausea, vomiting, fever, or abdominal pain
 Acute: ≦14 days
 Persistent: > 14 days but < 30 days duration
 Chronic: ≧30 days duration

Q:

DEFINITION of PUD


A:

Defects in the gastric or duodenal mucosa

Q:

EPIDEMIOLOGY of PUD

A:

- Duodenal ulcers> gastric ulcers

- Gastric ulcers: peak in 6th decade

Q:

SYMPTOMS of PUD

A:

• Epigastric pain 

 Worsened by food

 Worsened when hungry     

• Waterbrash

• Heartburn     
• Alarm Symptoms  

   - Anemia

   - Loss of weight

   - Anorexia + early satiety

   - Recent onset

   - Malaena/Haematemesis


Q:

MANAGEMENT of gastroenteritis

A:

1. Prevention 
• Hand hygiene 
• Avoid close contact with others 
2. Acute Management 
• Supportive Management 
 Give oral fluid repletion if mild dehydration and able to 
tolerate oral intake 
 iv fluids if severe dehydration or acute kidney injury 
• Pharmacological Management 
 In general, acute gastroenteritis does not require antibiotics which may actually increase risk of antibiotic-associated 
diarrhoea 
 Antibiotics recommended if: 
 Severe disease (fever,> 6 stools per day, 
immunocompromised patients) 
 Symptoms> 1 week 
• Surgical Management 
 Colectomy should be considered if toxic megacolon develops
3. Acute Clostridium Difficile Infection (positive toxin assay and symptoms) 
• Pharmacological Management 
 Moderate disease: Oral Metronidazole 400mg TDS 
 Severe disease, or elderly, or ↓ albumin: Vancomycin 125mg Q.DS 
 Relapse of C. diff. : Oral fidaxomicin 
• Procedural management 
 Faecal microbiome transplantation in relapse or recurrence 

Gastroenterology

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