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This document presents five GI-focused case discussions with key diagnostic and management principles:

1. <strong>Upper GI bleeding:</strong> A 58-year-old man with hematemesis, melena, hypotension, and tachycardia should receive immediate resuscitation with <strong>2 large-bore IVs, IV fluids, and IV proton pump inhibitor therapy</strong>. The most common cause of upper GI bleeding in the U.S. is <strong>peptic ulcer disease</strong>, most often related to <strong>NSAIDs or H. pylori</strong>. <strong>EGD</strong> is the best initial diagnostic and therapeutic test. Bleeding ulcers can be treated endoscopically with <strong>epinephrine injection, clipping, or cautery</strong>.

2. <strong>Acute pancreatitis:</strong> A 54-year-old woman with severe epigastric pain radiating to the back was found to have <strong>acute pancreatitis</strong>, diagnosed by symptoms plus elevated lipase. The most common U.S. causes are <strong>gallstones and alcohol</strong>, but in this case <strong>hypertriglyceridemia</strong> was identified. Evaluation should include <strong>liver tests, pancreatic enzymes, CBC</strong>, and if needed triglycerides and calcium. Treatment includes aggressive hydration and lowering triglycerides, with <strong>fenofibrate</strong> being the most effective listed medication.

3. <strong>Colon polyp management:</strong> For a large sessile or flat cecal polyp, <strong>endoscopic mucosal resection (EMR)</strong> is appropriate. A <strong>dye-based injection</strong> is used to lift and better define the lesion before resection, reducing risk of deep thermal injury.

4. <strong>Pancreatic cancer and biliary obstruction:</strong> A pancreatic head mass with a double-duct sign should be evaluated with <strong>endoscopic ultrasound (EUS)</strong> for tissue diagnosis. If biliary obstruction develops, <strong>ERCP</strong> is used for drainage and stent placement. <strong>Metal stents</strong> are preferred for palliation because they last longer than plastic stents.

5. <strong>Crohn’s ileitis and biologic therapy:</strong> A patient with refractory ileal Crohn’s improved on <strong>adalimumab</strong> after failing standard therapy. <strong>Cyclosporine is not typically used</strong> for mild-moderate Crohn’s ileitis. Before biologic therapy, screening should include <strong>TB testing, chest X-ray, and hepatitis B serology</strong>.

Meta Tag

Concept Upper Gastrointestinal Bleeding

Concept Intravenous Access

Concept Fluid Resuscitation

Concept Peptic Ulcer Disease

Concept Endoscopy

Concept Acute Pancreatitis

Concept Crohn Disease

Keywords

upper GI bleeding

peptic ulcer disease

acute pancreatitis

hypertriglyceridemia

endoscopic mucosal resection

pancreatic cancer

endoscopic ultrasound

ERCP

Crohn's ileitis

adalimumab

Upper Gastrointestinal Bleeding

Intravenous Access

Fluid Resuscitation

Peptic Ulcer Disease

Endoscopy

Acute Pancreatitis

Crohn Disease