Gastroenterology

A

• Acute Cholangitis — Diagnosis and Early Management

  Systemic infection from biliary obstruction; diagnose with Tokyo criteria; start broad-spectrum antibiotics and perform urgent biliary drainage (ERCP) based on severity.
• Acute Cholangitis — Tokyo Criteria, Antibiotics, and Urgent ERCP

  Charcot triad (fever, jaundice, RUQ pain) ± hypotension/AMS suggests cholangitis. Use Tokyo Guidelines for severity grading. Start broad IV antibiotics and arrange urgent biliary drainage—ERCP preferred; percutaneous transhepatic biliary drainage if ERCP not feasible.
• Acute Cholangitis — Tokyo Severity Grading, Early Antibiotics, and Biliary Drainage

  Systemic inflammation + cholestasis + imaging define diagnosis. Start early broad‑spectrum antibiotics and fluids; perform ERCP drainage urgently for Grade II–III disease and after stabilization for Grade I; tailor timing to sepsis severity and comorbidity.
• Acute Pancreatitis — Diagnosis & Early Management

  Diagnose with 2 of 3: typical epigastric pain, lipase/amylase ≥3× ULN, or imaging; early aggressive fluids (LR), pain control, early enteral nutrition; no routine antibiotics; evaluate gallstones and triglycerides.
• Acute Pancreatitis — Diagnosis and Management

  Diagnosis requires two of three: characteristic pain, lipase elevation, or imaging; early aggressive fluids and analgesia; early oral feeding when tolerated; manage gallstone disease and complications.
• Acute Pancreatitis — Early Fluids, Analgesia, and Enteral Nutrition

  Epigastric pain radiating to the back with elevated lipase/amylase (>3× ULN) and imaging findings. Provide early goal-directed fluids (prefer lactated Ringer’s), adequate analgesia, and early enteral nutrition; avoid prophylactic antibiotics. Identify gallstone etiology and perform cholecystectomy before discharge for mild cases.
• Acute Pancreatitis — Early Fluids, Analgesia, Nutrition, and Etiology Control

  Diagnose pancreatitis with 2 of 3: characteristic pain, lipase >3× ULN, or imaging. Give early goal-directed lactated Ringer’s, adequate analgesia, and start early enteral nutrition; treat causes (gallstones, alcohol, hypertriglyceridemia). Avoid routine antibiotics unless infected necrosis is suspected.
• Acute Pancreatitis — Early Fluids, Nutrition & ERCP Indications

  Early care centers on LR fluids, analgesia, and early enteral nutrition; ERCP reserved for cholangitis or persistent biliary obstruction.
• Acute Severe Ulcerative Colitis — IV Steroids, Rescue Therapy, and Colectomy Triggers

  Hospitalize for intensive monitoring, start IV corticosteroids, perform early flexible sigmoidoscopy, and escalate to infliximab or cyclosporine if steroid-refractory; coordinate with colorectal surgery for timely colectomy when failure criteria are met.
• Anal Fissures & Hemorrhoids — Outpatient Management

  Outpatient management focuses on fiber, topical therapies, and office procedures; escalate to surgery for refractory cases or complications.

C

• Caustic Ingestion — NPO, Early Endoscopy, and Perforation Surveillance

  Accidental or intentional ingestion of acids/alkalis causes esophageal/gastric injury. Keep NPO, avoid neutralizing/emesis/NG placement blindly, and perform early endoscopy (within 12–24 h) to grade injury; manage severe injuries in ICU with perforation surveillance and staged nutrition.
• Celiac Disease — Diagnosis, Diet, and Monitoring

  Test with tTG‑IgA and total IgA; confirm with duodenal biopsy (unless pediatric no‑biopsy criteria met). Lifelong gluten‑free diet; monitor serology, micronutrients, and bone health.
• Constipation — Slow Transit vs Pelvic Floor Dyssynergia

  Differentiate slow‑transit constipation from pelvic floor dyssynergia; pursue anorectal testing and targeted therapy (biofeedback) before empiric laxatives alone.

D

• Diverticulitis — Uncomplicated vs Complicated

  CT confirms diagnosis; many uncomplicated cases managed outpatient sometimes without antibiotics; complicated disease needs antibiotics, drainage, or surgery.

G

• Gastroparesis — Diagnosis & Prokinetic Therapy

  Confirm delayed gastric emptying (4‑hour scintigraphy). Manage with dietary measures, glycemic control, and prokinetics; consider pyloric therapies for refractory disease.
• GERD — Step‑Up/Step‑Down & PPI Deprescribing

  Use an 8‑week PPI trial for typical GERD without alarms; then step‑down to lowest effective dose or on‑demand. Deprescribe PPIs when no ongoing indication; reinforce lifestyle measures.

H

• Hypertriglyceridemia-Induced Pancreatitis — Insulin, Apheresis, and Long-Term Lipid Control

  Severe abdominal pain with TG >1000 mg/dL—hypertriglyceridemia‑induced acute pancreatitis (HTG‑AP).

I

• Irritable Bowel Syndrome — Rome IV‑Based Management

  Positive diagnosis using Rome IV; screen for celiac disease in IBS‑D/M; limited testing otherwise. Management combines diet (low‑FODMAP), gut‑directed pharmacotherapy, and psychological therapies.

L

• Lower Gastrointestinal Bleeding — ED Management

  Resuscitate, risk stratify, and obtain CTA for brisk bleeding when endoscopy is not immediately available; manage anticoagulants and coordinate GI and interventional radiology.
• Lower GI Bleed — Diagnosis & Management

  Assess hemodynamics and resuscitate; exclude brisk upper source; colonoscopy after prep for most; CTA for ongoing brisk bleeding; manage anticoagulation and target etiology.
• Lower GI Bleed — Initial Assessment and Localization

  Stabilize first; use CTA for brisk bleeding to localize; colonoscopy after prep for most; manage antithrombotics and consider IR embolization when needed.

M

• Microscopic Colitis — Diagnosis & Treatment

  Chronic watery, non‑bloody diarrhea with normal colonoscopy; diagnosis requires random biopsies. Budesonide is first‑line; review medications and bile acid malabsorption.

N

• Necrotizing Pancreatitis — Step‑Up Approach and Timing of Intervention

  Severe pancreatitis complicated by necrosis requires early enteral nutrition, goal‑directed resuscitation, and organ support. Reserve antibiotics for proven infection. Delay intervention until walled‑off necrosis (~4 weeks) when feasible; employ a step‑up approach starting with percutaneous or endoscopic drainage and escalating to minimally invasive necrosectomy if needed.
• Non-Variceal Upper GI Bleeding — Resuscitation, PPI, and Early Endoscopy

  Hematemesis or melena with hemodynamic changes suggests upper GI bleeding. Resuscitate with balanced transfusion strategy, start high-dose IV PPI, risk-stratify (GBS/Rockall), and arrange early endoscopy with endoscopic hemostasis for high-risk stigmata; resume antithrombotics per risk.
• Nonvariceal Upper GI Bleed — Endoscopy and PPI

  Resuscitate and risk stratify (Glasgow-Blatchford); give IV PPI, consider erythromycin pre-endoscopy; endoscopy within 24 hours with hemostasis for high-risk lesions; plan secondary prevention.
• Non‑Variceal Upper GI Bleeding — Risk Scores, PPI Strategy, and Endoscopic Hemostasis

  Resuscitate and risk‑stratify (Glasgow‑Blatchford). Administer high‑dose PPI and give pre‑endoscopy erythromycin when appropriate; perform early endoscopy with hemostasis. Transfuse at Hgb <7 g/dL unless exceptions; resume antiplatelets per risk/benefit.

S

• Small Intestinal Bacterial Overgrowth — Diagnosis & Treatment

  Diagnose SIBO with breath testing (glucose/lactulose) or jejunal aspirate; treat with antibiotics and correct underlying motility/anatomic disorders.

U

• Upper GI Bleed — Nonvariceal

  Resuscitate and risk stratify (Glasgow-Blatchford); high-dose PPI; endoscopy within 24 h for most, sooner if unstable; endoscopic hemostasis for high-risk stigmata; test and treat H. pylori.
• Upper GI Bleeding — Nonvariceal: Endoscopy & PPI Strategy

  Nonvariceal UGIB: resuscitate, risk‑stratify (GBS/Rockall), PPI therapy, and endoscopic hemostasis within 24 h; treat H. pylori; manage antithrombotics with clear restart strategy.
• Upper GI Bleeding — Resuscitation, Risk Scores, PPI/Octreotide, and Early Endoscopy

  Manage UGIB with ABCs, balanced transfusion targets (Hb ~7–8 g/dL), and early endoscopy (within 24 h; sooner if unstable). Use Glasgow‑Blatchford/Rockall for triage. High‑dose IV PPI for suspected non‑variceal bleeding; in suspected variceal bleeding, add octreotide and prophylactic antibiotics.

V

• Variceal Upper GI Bleeding — Resuscitation and Hemostasis

  Resuscitate with balanced strategy, start vasoactive therapy and antibiotics, and arrange urgent endoscopy; use balloon tamponade or self expanding stent as bridge when needed.