Clostridiodes difficile is a pretty big problem, causing quite a bit of morbidity and mortality every year, and it’s becoming more and more common. It can be pretty tricky to treat. C. diff is an anaerobic, spore-forming rod and it makes a toxin that contributes to the severity of the disease. It causes diarrhea and […]
Gastrointestinal
Gout
Caused by uric acid over-production or underexcretion Factors: DKA, myeloproliferative and lymphoproliferative disease, acute EtOH, hypothyroidism, acromegaly, hypo or hyperparathyroidism, chronic hemolytic anemia, obesity Medications: Decrease uric acid filtration: diuretics (thiazide and loop diuretics), nicotinic acid (Niaspan), salicylates (ASA), alcohol (EtOH), levodopa/carbidopa, ethambutol, pyrazinamide, ticagrelor Acute treatment: Colchicine, NSAIDs, corticosteroids (if NSAIDS contraindicated) Chronic treatment: Allopurinol or […]
Inflammatory Bowel Disease
Ulcerative Colitis: Rectum and colonic mucosa involvement, no small intestine involvement, no skip lesions Blood diarrhea, spasm of anal sphincter (Tenesmus), weight loss, fever Staging: Mild < 4 stools a day, no symptoms Mod > 4 stools a day, minimal symptoms Severe > 6 stools a day, temp > 99.5 F, HR > 90, ESR […]
GERD, PUD, Stress Ulcer Prophylaxis
GERD (gastroesophageal reflux disease) Only screen for H. pylori in the case of PUD, history of documented peptic ulcer disease or gastric mucosa-associated lymphoma. No endoscopy needed unless there are alarm symptoms. Lifestyle Modifications: Avoid alcohol, caffeine, chocolate, citrus, garlic, onions and mint Reduce fat Avoid eating 2-3 hours before bedtime Remain upright for 2 hours after […]
Helicobacter Pylori Treatment
PPI Triple Treatment: 3 drugs, 10-14 days PPI BID + clarithromycin 500 mg BID and amoxicillin 1000 mg BID or metronidazole 500 mg BID Bismuth-based treatment: 4 drugs, 14 days PPI BID+ metronidazole 250 mg TID and tetracycline 500 mg four times a day and bismuth 2 tabs four times a day Salvage Therapy: levofloxacin-based treatment for 10 […]
Liver Disease
Child-Pugh Scores for Cirrhosis Variable 1 Point 2 Points 2 Points encephalopathy absent mild-moderate severe to coma ascites absent slight moderate bilirubin <2 2-3 >3 albumin >3.5 2.8-3.5 <2.8 prothrombin time 1-4 4-6 >6 Class A = 5 points, class B=7-9 points, class C=10 or more points Ascites: Reduce dietary sodium, restrict fluid to 1.5 […]
Hepatitis
Hepatitis A – viral – spread person to person via feces. Pre-exposure prophylaxis Vaccines are available. Children are routinely vaccinated between their first and second birthdays. People who should consider vaccine – are traveling to countries where hepatitis A is common, are a man who has sex with other men use illegal drugs, have a […]
Spontaneous Bacterial Peritonitis
What Causes SBP Gram-Negative Bacteria (50%) E.coli (37%) Klebsiella other Gram-Positive Bacteria (50%) Strep pneumonia (10%) Other Strep Staphylococcus aureus Treatment of SBP SPB has a high mortality rate. Start treatment immediately. If ascitic fluid polymorphonuclear cell count is less than 250, start antibiotics. Poor prognosis if bilirubin < 8, albumin < 2.5 or creatinine > 2.1 Antibiotic […]
Pancreatitis and Irritable Bowel Syndrome
Pancreatitis: The early stage has a systemic inflammatory response (SIRS) or organ damage. Late associated with local complications. Signs: Abdominal pain, nausea and vomiting, jaundice, fever Local complications: necrosis, hemorrhage, pseudocyst, abscess, infection Systemic complications: SIRs, acute respiratory distress, shock, organ failure Causes: Alcohol, gallstones, drugs (azathioprine, adenosine, diuretics, estrogens, exenatide, mesalamine, pentamidine, sitagliptin, tetracycline, […]