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PACES Management > Abdo > Flashcards

Abdo Flashcards

1
Q

management for H Pylori

A

Triple eradication therapy 7d

1) high dose PPI taken 30 mins before meals
2) amoxicillin
3) clarithromycin or metronidazole

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2
Q

Management of Ascites

A 
Fluid restrict
Sit up
SAAG and signs of SBP
 MR diuretics > loop diuretics 
Ascitic drain
TIPS
ABx if peritonitis: cef
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3
Q

Management of Variceal Bleed

A

Fluids resus
NBM for OGD

Terlipressin on presentation + PPI

Try and reverse coagulopathy e.g. packed cells, vit K, FFP

Oesophageal varices: band ligation
Gastric varices: Endoscopic scleroptherapy injection of N-butyl-2-cyanoacrylate

IV antibiotics (tazocin)
offer TIPS if not controlled

consider Sengstaken-Blakemore tube as last resort

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4
Q

AI hep management

A

high dose steroids
azathioprine after

2 y duration

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5
Q

Management of peptic stricture

A

Balloon dilatation

PPI if caused by GORD

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6
Q

Management of Wilson’s disease

A

Penicillamine

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7
Q

Crohn’s induce remission

A

mild: oral pred
severe: IV hydrocortisone
consider elemental diet
if first mild presentation in 12m consider 5-asa or budesonide

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8
Q

Crohn’s maintain remission

A 
DMARDs: azathioprine (check TPMT first)
biologic therapies e.g. infliximab
biologic screen before starting
STOP SMOKING = as good as steroids
elemental diet
2nd-line: methotrexate

consider surgery

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9
Q

UC induce remission

A

mild: topical aminosalicylates, oral salicylates, oral steroids
consider elemental diet
Severe: IV hydrocortisone +/- ciclosporin/infliximab if ciclo CI

consider surgery
Add LMWH and D3 for bone protection

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10
Q

UC maintain remission

A

mild/moderate: topical ASA +/- oral
biologic screen before starting

consider azathioprine/mercaptopurine after 2 or more exacerbations in 12m or severe

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11
Q

IBS management

A

lifestyle (stress, depression, diet diary)

mostly diarrhoea/bloating: reduce insoluble fibre

if diarrhoea persists: loperamide

mostly constipation: increase fibre/laxatives

if severe constipation >12m: trial linaclotide

if pain: antispasmodic e.g. mebeverine or alverine citratre, consider trial TCA

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12
Q

Haemorrhoids management

A

medical: increase fibre/stool softener, topical analgesia

non-operative: rubber band ligation, sclerotherapy

operative: haemorrhoidectomy, HALO procedure

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13
Q

Decompensated Liver failure management

A

Empirical antibiotics e.g. tazocin
Laxatives e.g. lactulose aiming for BO 3x/24h (also helps with encephalopathy)
Pabrinex/chlordiazepoxide if alcohol
Diuretics/paracentesis if ascitic
Consider if variceal bleed or renal failure
optimise nutrition +/- NG

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14
Q

Coeliac management

A 
remove gluten
dietician referral
consider e.g. iron, vitamin D etc.
monitor tTG
Consider repeat endoscopy
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15
Q

Management for Appendicitis

A

Prophylactic antibiotics
laparoscopic appendectomy
if perforated: abdominal lavage

if appendix mass: broad spectrum abx, consider drainage and interval appendectomy

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16
Q

investigation for appendicitis

A

CT
consider USS for pregnancy, children, breastfeeding
MRI if pregnant and USS not diagnostic

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17
Q

Management of Acute Cholecystitis

A

IV Abx
Severe pain: Diclofenac or opioid
mild/moderate: paracetamol or NSAID

laparoscopic cholecystectomy on admission OR after 6w

consider percutaneous cholecystostomy if surgery contraindicated at presentation + conservative management unsuccessful

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18
Q

Management of Ascending cholangitis

A

IV Abx

ERCP within 24-48h for placement of stent and removal of stone

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19
Q

Management of gallstones

A

asymptomatic in gallbladder/biliary tree: nothing

asymptomatic in CBD: offer lap cholecystectomy

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20
Q

Difference between biliary colic, acute cholecystitis and cholangitis

A

colic: steady non-paroxysmal pain in epigastrium >30 mins

Acute cholecystitis: + fever and tenderness in RUQ pain

Cholangitis: fever + rigors, jaundice, RUQ pain
Reynold pentad: + neuro and shock

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21
Q

management acute pancreatitis

A

Fluid resus (3-6L)
analgesia
oxygen
IV Abx if infected/associated cholangitis
Enteral nutrition (start oral feeding if possible, otherwise NG tube)

ERCP within 72h
Blood gas for Glasgow-Imrie scoring
consider cholecystectomy if no cholangitis/bile duct obstruction

consider replacing Ca/Mg

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22
Q

Management of chronic pancreatitis

A

acute intermittent: no alcohol/smoking + analgesia

Persistent: as above +
Pancreatin enzyme replacement AND omeprazole

pseudocyt/biliary complications: endoscopic decompression under USS

intractable pain and pancreatic duct calcifications: ESWL

pancreatic head enlargement: distal pancreatectomy

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23
Q

management of acute diverticular disease

A

mild/moderate: 5d co-amoxiclav
if allergic: cefalexin with metronidazole
Paracetamol (avoid NSAIDs and opioids)
fluid replacement

clear liquids only, with a gradual reintroduction of solid food if symptoms improve over the following 2–3 days

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24
Q

investigations for acute diverticular disease

A

lactate
USS abdo pelvis
CT scan (contrast or non-contrast)
urgent colonoscopy if haemorrhage

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25
Q

Management for diverticular disease complications

A

Percutaneous drainage of large abscesses
peritoneal lavage in perforation
sigmoid resection and colostomy formation

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26
Q

GORD indications for 2ww OGD

A 
GI bleed (same day)
dysphagia
upper abdo mass
>55y AND weight loss AND dyspepsia/reflux/upper abdo pain
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27
Q

Management for dyspepsia

A

review medications
H pylori testing
trial full dose PPI

28
Q

management for GORD

A

PPI for 4-8w
if stricture/recurrence continue PPI

2nd line H2RA therapy
Nissen fundoplication if severe

29
Q

management of colorectal cancer

A

resection of bowel
heparin for 28d post-surgery
+/- chemoradiotherapy

30
Q

management for volvulus

A

sigmoid: therapeutic sigmoidoscopy decompression with rectal flatus tube insertion
surgery: Hartmann’s

caecal volvulus: laparotomy (often right hemicolectomy and ileocaecal resection)

31
Q

management for Bowel Obstruction

A

?fluid resus
if ischaemia/strangulation, surgery within 6h

no peritonitis: Drip and suck + conservative management for 72h

can consider adhesiolysis, but causes more adhesions later

32
Q

hernia management

A

strangulated/incarcerated = emergency surgery

inguinal: conservative/routine repair
femoral: urgent repair

33
Q

hernia approaches

A 
lockwood = low, elective
McEvedey = high, emergency

incision: Gridiron/Mcburney’s or Lanz

Lichtenstein mesh repair

34
Q

SBP management

A

resus if septic
empirical Abx e.g. gen 3 ceph

large volume paracentesis and albumin replacement

35
Q

perforated peptic ulcer manage

A

CT scan/ABG
CXR if CT not immediate
NO endoscopy

resuscitation + G&S

laparoscopic surgery as soon as possible (open if unstable patients) for primary repair +/- omental patch

Antibiotics

36
Q

bleeding peptic ulcer management

A

G&S and ABG
Blatchford score

Endoscopy ASAP
Rockall score after endoscopy
CT if endoscopy not available

resuscitation

Antibiotics, IV PPI

endoscopy can be diagnostic and therapeutic
adrenaline + either:
mechanical clips
thermal coagulation
fibrin/thrombin

start propranolol for prophylaxis
H pylori eradication

37
Q

Abdominal presentations of IBD

A 
diarrhoea + constipation +  bleeding
pancreatitis
gallstones
kidney stones
bowel cancer
PSC
38
Q

What is the Travis score

A

if CRP is >45 72h after steroids treatment for IBD, 85% need colectomy

39
Q

Management of Boerhaave’s

A

ALL: fluid resuscitation, antibiotics
Primary oesophageal repair through open thoracotomy
VATS with fundic reinforcement

40
Q

3 types of ischaemic bowel disease

A

acute mesenteric
chronic mesenteric
colonic (most common)

41
Q

3 types of acute mesenteric ischaemia

A

venous
embolic
thrombotic

42
Q

Management of ischaemic bowel disease

A

resus
empirical antibiotics
open embolectomy OR arterial bypass +/- bowel resection

43
Q

investigation of ischaemic bowel disease

A 
CT with contrast/angio
lactate
bloods
sigmoid/colonoscopy will show ischaemia
mesenteric angio
44
Q

Creatinine changes after starting drug before stopping

A

> 30%

45
Q

management of chronic diverticulosis

A

increase fluids and fibre
add laxative
lose weight
avoid NSAID and opiates

46
Q

diverticulitis complications

A 
haemorrhage
abscess formation
perforation/peritonitis
stricture and fistula
obstruction
sepsis
47
Q

oesophageal cancer management

A

non-metastatic/regional spread only: oesophagectomy
severe: stent, laser treatment
palliative chemoradiotherapy

48
Q

sigmoid volvulus X ray

A

upturned U shape of dilated bowel (coffee bean)

49
Q

severity score for UC

A 
Truelove and Witts
Frequency of stool
blood in stool
fever
tachycardia
anaemia
raised ESR
50
Q

investigations for flare up of IBD

A

Blood culture
Stool culture
Sigmoidoscopy (not colonoscopy as risk of perforation)
abdominal radiograph

51
Q

Ulcerative colitis associations

A

non-smokers (smoking makes better)
PSC
arthritis
colon cancer

52
Q

post splenectomy cautions

A

vaccines: pneumococcus, meningococcus, hib
long term Pen V
risk of malaria

53
Q

investigations achalasia

A

barium swallow
upper GI endoscopy (esp for malignancy)
manometry needed to confirm diagnosis

54
Q

management of achalasia

A

balloon dilatation
Surgical cardiomyotomy
Botox injections
Per-oral endoscopic myotomy

55
Q

Barrett’s oesophagus treatment

A

conservative: avoid triggers, lose weight, smaller meals, stop smoking, reduce alcohol, sleep with head raised
PPI
ranitidine if PPI not helping

Surgery: laparoscopic fundoplication
radiofrequency ablation

56
Q

glasgow-imrie score

A 
Pancreatitis
Pao2
Age
Neutrophils
Calcium
Renal function
Enzymes
Albumin
Sugar
57
Q

what to monitor in TPN

A

glucose
4h temp
daily electrolytes, inspection of line/dressing
fluid balance

58
Q

diagnosis of PSC

A

history
MR cholangiopancreatography (beading of bile duct)
Biopsy
No specific antibody, but may be ANCA+ will be AMA negative (that’s PBC)

59
Q

PSC management

A 
Conservative lifestyle optimisation
cholestyramide for pruritis
Vitamin supplements (D, calcium)
bisphosphonates
ERCP of any strictures
Liver transplant
60
Q

difference between femoral and inguinal hernia

A

femoral hernia is inferior and lateral to pubic tubercle

inguinal is superior and medial

61
Q

difference between indirect and direct inguinal hernia

A

reduce hernia and press on deep ring (midpoint of inguinal ligament)
if direct it will protrude on coughing

is very inaccurate

62
Q 
artery supply of abdomen
Stomach and liver
Duodenum
Ascending colon
Transverse
Descending/colon
A

Stomach and liver: coeliac trunk (L/R gastrics and hepatic artery)
Duodenum: SMA
Ascending colon: SMA
Transverse: proximal 2/3 SMA distal 1/3 IMA
Descending/colon: IMA

63
Q

Acute diverticulitis investigations

A

No bleeding: contrast CT

Bleeding: Urgent colonoscopy

64
Q

Acute diverticulitis management

A

Admission and supportive treatment
Analgesia: Paracetamol
ABx: Co-Amoxiclav or metro+another Abx (e.g. cef)
?Clear liquid diet/low residue diet

65
Q

ERCP complications

A

pancreatitis
cholangitis
haemorrhage
duodenal perforation

PACES Management (11 decks)

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