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11_Case Based Discussions

Pdf Summary

The document provides detailed case presentations and discussions focused on various medical conditions, primarily gastrointestinal (GI) issues. Here is a summary of the cases presented:<br /><br />**Case 1:** A 58-year-old male presents with upper GI bleeding, characterized by vomiting red blood and black stools. Key points for management include stabilizing the patient with IV access and fluids, administering proton pump inhibitors, and identifying the source of bleeding (most commonly peptic ulcer disease due to NSAIDs or Helicobacter pylori in the US). Endoscopy (EGD) is recommended for evaluation and treatment of GI bleeding, with treatment options being epinephrine injection, placing hemostatic clips, or cautery.<br /><br />**Case 2:** A 54-year-old woman has severe epigastric pain. With a background of cholecystectomy (gallbladder removal), differential diagnoses ruled out gallbladder-related issues. Elevated lipase levels confirmed acute pancreatitis, most commonly caused by gallstones and alcohol. Treatment involves hydration and lowering triglyceride levels using medications like fenofibrate.<br /><br />**Case 3:** A 67-year-old woman with a large cecal polyp is considered for endoscopic removal instead of surgery. Techniques discussed include injecting a dye to facilitate endoscopic mucosal resection (EMR), highlighting the procedure's precision and safety.<br /><br />**Case 4:** A 54-year-old man with a pancreatic mass causing bile duct obstruction presents with jaundice. An endoscopic ultrasound (EUS) is recommended for biopsy, and an ERCP for biliary stenting is used to relieve obstruction. Metal stents are preferred for long-term palliative management.<br /><br />**Case 5:** A 29-year-old female with Crohn’s Ileitis resistant to standard treatments undergoes successful treatment with the biologic, Adalimumab. Prior to introducing biologic therapy, specific precautions such as TB and hepatitis B screening are recommended.<br /><br />Each case underscores critical diagnostic and management steps for complex medical presentations, emphasizing systematic evaluation, stabilization, and evidence-based treatment strategies.

Keywords

gastrointestinal

GI bleeding

pancreatitis

cecal polyp

pancreatic mass

Crohn's Ileitis

endoscopy

biologic therapy

biliary stenting

diagnostic management