4 Gastrointestinal facts for the USMLE exams.
- All patients with a history of celiac disease are at an increased risk of developing intestinal lymphoma (T-cell lymphoma). This presents with GI symptoms despite adherence to a gluten-free diet.
- When acute pancreatitis is suspected, the first thing to do is get LFT’s, Lipase, and Amylase. Because upper GI pain is so common with many conditions, it’s important to get these biochemical markers to confirm suspicion. After confirming pancreatitis, the next step is to give IV fluids, NPO, NG tube. ** Most cases of acute pancreatitis will resolve with this conservative management in 5-7 days.
- If a patient being managed for acute pancreatitis develops a fever while in the hospital, get blood cultures and start them on IV Imipenem. This is because a fever is one of the earliest signs of a pancreatic infection. * There is a high rate of mortality when this isn’t caught and managed
- If peptic ulcer perforation is suspected, fast treatment (within 6hr of onset) is extremely important. Best initial test is abdominal xray (upright, supine), looking for free air on upright film. If positive, get a surgical consult for an emergency laparotomy.
- The most common cause of small bowel obstruction in a patient with a history of abdominal surgery is ADHESIONS