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Case Discussion

Pdf Summary

Case 1 discusses a 58-year-old male who is experiencing vomiting blood and black stools. The important next steps in his management include placing two large bore IVs, beginning IV fluids, and starting IV proton pump inhibitors to increase gastric pH. The most common cause of upper GI bleeding in the US is peptic ulcer disease, with NSAIDs and H. pylori infection being the main culprits. The best initial test for evaluating and treating upper GI bleeding is an EGD. If an actively bleeding ulcer is found during an EGD, treatment options include injecting epinephrine, placing a clip, and cauterizing the bleeding vessel. NSAIDs and aspirin are most likely the medications that caused the ulcer. <br /><br />Case 2 presents a 54-year-old woman with severe epigastric pain, nausea, and vomiting. She has a history of diabetes, hypertension, and hypothyroidism. The next best step in her evaluation is a right upper quadrant ultrasound. She is diagnosed with acute pancreatitis, with the most common causes in the US being gallstones and alcohol. Elevated triglyceride and calcium levels should be checked to look for other possible etiologies. Treatment goals for this patient include lowering her triglyceride levels and improving her hemoglobin and BUN. Fenofibrate is the medication that would lower triglycerides the most.<br /><br />Case 3 involves a 67-year-old female with a large polyp in the cecum of the colon. The recommended procedure is endoscopic resection, which can be done using an injection of dye-based solution to lift the lesion and provide better visualization. Case 4 discusses a 54-year-old man with a mass in the head of the pancreas causing blockage of the bile duct. An EUS is recommended to obtain a tissue diagnosis of the mass. ERCP is needed to relieve the biliary obstruction, and a metal stent should be placed. Finally, Case 5 describes a 29-year-old female with Crohn's ileitis. Adalimumab is used for her treatment, and the initial management for mild-moderate Crohn's ileitis typically does not involve cyclosporine. Chest X-ray is not typically done prior to starting biologic therapy in IBD.

Keywords

upper GI bleeding

peptic ulcer disease

EGD

actively bleeding ulcer

acute pancreatitis

gallstones

triglyceride levels

Fenofibrate

endoscopic resection

Crohn's ileitis