Complications and Management

Question 1

Diverticulitis Complications/Severe Signs

Answer 1

Bleeding from the diverticula
Perforation of the pouch
Abscess and Peritonitis

Question 2

Diverticulitis Mx

Answer 2

Investigation
- FBE, ESR, CRP, UEC
- Imaging – CT Scan**

Uncomplicated - Analgesics and Antibiotic (Co-amoxiclav), Soft and Low fiber diet

Severe Diverticulitis – Hospital and IV antibiotics

Colonoscopy – 6-8 weeks after to r/o Mass

Question 3

Pelvic Inflammatory Disease Mx

Answer 3

Investigations
- Discharge Swab (Chlamydia, Gonorrhea)
- STI Screening
- FBE, ESR, CRP

Non-severe - 3 Antibiotics
- Ceftriaxone
- Doxycycline
- Metronidazole

Severe - Refer to ED for IV antibiotics

Question 4

Acute Pancreatitis Mx

Answer 4

Investigations
- Lipase and Amylase**
- LFT
- Lipid profile (TG) and Ca levels
- FBE, ESR, CRP, UEC
- Imaging – USD for Gallstones
- Maybe CT Scan

Question 5

General Management to Mets in the Abdo

Answer 5

Investigations
- Endoscopy and Colonoscopy
- PET Scan/ Bone Scan
- FBE
- Tumor Maker - CEA

Management
- Chemotherapy
- Symptom Control - Pain and N/V
- MDT
- Advance Care Directive
- Family Meeting

Question 6

Hypercalcemia Investigations

Answer 6

PTH
Albumin and LFT
Phosphate and Calcium levels
UEC and eGFR
Vit D levels
FBC
CXR

Question 7

Hemorrhoid Management

Answer 7

Investigation
- Colonoscopy – to r/o CA
- FBE, Iron

Management - Depends grading

Low Grades – Conservative Management
- Fix Diet and constipation
- More Fluid
- More fiber
- Avoid Constipation
- Exercise and Lose Weight

High Grade – Surgical Management
- Rubber band ligation
- Sclerotherapy

Question 8

Kidney Stones Mx

Answer 8

Investigation - CT Scan, UEC, Urinalysis
<5mm - Conservative
- Pain - NSAIDS or Opioids
- Vomiting - Ondansetron
- Tamsulosin
- Strain while peeing, try catch
- Monitor Red flag
- F/u 24-48 hrs

> 5mm
- Refer Urologist
- ESWL - Shock wave therapy
- Percutaneous Nephrolithotomy - Surgery

Longterm Mx
- Good Hydration, Less Salt
- Stone Analysis
- Serum Ca, BUA, PTH, Urinary CA, Oxyalate and Citrate

Question 9

Pseudomembranous Colitis Mx

Answer 9

Stop Antibiotic
Investigation
- Stool Sample - C. Diff Toxin
- Stool MCS
- FBE, ESR, CRP
- IBD - Fecal Calprotectin
- Celiac Disease - Anti-TTG, Anti Gliadin Ab.
- Thyroid - TSH
- HIV Serology

Stop Ab
If confirmed - Metronidazole
Good Hydration
Red Flags
Review

Question 10

GORD Treatment

Answer 10

Meds - PPI, Omeprazole
Dietary Change - Avoid Caffeine, Spicy, fatty food
Alcohol, Smoking - Stop
NSAID - Change Meds
Weight Loss and Exercise
Small but frequent feeding, Don’t immediately lie down, eat slowly
Endoscopy every 2 years
Reading Materials, Red flags