Git Gib Variceal
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This document discusses the management of variceal hemorrhage, a lethal complication of cirrhosis. It covers the natural history of varices, including that 7% of patients develop or see variceal growth each year. Large varices, presence of red signs, advanced liver disease, and previous hemorrhage predict the 1-year risk of first hemorrhage, which is 12-15%. The risk of recurrent hemorrhage within 1 year is 60%, with 15-20% mortality per acute bleeding episode. It also discusses methods of risk stratification for portal hypertension and their ability to predict outcomes.
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1. Pulmonary embolism results from partial or complete obstruction of the pulmonary arteries, which can overload the right ventricle and compromise cardiac output.
2. Risk factors for pulmonary embolism range from strong risks like recent spinal cord injury or hip/knee replacement, to moderate risks such as oral contraceptive use or cancer, to weaker risks including prolonged immobility.
3. Diagnosis involves assessing the pre-test probability using prediction rules, d-dimer testing, and imaging with ultrasound, CT, or V/Q scan depending on the clinical situation. Biomarkers and echocardiography can help evaluate right ventricular function.
DVT
DVT is the formation of a blood clot in the deep veins, usually in the legs. Risk factors include age, immobilization, pregnancy, cancer, family history. Symptoms are leg swelling, pain, shortness of breath. Diagnosis involves a physical exam, Wells score, D-dimer test, ultrasound or CT scan. Treatment is blood thinners like heparin or warfarin to prevent clots from getting worse or causing pulmonary embolisms.
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Vasculitis refers to inflammation of blood vessels. This document discusses vasculitis syndromes including definitions, classifications, clinical presentations, diagnostic evaluations, and management. Vasculitides are classified based on the size of vessels predominantly involved as large, medium, or small vessel. Common small vessel vasculitis includes Wegener's granulomatosis and microscopic polyangiitis. Treatment involves immunosuppressants such as cyclophosphamide, steroids, methotrexate, and biologics depending on severity and type of vasculitis. Prompt diagnosis and treatment is important to prevent organ damage from ischemia.
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This document discusses upper gastrointestinal bleeding, including its definition, causes, and management. The causes are categorized as nonvariceal bleeding (80% of cases, most commonly from peptic ulcer disease) or bleeding related to portal hypertension (20% of cases, usually from gastroesophageal varices). Early endoscopy within 24 hours is recommended to identify the source of bleeding and guide treatment. Treatment depends on the specific cause but may include endoscopic therapies like epinephrine injection or thermal coagulation, as well as medications like PPIs. Surgery is considered if endoscopic treatment fails or for high risk lesions.
Upper gi bleeding
This document summarizes the presentation, evaluation, and management of a 70-year-old man with upper gastrointestinal bleeding due to esophageal varices from liver cirrhosis. Key points include: the patient presented with blood vomiting and black stools; examination found dehydration and signs of liver disease; endoscopy revealed esophageal varices that were banded to stop the bleeding. Variceal bleeding is a complication of portal hypertension in cirrhosis and has high rebleeding risks. Initial stabilization is followed by endoscopic treatment, vasoactive drugs, and antibiotics to prevent rebleeding.
Git Gib 2010 plus Pictures.
This document provides an overview of gastrointestinal bleeding (GIB), focusing on upper gastrointestinal bleeding (UGIB) and lower gastrointestinal bleeding (LGIB). It discusses evaluation, management, and treatment of acute GIB. For UGIB, initial management includes hemodynamic stabilization, finding the source of bleeding, and controlling the source. Most recurrent UGIB occurs within 3-4 days. For LGIB, common causes and initial evaluation are outlined. Colonoscopy is usually the initial test, and hemodynamic stabilization is the primary management focus for both UGIB and LGIB.
EHPVO ( Extra Hepatic Portal Vein Obstruction)
This document provides an overview of extra-hepatic portal vein obstruction (EHPVO). It discusses the prevalence, etiology, clinical features, diagnosis, management, and prognosis of EHPVO. Key points include that EHPVO is characterized by obstruction of the portal vein outside the liver, it is more common in India than Western countries, causes include thrombosis and hypercoagulable states, clinical features include variceal bleeding and splenomegaly, management involves preventing complications through anticoagulation and procedures like TIPS, and prognosis depends on the underlying cause and presence of complications.
Portal hypertension
The document summarizes portal hypertension and portal vein system. It describes that the portal vein is formed by the union of the splenic and superior mesenteric veins, running within the lesser omentum and posterior to the common bile duct and hepatic artery. Portal hypertension is defined as a hepatic venous pressure gradient greater than 5 mmHg and can be caused by pre-hepatic, intra-hepatic, or post-hepatic issues. Complications of portal hypertension include splenomegaly, ascites, and esophageal varices. Treatment involves pharmacological therapy, endoscopic procedures like band ligation, and transjugular intrahepatic portosystemic shunt placement.
UGIB - ppt 2023.pptx
This document provides an overview of upper gastrointestinal bleeding (UGIB), including its definition, classification, epidemiology, clinical features, diagnostic evaluation, and management. Some key points:
1. UGIB is more common than lower GI bleeding, with a reported incidence of 170 patients per 100,000 population per year. The most common cause is peptic ulcer disease (40% of cases).
2. Risk of rebleeding is higher in patients on antiplatelet therapy and those with recurrent bleeding within 48-72 hours. Mortality is 5-10% for severe UGIB.
3. Diagnostic evaluation includes endoscopy within 24 hours to identify the source of bleeding, as well as
UGIB.pptx
This document provides an overview of upper gastrointestinal bleeding (UGIB). It begins with definitions and common presentations of UGIB. The initial approach involves rapid assessment and resuscitation of unstable patients. Diagnostic studies like endoscopy are important to identify the source of bleeding. Common causes of UGIB include peptic ulcers, esophageal/gastric varices, and angiodysplasia. Management depends on the cause and severity but typically involves hemostasis, preventing rebleeding, and treating the underlying condition.
Hepatic Failure
This document discusses critical care aspects of chronic hepatic failure. It covers complications like variceal hemorrhage, refractory ascites, spontaneous bacterial peritonitis, and hepatic encephalopathy that often require ICU admission. It describes treatments for these complications including pharmacologic, endoscopic, radiologic, and surgical options. It also discusses management of portal hypertension, variceal bleeding, ascites, hepatic encephalopathy, and other issues related to caring for patients with chronic liver disease in the intensive care setting.
UGIB-Seminar.pptx
This document summarizes a presentation on the epidemiology, definition, etiologies, risk stratification, and management of upper gastrointestinal bleeding (UGIB). Some key points:
- UGIB accounts for 50% of GI bleeding admissions and has a mortality rate of 5-10% despite medical advances.
- Peptic ulcer disease, esophageal/gastric varices, Mallory-Weiss tears, and Dieulafoy's lesions are common causes.
- Risk scoring systems like Glasgow-Blatchford and Rockall are used to predict outcomes and guide management. High-risk stigmata on endoscopy indicate need for intervention.
- Prevention focuses on H. pylori
GASTROINTESTINAL-BLEEDING.ppt
The document provides information on gastrointestinal bleeding (GIB), including epidemiology, presentation, etiology, evaluation, and management. It notes that GIB can be divided into upper or lower sources. Upper GIB is more common and accounts for approximately 67 cases per 100,000 people annually. Clinical presentations include hematemesis, melena, and hematochezia. Risk stratification guides management, with unstable patients admitted to the ICU. Initial evaluation involves hemodynamic monitoring, labs, and upper endoscopy within 24 hours for diagnosis and treatment. Endoscopy allows for control of bleeding in 85-90% of actively bleeding cases.
Approach to patients with upper gi bleeding
This document provides an overview of a seminar on gastrointestinal bleeding. It begins with an introduction and outline. It then covers topics like the anatomy of the GI tract and sources of bleeding. Diagnostic assessments including history, exams, and tests are reviewed. Approaches to resuscitation, classification of shock, and fluid management are outlined. Etiologies of upper and lower GI bleeding like ulcers, varices, and tumors are summarized. Endoscopic and surgical management strategies are also discussed. Risk factors for poor prognosis with GI bleeding are listed. The document concludes with a risk score to predict need for intervention in GI bleeding cases.
Management of critically-ill cirrhotic patients
This document discusses the management of critically ill cirrhotic patients, focusing on those with acute variceal bleeding. Cirrhotic patients are prone to life-threatening complications requiring emergency care. Variceal bleeding remains a leading cause of mortality, though outcomes have improved over time. Management involves fluid resuscitation, blood product administration, antibiotic prophylaxis, vasoactive drugs, and endoscopic therapy all within 6-12 hours of admission. Early use of covered transjugular portosystemic shunt may improve outcomes in high-risk patients.
4 s.full
Acute gastrointestinal bleeding is a common medical emergency that frequently results in hospitalization. Rapid initial assessment of clinical parameters such as estimated volume of blood lost, appearance of expelled blood, hypotension, mental status changes, and coagulopathy should all be evaluated as part of the outcomes prediction equation. For upper gastrointestinal bleeding, early endoscopy of the upper gastrointestinal tract will also provide important information to aid in efforts to predict risk. Endoscopic evidence of ongoing rapid bleeding or the presence of a “visible vessel” or adherent clot on the ulcer base are findings that are associated with a high likelihood of continued bleeding or recurrent bleeding. Endoscopic therapy can reduce the rates of recurrent bleeding, surgery, and length of hospital stay in patient with
Git 4th gib ulsi21
This document discusses gastrointestinal bleeding (GIB), summarizing its main causes and approaches to management. It notes that upper GIB accounts for 80% of cases, with the most common causes being peptic ulcer disease, esophageal varices, esophagitis, and Mallory-Weiss tears. Lower GIB is more common in the elderly and can be caused by conditions like diverticulosis, colitis, ischemia, and hemorrhoids. Small intestinal bleeding is relatively uncommon but can now be identified in most patients using video capsule endoscopy, deep enteroscopy, or radiological imaging. The document provides guidance on assessing severity, differentiating upper from lower sources, initial resuscitation measures, the role of endoscopy,
Similar to Git Gib Variceal (20)
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Git j club fiber in git20
Dietary fiber from whole foods like grains, legumes, vegetables, and fruits has demonstrated benefits for gastrointestinal (GIT) health. Isolated and extracted fibers also show promising regulatory effects on the gut and microbiome. However, fibers have varying physicochemical properties depending on their origin and processing that influence their functional characteristics and clinical applications. More research is needed, including well-designed randomized controlled trials, to determine which fiber sources, characteristics, doses and durations optimize GIT health benefits and manage gastrointestinal disorders. Combining fibers with different physiological effects may be a promising therapeutic strategy.
Med j club mm covid20
- Coronaviruses typically cause common colds but SARS-CoV and MERS-CoV can cause pneumonia, respiratory failure, and death. A novel coronavirus, SARS-CoV-2, emerged in Wuhan, China in late 2019 and caused a global pandemic.
- SARS-CoV-2 spreads mainly through respiratory droplets when people cough, sneeze or talk within 6 feet of each other. Asymptomatic and pre-symptomatic people are highly infectious.
- COVID-19 symptoms range from mild to critical illness. The elderly and those with pre-existing conditions are at higher risk for severe disease. Diagnosis involves PCR testing of respiratory samples.
GIT J Club IBD- sexual dysfunction20.
- Sexual dysfunction and infertility are more prevalent in men with IBD compared to the general population.
- Depression is the most consistent negative predictive factor of sexual function among men with IBD.
- Sulfasalazine can reversibly reduce male fertility, so it is recommended to discontinue 3-4 months prior to conception. Most other IBD medications do not significantly impact fertility.
- Men with IBD have an increased risk of prostate cancer and prostate cancer screening guidelines for higher risk patients should be followed.
GIT J Club IBD- pregnancy2020
The document summarizes a consensus clinical care pathway for women with inflammatory bowel disease (IBD) who are considering pregnancy or are pregnant. The pathway was created by an expert multidisciplinary team representing multiple societies to provide standardized, evidence-based recommendations for gastroenterology and obstetric providers to ensure healthy pregnancies for women with IBD. It addresses the lack of consistent advice available previously by compiling available data on therapeutic options for IBD that have increased over the last 15 years and putting them into an easily accessible format for clinical practice.
Med 5th geriatrics20
This document provides an overview of geriatrics and common issues in caring for elderly patients. It discusses how biological age is more important than chronological age in clinical decision making. Frailty and disability are also addressed. Common geriatric problems like falls, delirium, incontinence and adverse drug reactions are examined in terms of presentation, evaluation, and management strategies. The importance of a comprehensive assessment, considering multiple comorbidities and functional status, is emphasized in developing treatment plans for elderly patients.
GIT 4th abd wall pain
Here are the answers to the CME questions:
1. b
2. e
3. a
4. b
5. d
6. b
7. Inguinal hernias
8. E
GIT 4th endoscopy indications20
Upper and lower GI endoscopies have diagnostic, therapeutic, and screening indications. For upper endoscopy, common diagnostic indications include dyspepsia in patients over age 60 or with red flags, upper GI bleeding, and dysphagia. Therapeutic uses include treatment of bleeding, removal of foreign bodies, dilation of strictures, and stenting. Screening is done for portal hypertension, Barrett's esophagus, eosinophilic esophagitis, and cancers. Lower endoscopy indications involve diagnostic evaluation of bleeding, abdominal pain, diarrhea, and screening of average-risk adults over 50 and high-risk groups. Therapeutic colonoscopy is used for polypectomy, bleeding treatment, and stricture dilation
GIT J Club from UEG Week 2018.
Dr. Hiwa Abubakir and Dr. Mohamed Alshekhani discuss the management of nonvariceal gastrointestinal bleeding. They recommend endoscopy within 24 hours, or earlier for high-risk patients, to identify and treat the bleeding source. A variety of endoscopic tools can be used for hemostasis, including injection of adrenaline combined with clips, bands, electrocautery, or laser coagulation. Newer tools like over-the-scope clips are best for high-risk or recurrent bleeders. Doppler probes help ensure complete vessel occlusion. Additional prothrombotic agents or interventions may be needed in some cases.
Med j club dm antithrombosis19
The document discusses antithrombotic strategies for patients with diabetes who are at risk of cardiovascular events. It proposes strategies for primary prevention, stable coronary artery disease, acute coronary syndromes, ischemic stroke, peripheral artery disease, atrial fibrillation, and venous thromboembolism. More aggressive antithrombotic therapies are associated with greater reduction in recurrent cardiovascular events for patients with diabetes. However, these strategies must be weighed against the risk of bleeding. Further clinical trials are still needed to better understand optimal antithrombotic treatment for cardiovascular patients with diabetes.
Git 4th GC18.
1) Gastric carcinoma is the third leading cause of cancer death worldwide, with highest incidence in East Asia and parts of South America.
2) Risk factors include H. pylori infection, smoking, diet high in salted/preserved foods, and family history of gastric cancer.
3) Early detection through endoscopy in dyspeptic patients over 50 years old or with red flags can improve outcomes, as resection allows for potential cure in early gastric cancer confined to mucosa or submucosa.
GIT J Club IBS NEJM17.
This document summarizes guidelines for the diagnosis and management of irritable bowel syndrome (IBS). It defines IBS and its subtypes based on the Rome IV criteria. It recommends diagnosing IBS based on symptoms in the absence of alarm features or abnormal test results. Limited testing like fecal calprotectin can help distinguish IBS from inflammatory bowel disease. Treatment involves dietary changes, probiotics, antispasmodics, antidepressants, and targeted therapies depending on IBS subtype and predominant symptoms. For refractory cases, a multidisciplinary approach including psychological support may help manage persistent symptoms.
GIT 4th indication for upper GI endoscopy.
Upper gastrointestinal endoscopy has diagnostic, therapeutic, and screening indications. Diagnostically, it is used to detect diseases causing dyspepsia like gastric cancer, investigate upper GI bleeding, diagnose dysphagia, remove foreign bodies, assess GERD, detect esophageal varices, and diagnose celiac disease. Therapeutically, it treats upper GI bleeding, removes foreign bodies, dilates strictures, treats achalasia, places stents, treats GERD, eradicates Barrett's esophagus, inserts feeding tubes, and performs bariatric procedures. Screening indications include detecting Barrett's esophagus, portal hypertension, and cancers of the esophagus and stomach in high-risk patients
GIT Cholestatic AI HBD 17
The document discusses various autoimmune and cholestatic liver diseases including primary biliary cholangitis, primary sclerosing cholangitis, and intrahepatic cholestasis of pregnancy. It provides details on the epidemiology, clinical features, diagnosis, and management of these conditions. It also includes several multiple choice questions to test understanding of topics covered in the document.
GiIT 4th CRC 2017.
- Screening and surveillance are recommended for CRC starting at age 50 to detect and remove precancerous polyps through colonoscopy.
Git j club colonoscopy mistakes.
1. The document outlines 19 potential mistakes that can occur during colonoscopy procedures. These include doing colonoscopies without proper indications or patient evaluation, failing to adequately prepare the colon, misdiagnosing conditions like ulcerative colitis or hemorrhoids, not performing important parts of the exam like ileal intubation or biopsies, and not adhering to quality standards. Addressing these issues can help improve safety, accuracy of diagnoses, and overall quality of colonoscopy.
GIT 4th ibd 2017
This document provides an overview of inflammatory bowel disease (IBD), including ulcerative colitis and Crohn's disease. It discusses risk factors, clinical manifestations, diagnostic testing, and treatment approaches. The main points are:
- IBD is characterized by idiopathic inflammation of the gastrointestinal tract. The two main types are ulcerative colitis and Crohn's disease.
- Genetic and environmental factors contribute to risk. Smoking increases risk for Crohn's but decreases risk for ulcerative colitis.
- Symptoms vary based on disease location but may include abdominal pain, diarrhea, bleeding, weight loss, and nutritional deficiencies. Extraintestinal manifestations are more common with Crohn's.
GIT 4th IBS 2017
This document provides information on irritable bowel syndrome (IBS), including its definition, diagnostic criteria, subtypes, differential diagnosis, evaluation, and management approaches. Some key points:
- IBS is a common functional gastrointestinal disorder characterized by abdominal pain and altered bowel habits. It affects 10-15% of the population.
- Diagnosis is based on fulfilling the Rome symptom criteria, with subtyping based on predominant stool pattern. Additional testing is usually not needed in absence of alarm features.
- Treatment involves reassurance, dietary modifications, antispasmodics, laxatives/antidiarrheals based on subtype, and tricyclic antidepressants/SSRIs for refractory cases.
Ppi seminar hiwa.
This document discusses the classical and long-term indications for PPI use, including GERD, Barrett's esophagus, use with NSAIDs, use with anti-platelets, and non-ulcer dyspepsia. For GERD, guidelines recommend daily PPI for erosive esophagitis but intermittent PPI courses may be sufficient for many patients. For Barrett's esophagus, the absolute cancer risk reduction with daily PPI is low. For NSAID and anti-platelet users at high risk of bleeding, the benefits of daily PPI are well documented. Intermittent PPI courses are often sufficient for non-ulcer dyspepsia, though some patients may require long-
Ppi symposium araz.
This document discusses potential long-term side effects of PPI use including increased risk of dementia, chronic kidney disease, and fractures. It notes that the evidence for associations between PPI use and these conditions is not conclusive. The document advises using the lowest effective dose of PPIs for indicated conditions and avoiding long-term daily use when possible. It also stresses the importance of only prescribing PPIs for appropriate indications and discontinuing them when no clear benefit exists.
Ppi symposium muhsin
The document summarizes short-term side effects of PPIs (proton pump inhibitors), which are generally well tolerated. The most common side effects are headache, diarrhea, abdominal pain and nausea. Diarrhea appears to be related to acid suppression and the overall incidence is less than 5%, though it may be dosage and age related. PPIs are considered safe for short-term use and have similar safety profiles to H2 blockers. PPIs should be used cautiously in patients with liver disease.
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Git Gib Variceal
- 1. Prepared by: Dr. Mohammad Shaikhani MBChB/CABM/FRCP
- 3. Small varices Large varices No varices 7-8%/year 7-8%/year Varices Increase in Diameter Progressively Merli et al. J Hepatol 2003;38:266 VARICES INCREASE IN DIAMETER PROGRESSIVELY
- 7. Capsule Endoscopy for Screening for Varcies Grade 3 Varices Grade 1 Varices