UPPER GI BLEED

*Bleeding Peptic Ulcer

*Gastritis
*Gastric Cancer
*Esophageal Varices
*Mallory-Weiss Syndrome

W/U

BLOOD IN STOOL

W/U
-RECTAL Exam
-Colonoscopy
-CBC
-PT/PTT/INR
-CT-Abd/Pelvis
-CEA
-AST/ALT/Bilirubin/AP

*Colorectal Cancer
*Anal Fissure
*Hemorrhoids
*C diff (abx use)
*Diverticulosis
*Ischemic Bowel Dz
*IBD
*UC
*Crohns

CBC diff, Electrolyte, ESR

RECTAL Exam
AST/ALT/Bilirubin/AP
Barium Swallow, Endoscopy
H pylori Testing

orthostatics vitals!!!

CONSTIPATION
*Colorectal Cancer
*Low Fiber Diet
*HypOthyroid
*Inflammatory Bowel Disease
*Irritable Bowl Syndrome
*Celiac Dz *Angyodysplasia
*Depression
*Substance abuse (eg; heroin)

W/U

DIARRHEA
*Carcinoid Syndrome
*Crohns Dz
*Viral/Bacterial Gastroenteritis
*Food Poison *HypERThyroid
*IBD *Lactose Intolerance *UC
*Pseudomembranous Colitis
*Travelers Diarrhea
*Giardia (GI parasitic infection)
*Amebiasis
*HepA
*Cryptosporidiosis

W/U

-CBC diff, Electrolyte, ESR

-Rectal Exam, stool occult blood
-CT-Abdomen/Pelvis
-AST/ALT/Bilirubin/AP
-Colonoscopy, TSH, Urine Toxicology
-Female pelvic exam

-CBC diff, Electrolyte, ESR

-Rectal Exam
-AST/ALT/Bilirubin/AP
-Colonoscopy
-CT-Abdomen Pelvis
-TSH
-Urine Toxicology
-Urinary 5-HIAA
-Stool for ova and parasites
-Stool for c difficile toxin

DRAIN
Diverticulosis (Most common reason), Drugs
(Warfarin)
Rectal bld (Fissures)
Angiodysplasia/Anal sex
Inflammatory bowel disease (UC, Crohns)/ Infectious
diarrhea/ Ischemic colitis/Injury
Neoplasms

PEDIATRICS
BEHAVIORAL DISORDER!
*ADHD
*Conduct Disorder
*Manic Disorder
*Adjustment Disorder
*Oppositional-Defiant Disorder
*Age-Appropriate Disorder
SEIZURES!
*Simple Febrile Seizure (no prior hx of seizures, duration <15 min, fever)
*Meningitis (decreased urine output, decreased appetite, fever, tonic clonic seizures
*HypOnatremia
*UTI
*Occult Bacteremia

W/U
-Physical Exam

W/U
-Physical Exam
-CBC diff, Electrolyte, ESR
-Blood Culture
-LP-CSF analysis
-EEG
-UA, urine culture
-CT head
Tongue/head trauma, has this happened before?, post
ictal symptoms?, whole body shaking?, family hx of
seizures?

GI SYMPTOMS!
*Gastroenteritis
*GERD
*Pyloric Stenosis
*Hepatitis
*Duodenal Atresia
*UTI
*Formula Allergy
*Colic (Persistent ongoing & subsides after passing flatus)
*Low Fiber Diet
*Hirschprungs
*Lead Poison
CHILD WITH DIARRHEA!
*Viral gastroenteritis (Most common!!!; Daycare, fever, watery diarrhea, Low grade fever
*Bacterial diarrhea (daycare, acute diarrhea, low grade fever)
*Malabsorption (watery diarrhea, dry mouth)
*UTI (diarrhea in infants may be a nonspecific response to an infection such as UTI or pyelonephritis)
*Intussuception (abd pain, vomiting, bldy jelly stools)
*Bacteremia ( high fever, drowsy, decreased urine output)
*Lactose Intolerance

CHILD WITH NOISY BREATHING

*Croup (noisy breathing, difficulty breathing, fever, 6 mo-3yrs)
*Epiglottitis (Occasional voice hoarseness, occasional muffling, 2-6yrs, drooling)
*Foreign body aspiration (Sudden onset while playing with toys, noisy breathing)
*Laryngitis (>5yrs, hoarse voice)
*Retropharyngeal abscess (<6yrs, drooling, muffled voice)
*Angioedema (allergic response or hereditary, , sridor, facial edema)
*Peritonsillar abscess (>10 yrs, gradual, hx of sore throat and tonsillitis)
*Laryngeal papilloma (chronic, hoarse voice, 3 mo-5yrs)

W/U
-Physical Exam
-CBC diff, Electrolyte, ESR
-US-Abdomen
-ALT/AST/B/AP
-Endoscopy
-Rectal exam
-Chest-XR
-Tympanocentesis Culture

W/U
-Physical exam
-CBC
-Electrolytes (for diarrhea)
-Rotavirus Enzyme immunoassay/norovirus PCR (for viral
gastroenteritis)
-Rectal exam
-Stool exam for occult bld
-Stool leukocytes, culture, ova, parisitology, & pH (for bacterial
pathogen)
-U/S abd
-Bld cultures (to R/O bacteremia)
-Abd xrya (to look for obstruction; for intussusception)
-UA

W/U
-ABG
-CXR-PA and lateral
-XR-neck, AP and lateral
-CBC with Diff
-Bronchoscopy
-Direct laryngoscopy