management of upper GI bleed

a complete summary of management of UGI bleed

for surgical candidate, this should be in finger tip, is perhaps is for HO/ medical student as a reference

Management of variceal bleed

management of variceal bleed..

seem too complicated. but just follow the flow chart

if u wanna classify the management, a good way is to divide it

- initial resuscitation

- OGDS and banding

- sangtaken blackmore tube, TIPSS

- surgery: porto-caval bypass/ esophageal transection/ liver transplantation

Management of non variceal UGI bleed

Upper GI　bleed basically divided into variceal and non-variceal bleed

the management is somehow different

(even though both of them started fr resuscitation and then OGDS)

just follow the flow chart and you won't get wrong

for the complete management and management of variceal UGIB will be posted later

Forrest classification

it is important as it predicted the rate of mortality and rebleed

somohow i find out that lots of junior dr cannot remember this classification

thus just to post up as a reference.

fluconazole as first line of fungal infection

fungal infection always been ignored, it happened more common than it has been detected

this is because medical personal does not suspect it, and it is difficult to be cultured.

thus some studies suggest that to start fluconazole empirically in high risk patients (as noted in upper Left conner). it is daily dose, and so far is 1 of the safest drugs

the evidences of the studies shown in another 3 charts. it will reduce mortality for at least 50%

but beware not all candida will respond to fluconazole, eg candida kruzei that need better antifungus..

bowel prep rules

this is basically to induce diarrhoea to patient

so that procedure of large bowel can be done

example: colonoscope, or surgery.

different hospital use different protocol of bowel prep

even different surgeon uses different type and time

basically it starts the night before procedure

and usually repeated for twice, sometimes 3 times

(for certain pt, it even started 2 days prior to procedure)

some formulary given orally and some per rectally

below is the caution of giving bowel prep

this is because sometimes large amount of fluid shift will do harm to pt,

particularly for those with heart, lung and kidney diseases

BIRAD classification in breast examinatin

triple assessment of breast is very important during under grate exam

in fact it will be 1 of the question during phase 3A

triple assessment included:

1) clinical examination

2) imaging: ultrasound for those < 35 years old, mammogram for > 35 years old

3) pathological sampling: usually FNAC is sufficient, but sometimes we do request for excisional biopsy or incisional biopsy (very rare)

this topic i will bring it a bit deep, regarding BIRADs classification

this is during imaging, the common language btw radiologist and surgeon, regarding management and follow up of patient.

definitely it won't be asked during under grate exam

but post grate... it could be asked

lots of ppl think that it would be mentioned at the end of radiological report

but if suddenly been asked during exam, surely u will know how insufficient u are..

Los Angle classification

this is for reflux esophagitis.

these 2 posters actually pasted on the wall of scope room UMMC

is picture and description

easy to memorize and reproduce

if medical student mention this, can impress the examiner

but post grate candidate should know this by heart

treatment of Helicobacter pylori

most of the doctor know that triple therapy for Helicobacter pylori

but actually there are 4-5 lines of treatments

we use quadruple therapy if triple therapy fail, which can be as high as 20%

algorithm as showed in above picture

(modified from nycomed)

introduction

everything under the sun can be classified

this is one of my prof used to say

so to start, i classify this into various categories

simply as follow:

- head and neck

- cardiothoracic

- breast and endocrine

- abdomen

- gastrointestinal

- urolory/ renal

- vascular

- principle

- physiology/ pathology

- metabolism

- infective: including antibiotic etc

- miscellaneous: including some anatomy and anaesthesiology that cannot classify elsewhere

hope this will progress well..