347.4 📋 章末速蚘 Summary

347.4.1 🔑 䞀句話瞜結

GI symptoms framework(1) abdominal pain — visceral (poorly localized midline) vs parietal (sharp localized) vs referred(2) nausea + vomiting — GI/CNS/metabolic/medicationCTZ + vomiting centerantiemetics by mechanism (5-HT3, dopamine, NK1, muscarinic, antihistamine)(3) dysphagia — oropharyngeal (stroke, ALS, MG — modified barium swallow) vs esophageal (structural rings/strictures/EoE/malignancy + motility achalasia/DES/scleroderma — EGD + manometry)(4) dyspepsia — functional vs organic; H. pylori testing + PPI trial + EGD if alarm features (≥ 60 yo, weight loss, dysphagia, GI bleeding, vomiting, family history, anemia)(5) diarrhea — acute < 14 d (infectious mostly — viral most common, bacterial Salmonella/Campy/E. coli, C. diff, parasitic Giardia/Crypto) vs chronic > 14 d (secretory/osmotic/inflammatory/malabsorptive/motility)(6) GI bleeding — UGIB above ligament of Treitz (PUD most common, variceal, Mallory-Weiss, esophagitis, malignancy — hematemesis/melena/coffee-ground; EGD + PPI + somatostatin for variceal) vs LGIB below (diverticulosis #1, AVM, IBD, ischemic colitis — hematochezia typical; colonoscopy + CT angio for massive) vs obscure (small bowel — capsule endoscopy, balloon-assisted enteroscopy)(7) constipation — functional + drugs (opioids, anticholinergic, CCB) + endocrine (hypothyroid, DM, hyperCa) + neurogenic + mechanical(8) anorexia + weight loss — malignancy/endocrine/infection/GI/mental health workup(9) jaundice — pre-hepatic (hemolysis → unconjugated) vs hepatic (hepatocellular → mixed; Gilbert) vs post-hepatic cholestatic (stones, malignancy, drugs, PBC, PSC → conjugated)workup framework: history + physical + LFT + US + further per indicationendoscopy types: EGD, colonoscopy, capsule, single/double balloon, ERCP, EUS; specialized tests: manometry, pH monitoring, breath tests (H. pylori, lactose, SIBO), liver elastography (FibroScan)。

347.4.2 💊 治療粟芁

  • nausea / vomiting5-HT3 antagonists (ondansetron) for chemo/post-op + dopamine antagonists (metoclopramide, prochlorperazine) + antihistamines (meclizine) for vestibular + steroids adjunct + NK1 antagonist (aprepitant) for chemo
  • acute diarrheahydration mainstay + loperamide if no infection + specific antimicrobial per cause; C. diff → vancomycin PO or fidaxomicin
  • constipationlifestyle (fiber, fluid) + osmotic laxative (polyethylene glycol, lactulose) + stimulant (senna, bisacodyl) + stool softeners + prokinetics (prucalopride 5-HT4 agonist) + lubiprostone or linaclotide for IBS-C
  • UGIBPPI infusion + IV access + transfusion + endoscopy within 24 h; variceal → somatostatin/octreotide + ceftriaxone + EGD with banding + TIPS if refractory
  • LGIBcolonoscopy + CT angiography for massive bleeding + transfusion + AC management
  • functional dyspepsiaPPI + H. pylori eradication if positive + prokinetics + antidepressants (TCAs, SSRIs) for refractory
  • alarm features in dyspepsia≥ 60 yo, weight loss, dysphagia, GI bleeding, vomiting, family history, anemia → EGD without delay

347.4.3 🎯 盧醫垫的考前提醒

  1. abdominal pain typesvisceral (poorly localized midline, autonomic afferents, dull/crampy) vs parietal (sharp localized, somatic afferents, peritoneal irritation) vs referred (shared embryologic origin, distant from source)
  2. dysphagia workfloworopharyngeal (modified barium swallow) vs esophageal (EGD + manometry)structural (rings, strictures, EoE, cancer) vs motility (achalasia “bird beak” sign, DES, scleroderma)
  3. dyspepsia alarm features warranting EGD≥ 60 yo (some say 55), weight loss, dysphagia, GI bleeding (melena/hematemesis), vomiting persistent, family history of GI cancer, anemia, early satiety
  4. stool calprotectin distinguishes IBD (elevated, > 250 typical) from IBS (normal) — important screen
  5. diarrhea acute (< 14 d) vs chronic (> 14 d, often > 4 weeks)acute mostly viral (norovirus most common adult, rotavirus pediatric); chronic divided into secretory/osmotic/inflammatory/malabsorptive/motility
  6. UGIB definitionabove ligament of Treitz; PUD #1 cause; variceal bleeding emergency needs somatostatin + IV ceftriaxone + EGD with banding
  7. LGIB definitionbelow ligament of Treitz; diverticulosis #1 cause in adults; AVM, IBD, ischemic colitis, malignancy others; obscure GI bleeding from middle small bowel — capsule endoscopy first
  8. jaundice 3 categoriespre-hepatic (hemolysis — unconjugated bilirubin ↑) + hepatic (hepatocellular pattern — mixed) + post-hepatic cholestatic (extrahepatic obstruction stones/malignancy or intrahepatic — conjugated bilirubin ↑); workup LFT + US first
  9. acute mesenteric ischemiapain out of proportion to exam findings + AF (embolic source) + elderly + lactate ↑ + CT angiography; emergent surgical
  10. functional GI disorders Rome IV criteriaIBS, functional dyspepsia, chronic constipation, etc.; persistent symptoms without identifiable organic cause; treat with combination of dietary, behavioral, and pharmacologic