GI brief Flashcards

1
Q

Describe the first step in the management of a patient with hematemesis.

A

Establish an IV line and administer normal saline.

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2
Q

If pt needs blood: hametestmessis

A

packed RBCs.

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3
Q

What is the investigation of choice for hematemesis?

A

Upper GI endoscopy.

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4
Q

What is the diagnosis for an infant with persistent non-bilious vomiting starting at 2-6 weeks, marked dehydration, and weight loss?

A

Congenital hypertrophic pyloric stenosis (CHPS).

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5
Q

Inv of choice of CHPS:

A

US.

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6
Q

What is the treatment of CHPS?

A

First correct dehydration and electrolyte imbalance, then consider surgery.

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7
Q
  • Vomiting at 2-6 Ws+ marked dehydration, bad general condition:
A

CHPS.

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8
Q
  • Vomiting at 2-6 Ws+ NO dehydration, good general condition:
A

GERD.

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9
Q

Describe the presentation of a patient with acquired pyloric stenosis.

A

Long-standing history of peptic ulcer disease, recurrent vomiting occurring 1 hour after a meal, and a succussion splash on physical exam.

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10
Q

What is the first most common cause of peptic ulcer disease (PUD)?

A

H. pylori infection.

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11
Q

What is the second most common cause of PUD?

A

Smoking (other causes include stress, alcohol, NSAIDs).

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12
Q

Inv of choice of PUD:

A

upper GI endoscopy (biopsy only from gastric cancer).

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13
Q

What is the regimen for eradicating H. pylori?

A

Amoxicillin, clarithromycin, proton pump inhibitor (PPI).

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14
Q

Why is metronidazole removed from the regimen for H. pylori eradication?

A

Due to bacterial resistance.

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15
Q

What is the follow-up test after treatment for H. pylori infection?

A

Urea breath test.

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16
Q

What is the best advice for a patient with PUD?

A

Stop smoking.

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17
Q

TTT of Pt with PUD develops hematemesis:

A

1st step: IV line& normal saline. If need blood: packed RBCs.

Then: endoscopy& injection of adrenaline or heat probe if visible bleeding.

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18
Q

Describe the first step in the treatment of a patient with PUD who develops hematemesis.

A

Establish an IV line, administer normal saline, and consider packed red blood cells if needed. Then proceed to endoscopy and consider injection of adrenaline or heat probe if visible bleeding.

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19
Q

Pt with PUD develops severe abdominal pain referred to back:

A

perforation.

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20
Q

What is the first step investigation in suspected perforation in a patient with PUD?

A

Perform an erect x-ray to check for air under the diaphragm.

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21
Q

TTT of perforation:

A

resuscitation 1st & then surgery.

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22
Q

What are the symptoms of early dumping syndrome?

A

Nausea, abdominal pain, fullness, diarrhea, and flushing within 1 hour after a meal. mainly due to hypovelemia

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23
Q

What are the symptoms of late dumping syndrome?

A

Symptoms occurring 1-3 hours after eating, mainly due to hypoglycemia.

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24
Q

What is the treatment for dumping syndrome?

A

Diet modification, including light frequent meals with decreased carbohydrate content.

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25
Q

Describe the treatment of choice for morbid obesity with a BMI over 35.

A

Surgery, specifically gastric band ligation.

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26
Q

What is the diagnosis when a patient with a history of gastric band ligation presents with severe vomiting?

A

Band slip.

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27
Q

What is the preferred investigation for band slip after gastric band ligation?

A

Barium meal.

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28
Q

How is band slip typically treated?

A

Surgery.

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29
Q

Define the prophylaxis for bleeding of esophageal varices.

A

Beta-blockers (BBs).

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30
Q

What is the treatment for ruptured esophageal varices, similar to upper GI bleeding, along with Fresh Frozen Plasma (FFP)?

A

Same as upper GI bleeding + FFP.

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31
Q

Describe the likely condition when an exam shows peri-anal swelling in a patient with bleeding per rectum and the bleeding is painless.

A

Piles.

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32
Q

What is the probable diagnosis when an exam reveals peri-anal swelling in a patient with painful bleeding per rectum?

A

Peri-anal hematoma.

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33
Q

Old pt with bleeding per rectum DT piles:

A

colonoscopy is a MUST.

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34
Q

How should recurrent pilo-nidal sinus be managed effectively?

A

Radical excision.

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35
Q

Define the most common cause of peri-anal fistula.

A

Anal abscess.

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36
Q

What is the most common cause of recurrent peri-anal fistula?

A

Crohn’s disease.

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37
Q

MCC of multiple anal fissures:

A

chrone’s disease.

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38
Q

Describe the most important examination for a patient with an anal fissure.

A

Just inspection (No digital rectal examination).

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39
Q

What is the primary treatment for an anal fissure?

A

Local glyceryl trinitrate cream.

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40
Q

How should an anal fissure in Crohn’s disease be managed?

A

Infliximab.

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41
Q

What is the most likely cause when a mother reports finding blood in her infant’s diaper?

A

Anal fissure.

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42
Q

Describe the most common causes of bleeding per rectum overall.

A

Piles and fissure.

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43
Q

What is the most common cause of bleeding per rectum in infants?

A

Anal fissure.

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44
Q

MCC in adult: bleeding per rectum

A

upper GIT bleeding (peptic ulcer).

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45
Q

Another MCC in adult:bleeding

A

MCC in adult: diverticulosis (cancer must be excluded).

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46
Q

BPR in pt with AF:

A

ischemic colitis.

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47
Q

1st episode of BPR in old pt: investigation.

A

colonoscopy is a MUST

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48
Q

How should bleeding per rectum be managed initially?

A

IV line and normal saline; administer packed RBCs if needed.

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49
Q

What is the next step if upper GI endoscopy and colonoscopy fail to reveal the site of bleeding?

A

Capsule endoscopy.

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50
Q

Define the most common hernia to complicate.

A

femoral

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51
Q

What is a significant sign indicating a complication of a hernia?

A

No impulse on cough.

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52
Q

Describe the diagnosis when a patient with a hernia develops vomiting, absolute constipation, and abdominal distension.

A

Intestinal obstruction.

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53
Q

What is the initial step in suspected intestinal obstruction?

A

Abdominal x-ray followed by surgery

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54
Q

What condition is likely when abdominal swelling is observed below the scar of a previous surgery?

A

Incisional hernia.

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55
Q

MC PF of incisional:

A

hematoma.

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56
Q

Examination of incisional hernia:

A

ask pt to stand and cough.

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57
Q

Describe the management of an infant with an irreducible inguinal hernia.

A

Surgery as soon as possible.

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58
Q
  1. If obstruction or strangulation:
A

immediate surgery.

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59
Q

What is the ‘rule of 6-2’ in the treatment of reducible inguinal hernias in infants?

A

Birth to 6 weeks: surgery in 2 days. 6 weeks to 6 months: in 2 weeks. More than 6 months: in 2 months.

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60
Q

Umbilical hernia in pediatric:

A

observe if< 4 ys & surgery if > 4 ys.

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61
Q

How is a patient with divarication of recti diagnosed?

A

Rising up without support.

62
Q

What is the recommended treatment for divarication of recti?

A

Physiotherapy.

63
Q

What is the most important step in the treatment of a child who ingests a corrosive substance?

A

Endoscopy within 24 hours.

64
Q

Long term TTT of corrosive injury:

A

dilators.

65
Q

Describe the first-line investigation for achalasia.

A

Barium study.

66
Q

What is the preferred investigation for achalasia?

A

Manometry.

67
Q

How is achalasia typically treated?

A

Surgery with ‘Heller myotomy’.

68
Q

What is the treatment of choice for achalasia in elderly patients who are not fit for surgery?

A

Dilators.

69
Q

What is the diagnosis for a young female experiencing attacks of dysphagia and chest pain?

A

Diffuse esophageal spasm.

70
Q

What is the characteristic appearance of esophageal spasm on a barium study?

A

Corkscrew appearance.

71
Q

What is the treatment for esophageal spasm?

A

Nitroglycerine, Calcium Channel Blockers.

72
Q

Describe the diagnosis for a patient with dysphagia, heartburn, and food impaction, with a history of atopic or autoimmune diseases.

A

Eosinophilic esophagitis.

73
Q

What is the preferred investigation for eosinophilic esophagitis?

A

Upper GI endoscopy.

74
Q

What is the first-line medical treatment for eosinophilic esophagitis?

A

Diet modification. PPI is the first-line medical treatment.

75
Q

What is the diagnosis for a patient presenting with heartburn, regurgitation, and retrosternal discomfort?

A

GERD (Gastroesophageal Reflux Disease).

76
Q

Describe the best investigation for GERD.

A

24-hour pH monitoring.

77
Q

What is the mainstay treatment for GERD?

A

Conservative
Proton pump inhibitors are the drugs of first choice, given initially once in the morning at standard dose (omeprazole 20 mg, pantoprazole 40 mg, lansoprazole 30 mg, rabepra- zole 20 mg).
https://www.racgp.org.au › …PDF
Gastro-oesophageal reflux disease - RACGP

78
Q

What is the first-line medical treatment for GERD?

A

PPI (Proton Pump Inhibitors).

79
Q

What is the investigation of choice for severe cases of GERD?

A

Upper GI endoscopy.

80
Q

Describe the diagnosis for a patient with intermittent dysphagia, postprandial pain, and palpitations.

A

Hiatal Hernia (para-esophageal hernia).

81
Q

What is the preferred investigation for hiatal hernia?

A

Barium study.

82
Q

What is the treatment of choice for hiatal hernia?

A

Surgery.

83
Q

What is the diagnosis for a patient with prolonged GERD who develops dysphagia and experiences relief of heartburn?

A

Esophageal stricture.

84
Q

Describe the investigation of choice for esophageal stricture.

A

Upper GI endoscopy.

85
Q

What condition is a patient with long-standing GERD at risk of developing?

A

Barrett’s esophagus (precancerous; risk adenocarcinoma of the esophagus)

86
Q

What is the investigation of choice for adenocarcinoma of the esophagus?

A

Endoscopy

87
Q

If metaplasia is detected, what is the recommended procedure?

A

Biopsy

88
Q

What is the suggested action if low-grade dysplasia is found during endoscopy for esophageal adenocarcinoma?

A

Repeat the endoscopy every 6 months

6 months
If LGD persists, consider referral for endoscopic therapy; otherwise, repeat endoscopy every 6 months until clear of dysplasia

89
Q

What is the recommended treatment for high-grade dysplasia in esophageal adenocarcinoma?

A

Ablation or surgery

90
Q

What is the best treatment for esophageal adenocarcinoma?

A

PPI (Proton Pump Inhibitors) - very important

91
Q

Describe the typical patient presentation for esophageal cancer.

A

Old male smoker, alcoholic with recent dysphagia, weight loss

92
Q

What is the most common type of esophageal cancer?

A

Squamous cell carcinoma (SCC)

93
Q

What is the most important risk factor for adenocarcinoma of the esophagus?

A

Barrett’s esophagus

94
Q

Alcoholic vomit up blood after violent retchingor vomiting…

A

Dx: Mallory weiss $.

95
Q

What is the definitive diagnostic procedure for conditions like Mallory-Weiss tears?

A

Endoscopy

96
Q

What is the main treatment approach for Mallory-Weiss tears?

A

Conservative management; if bleeding persists: cauterization or epinephrine injection

97
Q

Describe the presentation of Boerhaave syndrome.

A

Alcoholic with severe chest pain, pleural effusion after violent retching or vomiting hypotension

98
Q

What is the main treatment for Boerhaave syndrome?

A

Emergent surgery

99
Q

At what age should screening for familial adenomatous polyposis (FAP) start with colonoscopy?

A

12 years old

100
Q

What is the fate of individuals with FAP?

A

100% develop cancer

101
Q

What is the main treatment approach for FAP once polyps start to appear?

A

Surgery

102
Q

What syndrome is characterized by FAP, epidermoid cysts, desmoid tumors, and osteomas?

A

Gardner’s syndrome

103
Q

What syndrome involves hamartomatous polyps of the colon, lip pigmentation?

A

Peutz-Jeghers syndrome

104
Q

What is the most common premalignant colonic adenoma?

A

Villous adenoma

105
Q

Which type of colonic adenoma is most likely to cause electrolyte disturbances?

A

Villous adenoma

106
Q

Which type of colonic polyp has the least malignant potential?

A

Tubular adenoma

107
Q

What are the most common symptoms of cancer in the cecum?

A

Anemia, pallor, and fatigue

108
Q

What are the most common symptoms of cancer in the rectum?

A

Bleeding per rectum

109
Q

What are the most common symptoms of cancer in the left colon?

A

Altered bowel habits

110
Q

What is the preferred investigation for colon cancer?

A

Colonoscopy

111
Q

What should be considered in an old male with iron deficiency anemia?

A

Colon cancer until proven otherwise

In an older male with iron deficiency anemia, several key considerations should be taken into account to identify the underlying cause:

  1. Gastrointestinal Bleeding:
    • Colorectal Cancer: This is a significant concern and should be ruled out through appropriate screening, including colonoscopy.
    • Gastric Ulcers: Upper GI endoscopy can help detect peptic ulcers or other sources of upper GI bleeding.
    • Diverticulosis: Common in older adults and can lead to chronic blood loss.
  2. Dietary Insufficiency:
    • Assess dietary intake to ensure that there is sufficient iron intake. This is less common but should still be considered.
  3. Malabsorption Syndromes:
    • Celiac Disease: Can lead to poor absorption of iron from the diet.
    • Atrophic Gastritis: Common in the elderly and can affect iron absorption.
  4. Chronic Diseases:
    • Chronic kidney disease, heart failure, or chronic inflammatory diseases can contribute to anemia of chronic disease, which may coexist with iron deficiency.
  5. Medications:
    • Non-steroidal anti-inflammatory drugs (NSAIDs) and anticoagulants can cause GI bleeding.
  1. History and Physical Examination:
    • Detailed history of GI symptoms, medication use, and dietary habits.
    • Physical examination focusing on signs of chronic disease or GI pathology.
  2. Laboratory Tests:
    • Complete blood count (CBC) with iron studies (serum iron, ferritin, total iron-binding capacity).
    • Stool occult blood test to check for hidden GI bleeding.
  3. Endoscopic Procedures:
    • Colonoscopy: To rule out colorectal cancer and other sources of lower GI bleeding.
    • Upper GI Endoscopy: To detect upper GI sources of bleeding.
  4. Other Imaging:
    • If endoscopy is inconclusive, consider imaging studies like CT enterography to evaluate the small intestine.

For more detailed information, refer to the RACGP guidelines and other authoritative sources such as:
- RACGP Clinical Guidelines: Iron Deficiency Anaemia
- UpToDate: Evaluation of Iron Deficiency in Adults

112
Q

What is the first step in the evaluation of a patient with suspected colon cancer?

A

FOBT (Fecal Occult Blood Test); if positive finding: colonoscopy

  1. Initial Assessment:
    • History: Detailed medical and family history.
    • Physical Examination: Includes a digital rectal exam.
  2. Screening Tests:
    • Fecal Occult Blood Test (FOBT).
    • Fecal Immunochemical Test (FIT).
  3. Diagnostic Procedures:
    • Colonoscopy: Gold standard for diagnosis.
    • Flexible Sigmoidoscopy: If colonoscopy is not available.
    • CT Colonography: Alternative if colonoscopy is not possible.
  4. Imaging Studies:
    • CT Scan: Abdomen and pelvis.
    • MRI: For local spread, especially in rectal cancer.
  5. Laboratory Tests:
    • Complete Blood Count (CBC).
    • Liver Function Tests.
    • Carcinoembryonic Antigen (CEA).
  6. Multidisciplinary Team Review:
    • Refer for further management and treatment planning.

For more details, refer to the RACGP guidelines.

113
Q

What is the initial step for high-risk patients in colon cancer screening?

A

Colonoscopy from the beginning

114
Q

What is the recommended treatment sequence for colon cancer patients?

A

Chemotherapy and radiotherapy pre-operatively, followed by chemotherapy post-operatively

115
Q

What is the follow-up protocol after surgery for colon cancer?

A

Colonoscopy every year and CEA (Carcinoembryonic Antigen)

116
Q

Old age with prolonged constipation develops painless bleeding per rectum

A

Diverticulosis.

117
Q

What is the most common site for diverticulosis?

A

Sigmoid colon

118
Q

What is the main treatment approach for diverticulosis?

A

Increase fiber diet

119
Q

Describe the presentation of a patient who develops fever and left lower quadrant pain. What is the likely diagnosis in this case?

A

Patient with diverticulosis presenting with fever and LLQ pain is likely diagnosed with acute diverticulitis.

120
Q

What is the imaging modality of choice for investigating acute diverticulitis?

A

CT scan is the imaging modality of choice for acute diverticulitis.

121
Q

What is the initial treatment approach for acute diverticulitis, focusing on intravenous fluids and antibiotics? What is the next step if perforation occurs?

A

Initial treatment for acute diverticulitis involves conservative management with IV fluids and antibiotics. Surgery is indicated in case of perforation.

122
Q

Define the most common cause of painless rectal bleeding in the elderly population.

A

Diverticulosis is the most common cause of painless rectal bleeding in the elderly.

123
Q

Describe the typical symptoms seen in a patient with chronic abdominal pain, distension, and alternating diarrhea and constipation.

A

Symptoms of IBS include chronic abdominal pain, distension, and alternating diarrhea and constipation.

124
Q

What is the recommended drug for treating IBS?

A

The drug of choice for treating IBS is an SSRI.

125
Q

What is the most common cause of bloody diarrhea?

A

Campylobacter is the most common cause of bloody diarrhea.

126
Q

What is the second most common cause of bloody diarrhea?

A

Shigella is the second most common cause of bloody diarrhea.

127
Q

How would you manage traveler’s diarrhea caused by E. coli?

A

Traveler’s diarrhea caused by E. coli is managed mainly with fluid replacement.

128
Q

Describe the most common cause of diarrhea in pediatric patients.

A

The most common cause of diarrhea in pediatrics is viral infections.

129
Q

What is the most common virus causing diarrhea in children?

A

Rotavirus is the most common virus causing diarrhea in kids.

130
Q

What neurological condition can present with diarrhea followed by weakness and areflexia?

A

Guillain-Barré Syndrome (GBS) can present with diarrhea followed by weakness and areflexia.

131
Q

What condition is characterized by diarrhea followed by renal impairment?

A

Hemolytic Uremic Syndrome (HUS) is characterized by diarrhea followed by renal impairment.

132
Q

Describe the presentation of a patient with bloody diarrhea followed by right upper quadrant pain. What is the likely causative agent?

A

Bloody diarrhea followed by RUQ pain is suggestive of amebic infection.

133
Q

What parasite is commonly associated with diarrhea after camping activities?

A

Giardia is commonly associated with diarrhea after camping.

134
Q

Describe the typical presentation of chronic bloody diarrhea in a young male. What condition is often implicated in this scenario?

A

Chronic bloody diarrhea in a young male is often associated with Irritable Bowel Syndrome (IBS).

135
Q

What is a common cause of diarrhea following prolonged antibiotic use?

A

Clostridium difficile infection is a common cause of diarrhea following prolonged antibiotic use.

136
Q

How would you treat Clostridium difficile infection?

A

Clostridium difficile infection is treated with metronidazole or vancomycin.

137
Q

What antibiotic is commonly associated with causing Clostridium difficile infection?

A

Clindamycin is commonly associated with causing Clostridium difficile infection.

138
Q

Diarrhea after eggs or chicken

A

salmonella

139
Q

Diarrhea just hours after meal…..

A

staph toxin

140
Q

Diarrhea in bed ridden with constipation…

A

fecal impaction

141
Q

Main ttt of diarrhea…..

A

fluid

142
Q

Describe the treatment approach for Staphylococcal toxin-induced diarrhea.

A

Staphylococcal toxin-induced diarrhea is primarily managed with fluid replacement.

143
Q

TTT of traveler diarrhea…..

A

fluid only

144
Q

What is the treatment of choice for Shigella or Campylobacter infections?

A

Antibiotics are the treatment of choice for Shigella or Campylobacter infections. Ciproflaxin

145
Q

How would you manage diarrhea caused by Entamoeba histolytica or Giardia lamblia?

A

Diarrhea caused by Entamoeba histolytica or Giardia lamblia is managed with metronidazole.

146
Q

Describe the diagnosis of pseudomembranous colitis in a patient with severe watery diarrhea after prolonged antibiotic use. What is the causative organism?

A

Pseudomembranous colitis is diagnosed in a patient with severe watery diarrhea after prolonged antibiotic use, commonly caused by Clostridium difficile.

147
Q

MC antibiotic causing pseudomembranous colitis :

A

clindamycin.

148
Q

If mild diarrhea………..
Clostridium defficle

A

just fluid

149
Q

What is the first-line medical treatment for pseudomembranous colitis?

A

Metronidazole is the first-line medical treatment for pseudomembranous colitis.

150
Q

What is the next step if diarrhea persists after treatment with metronidazole for pseudomembranous colitis?

A

Oral vancomycin is the next step if diarrhea persists after treatment with metronidazole for pseudomembranous colitis.