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Management of Acute Upper GI Bleed
With a mortality rate of 2-10%, upper gastrointestinal bleeding (UIB) is a frequent medical emergency. Patients who have been determined to have a very low risk of dying or needing an intervention can be treated as outpatients. Red cell transfusion at a hemoglobin level of 70–80 g/L and intravenous fluids as needed for resuscitation are advised for all other patients. Proton pump inhibitors (PPIs) and the prokinetic drug erythromycin may be delivered when resuscitation is started, with antibiotics and vasoactive medications advised in patients with cirrhosis. Endoscopy should be performed within 24 hours, with early endoscopy being explored in high-risk patients, such as those with hemodynamic instability, following resuscitation.
About the Speaker
Dr. PRITHVI PRIYADARSHINI SHIVALINGAIAH
MBBS,MD,DNB DM, Gastroenterology in CMC Hospital Dubai
Approach to Infants with GERD-like Symptoms
Begin by obtaining a detailed history, focusing on feeding patterns, regurgitation frequency, and associated symptoms such as irritability and poor weight gain. Conduct a thorough physical examination to identify signs of distress, such as arching of the back, fussiness during or after feeds, and respiratory symptoms. Rule out other causes of similar symptoms, including infections, metabolic disorders, and structural abnormalities. Evaluate the infant's feeding technique, assess for possible overfeeding or intolerance to certain formulas, and consider breastfeeding practices. Implement non-pharmacological interventions, such as feeding position adjustments, smaller and more frequent feeds, and thickening of feeds with rice cereal. If conservative measures prove ineffective, consider acid-suppressing medications under the guidance of a pediatric gastroenterologist, taking into account potential risks and benefits.
Case Discussion on Management of Ulcerative Colitis
Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) characterized by inflammation and ulceration of the colon and rectum. Ulcerative colitis is one of the two main types of inflammatory bowel diseases, the other being Crohn's disease. Common symptoms include abdominal pain, diarrhea, rectal bleeding, and an urgent need to have a bowel movement. It is a lifelong condition with periods of flare-ups and remission, making long-term management crucial. Unlike Crohn's disease, UC primarily affects the colon and rectum, often starting in the rectum and spreading upwards. The severity of UC can vary, ranging from mild with occasional symptoms to severe and debilitating. The exact cause of UC is unknown, but it's believed to result from a combination of genetic, environmental, and immune system factors. Diagnosis involves a combination of medical history, physical examination, colonoscopy, and imaging studies to visualize the colon. Treatment aims to reduce inflammation and manage symptoms. Medications, dietary changes, and in severe cases, surgery may be necessary.
Gastroesophageal Reflux Disease: Case Discussion
Gastroesophageal reflux disease (GERD) is a digestive disorder that occurs when stomach acid flows back into the esophagus, causing heartburn and other symptoms. GERD can cause damage to the esophagus, pharynx, or respiratory tract if left untreated. Symptoms of GERD include heartburn, regurgitation of sour or bitter liquid, difficulty swallowing, and chest pain. A diagnosis of GERD starts with a physical examination and a description of symptoms and medical history. Treatment for GERD includes lifestyle changes such as losing weight, avoiding alcohol and tobacco, and avoiding large meals before bedtime. Medications such as antacids, H2 blockers, and proton pump inhibitors can also help relieve symptoms. In severe cases, surgery may be necessary.