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GI Bleeding, Pancreatitis, Clostridium difficile_Krishnan - 1

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This document provides an overview of gastrointestinal bleeding (GIB), Clostridium difficile (C. difficile) colitis, and acute pancreatitis. <br /><br />For severe GIB, initial resuscitation and triage are crucial, with the placement of short and wide IV access. Hemodynamically unstable patients with active bleeding or severe comorbidities should be admitted to the ICU. Intubation may be necessary for patients with active hematemesis. Risk stratification tools such as the Rockall and Glasgow Blatchford scores can guide therapy. Early endoscopy within 24 hours is recommended for nonvariceal GIB, while variceal bleeding requires vasoactive medications, prophylactic antibiotics, and early transjugular intrahepatic portosystemic shunt (TIPS) for high-risk patients.<br /><br />In C. difficile colitis, diagnosis is based on clinical suspicion and diagnostic testing, although testing should only be done when clinically indicated. Treatment options include vancomycin or fidaxomicin for severe disease. Surgery may be necessary for complications such as megacolon or perforation.<br /><br />Acute pancreatitis can be diagnosed based on clinical parameters and imaging findings. Severity can be assessed using the Atlanta criteria or the Bedside Index of Severity in Acute Pancreatitis (BISAP) score. Aggressive fluid resuscitation does not improve outcomes and may increase the risk of fluid overload. Routine antibiotics are not recommended, but enteral nutrition should be used.<br /><br />Overall, this document provides a concise summary of key points in the management of GIB, C. difficile colitis, and acute pancreatitis.

Keywords

gastrointestinal bleeding

Clostridium difficile colitis

acute pancreatitis

resuscitation

triage

hemodynamically unstable

Rockall score

Glasgow Blatchford score

endoscopy

variceal bleeding