Gastroenterology Archives - Page 3 of 6 - The Emergency Medical Minute

Gastroenterology

Podcast 638: Pyogenic Liver Abscess

Contributor: Aaron Lessen, MD Educational Pearls: Pyogenic liver abscesses can be caused by Intra-abdominal infection progressing to peritonitis which then drains into liver Bacteremia leading to hematogenous spead and seeding Local biliary infection with contiguous spread Patients typically present with signs of sepsis or septic shock and the abscess can be diagnosed using ultrasound or…

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Pneumatosis Intestinalis

pneumatosis intestinalis Chief Complaint: Generalized Weakness HPI: 55-year-old male with a past medical history of hypertension, diabetes mellitus type II, hypothyroidism and testicular cancer in remission presents to the Emergency Department with the chief complaint of shortness of breath and generalized weakness. He reports he was in his normal state of health the day prior….

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Podcast 613: Spontaneous Bacterial Peritonitis

  Contributor: Sam Killian, MD Educational Pearls: Spontaneous bacterial peritonitis (SBP) is an infection of peritoneal fluid that typically occurs in cirrhotic patients Symptoms may include abdominal pain, fever, and/or altered mental status Paracentesis is diagnostic test of choice. Diagnostic criteria includes > 250 polymorphonuclear cells (PMNs) or a positive gram stain/culture Treatment is typically…

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Podcast 592: TXA for GIB

Contributor: Ricky Dhaliwal, MD, JD Educational Pearls: Tranexamic acid (TXA) as shown to have mortality benefit to patients with traumatic GI hemorrhage but should it be used to achieve hemostasis in atraumatic GI bleeding? HALT-IT study looked at TXA for the treatment of upper and lower GI hemorrhage and found no 5 day mortality benefit…

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Seeking Pleasure, Suffering Pain

Seeking Pleasure, Suffering Pain Chief Complaint: Abdominal Pain HPI: 21-year-old male presenting to the emergency department after placing a glass mason jar in his rectum 3 days ago, this was done for self-pleasure and experimentation. States that yesterday he tried having a bowel movement after taking stool softener and MiraLAX, reportedly resulted in a normal…

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Podcast 551:  PPIs are Not Benign

  Contributor: Don Stader, MD Educational Pearls: PPIs (Proton pump inhibitors) reduce stomach acid levels and are commonly prescribed in patients with GERD or peptic ulcer disease Stopping a PPI after sustained use for a month or longer can lead to withdrawal – causing a rebound indigestion or reflux due to a surge in acid…

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Podcast 547: Capsaicin Cream to the Rescue

Author: Aaron Lessen, MD Educational Pearls: A recent retrospective study looked capsaicin cream in treating cannabinoid hyperemesis syndrome in regards to length of stay, cost analysis, use of rescue therapies, and adverse events Results showed a trend towards reduced length of stay but did not reach statistical significance Use of opioids was reduced in the…

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Podcast 528:  Decompensated Liver Failure 

Contributor: Michael Hunt, MD Educational Pearls: Cirrhosis is the end stage of chronic structural damage to the liver. This is most commonly due to  alcohol but other causes viral hepatitis and hepatotoxic drugs Cirrhotic patients are very prone to GI bleeding and infections, partially due to the role the liver plays in producing immune and…

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Podcast # 477: Postpolypectomy Electrocoagulation Syndrome

Author:  Nick Hatch, MD Educational Pearls: Postpolypectomy electrocoagulation syndrome (PES) is a rare complication of polypectomy and electrocautery during colonoscopy Occurs when cautery causes transmural thickening from a contact burn Patients can present as if they have peritonitis, with guarding, leukocytosis, fever, etc. CT is the imaging of choice mainly to evaluate for bowel perforation…

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Podcast # 471: Cyclic Vomiting

Author: Don Stader, MD Educational Pearls: Cyclic vomiting syndrome (CVS) is different than cannabis hyperemesis syndrome (CHS). It is important to differentiate the two. CHS is thought to be caused by activation of THC receptors in the gut CVS is associated with migraines and therefore responds to similar medications Olanzapine (Zyprexa) is an alternative to…

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