Gastroenterology Archives - The Emergency Medical Minute

Gastroenterology

Podcast 815: Fluid Resuscitation in Pancreatitis

Contributor: Aaron Lessen, MD Educational Pearls: Historically, pancreatitis has been treated with aggressive IV fluid rehydration. Recently published data shows this may not be appropriate. A randomized, controlled, multi-hospital trial evaluated outcomes for patients with acute pancreatitis receiving lactated Ringer’s solution    Aggressive fluid resuscitation group received 20ml/kg bolus + 3ml/hour  Moderate fluid resuscitation groups received…

Read More

Podcast 805: Tunneled Peritoneal Catheter

Contributor: Aaron Lessen, MD Educational Pearls: Patients with recurrent ascites may need frequent outpatient or emergency department paracentesis which can be time consuming and uncomfortable for patients.  Tunneled peritoneal catheters are a permanent alternative therapy which allows fluid drainage at home by patient or caregiver.  There has been theoretical concern that long term placement of…

Read More

Podcast 792: Rectal Prolapse

Contributor: Jarod Scott, MD Educational Pearls: Rectal prolapse is an evagination of the rectal tissue through the anal opening Factors that weaken the pelvic floor muscles increase the risk of rectal prolapse These include age > 40, female, multiple pregnancies, constipation, diarrhea, cystic fibrosis, prior pelvic floor surgeries, or other pelvic floor abnormalities Noninvasive treatment…

Read More

Tastes so good, hurts so bad

tastes so good, hurts so bad Chief Complaint: Esophageal Foreign Body HPI: 31-year-old male presents to emergency department with reports of an esophageal foreign body. He states that he was eating chicken and had a large piece of chicken get stuck in his chest. He is vomiting up liquid after attempts of swallowing water, not…

Read More

Podcast 767: Transaminitis and Rhabdomyolysis

 Contributor: Sam Killian, MD Educational Pearls: Transaminitis refers to the elevation of transaminases, enzymes of the liver (AST and ALT) Elevation of ALT is relatively specific to the liver, but AST is found in more organs than the liver including the muscle If AST is significantly greater than ALT, consider a musculoskeletal origin such…

Read More

Atraumatic Spleen Rupture

Atraumatic Spleen rupture Chief Complaint: Abdominal Pain HPI 41-year-old male presents to the emergency department with reports of the same exact abdominal pain as prior episodes of pancreatitis described as beginning last night, progressively worsening, 10 out of 10, epigastric, sharp, and stabbing. It is the same as pancreatitis pain he has had in the…

Read More

Podcast 747: Food Impaction

Contributor: Ricky Dhaliwal, MD Educational Pearls: Esophageal food impaction can be managed in the ED prior to calling GI for endoscopy Coca-cola, glucagon, benzodiazepines, calcium channel blockers, and dissolved nitroglycerin are all options to try For pediatric patients, weighted bougies can be used under sedation to attempt retrieval of the food bolus  Always evaluate airway…

Read More

A Painful Twist

a painful twist Chief Complaint Abdominal Pain HPI 47-year-old female presenting to the emergency department with approximately 2 hours of right upper quadrant pain described as sharp, constant, worse with movement, and associated with nausea. Patient self-induced emesis x1. She has never had this before. It did not change with 2 tablets of Tylenol at…

Read More

Podcast 738: Acute Mesenteric Ischemia

Contributor: Ian Gillman, PA-C Educational Pearls: Acute mesenteric ischemia is a condition where bowel loses blood supply from an acute occlusion of the mesenteric arteries A frequent sign is abdominal pain that is out of proportion to the exam Atrial fibrillation is one risk factor for mesenteric ischemia Treatment includes anticoagulation and possible surgical intervention…

Read More

Podcast 727: Antibiotics for Diverticulitis

Contributor: Aaron Lessen, MD Educational Pearls: Classically, diverticulitis is diagnosed via CT scan and patients are discharged home on antibiotics if they are without complication The DINAMO study is a multicenter open-label RCT that evaluated if it is safe to not give antibiotics to patients with mild acute diverticulitis Found no difference in readmission, return…

Read More

 

Stay up to date by
joining our mailing list!