ملح الباطنيةDr.Ahmedjuwair

💎 Evaluation of Occult Bleeding :- • Asymptomatic positive FOBT/FIT from routine CRC screening → colonoscopy • Symptomatic positive FOBT/FIT or iron deficiency anemia → colonoscopy + upper endoscopy • Exception: anemia definitively from non-GI source (menstruation, blood donation, recent surgery) • Iron deficiency anemia: evaluate for celiac disease with IgA anti-tTG or duodenal biopsy • After upper endoscopy + colonoscopy: source remains unexplained in 30–50% • If iron deficiency anemia + negative scopes + no small bowel symptoms: empiric iron trial recommended • Oral elemental iron commonly 150 mg daily • Lower doses 60–100 mg daily or alternate-day dosing may be equally effective and better tolerated

💎 Most common causes of occult bleeding with iron deficiency: • Neoplasms • Vascular abnormalities (angioectasias) • Acid-peptic lesions (esophagitis, PUD, erosions in hiatal hernia) • Infections (nematodes esp hookworm, tuberculosis) • Medications (NSAIDs, aspirin) • IBD ✅️Current 2026

💎in patients using Warfarin Endoscope(Upper or Lower GIT) is safe if INR Less than 2.5 ✅️Current 2026

💎Clostridium difficile ---> this term was previously But now it is--> Clostridioides difficile ✅️Current 2026

💎Simethicone has no proven clinical benefit for intestinal gas . ✅️Current 2026

H.pylori Antibody not recommended in diagnosing H.pylori disease The Recommended tests are (H.pylori Ag or Urea breath test) Accuracy rate 95%. ✅️Current 2026

Low dose Tricyclic antidepressants have benefit in treatment of functional dyspepsia But SSRIs don't appear beneficial. ✅️Current 2026

Updated H.pylori Eradication Therapy.

💎In COPD:- 🍓keep Spo² between 88-92% only if the patient with risk factors for hypercapnia. But if the PCo² is normal on ABG Keep Spo² on target range(94-98%)

💎In diagnosing Pneumothorax:- 🍓Clinically--> acute ipsilateral chest pain and dyspnea in a Tall, Thin smoker patient , or in a patient with underlying pulmonary disease , associated with cough and tachycardia ,diminished breath sounds,decreased tactile fermitus, reduced chest movement, and hyperresonance on percussion. Trachial shift can occur in Tension Pneumothorax 🍓On imaging (CXR):- --> CXR shows pleural line with absent lung markings peripheral to it (White arrow in image) --> mediastinal shift can be seen in Tension Pneumothorax --> also in Supine position look for Deep sulcus Sign . ✅️CURRENT 2026

💎In complicated parapneumonic effusions:- 🍓Tube Thoracostomy is indicated if:- 1-pleural fluid glucose < 60 mg/dL 2- or PH <7.2 Also drainage may also be required if:- 1-PH 7.2-7.3 2- or LDL >1000 U/L 💎Note:- Uncomplicated paraneumonic effusions are sterile often resolve with Antibiotics alone they don't require drainage. ✅️CURRENT 2026

🍓pleural fluid ADA > 60 U/L has about 90% sensitivity and specificity in diagnosis of TB TB is rare if ADA < 40 U/L ✅️CURRENT 2026

💎In Transudative pleural effusion in patient with heart failure:- 🍓Aggressive diuresis can produce Psudoexudate. ✅️CURRENT 2026

💎in Pulmonary Arterial Hypertension (PAH):- 🍓Anticoagulants are no longer favored because benefit has not been proven. 🍓 Oral calcium channel blockers may be used only in patients with a significant vasodilator response (not randomly prescribed). 💎in diagnosis of Alveolar Hemorrhage Syndromes:- 🍓Rapid clearing of diffuse infiltrates on CXR or CT supports the diagnosis 🍓The preferred diagnostic test is bronchoscopy with sequential Broncho-Alveolar Lavage (BAL). ✅️CURRENT 2026

الكتاب متوفر في :- مكتبة الراقي - صنعاء مكتبة التاج - ذمار

💎On imaging:- 🍓If pulmonary infiltrates are located centrally (Batwing or Butterfly patterns)--> Think about Pulmonary Edema. Also, Kerley B Lines: These are short, horizontal lines found at the periphery (near the rib cage) at the lung bases, representing fluid in the small septa between lung segments. 🍓But if pulmonary infiltrates are located peripherally (appears as "Photographic negative " of pulmonary edema) ---> Think about :- 1-Eosinophilic pneumonia or 2- Organizing pneumonia or 3- Pulmonary embolism (The most classic peripheral sign is known as Hampton’s Hump) or 4- Lung Contusion.