Alimentary Management Flashcards
Coeliac disease
Gluten free diet
Must be referred to a state registered dietician
Chron’s disease
medical
- 5ASAs (aminosalicyclates)
- Steroids: prednisolone/ budenosine (used over 4-8 weeks with decreasing dosage
- Thiopurines (immunomodulators)
- Biologics e.g. infliximab (immunomodulators)
Surgery
Chron’s disease
surgical
Resection: Part of the bowel is removed
Colectomy: Entire colon is removed (rectum can be connected to ileum - pouch surgery)
Protocolectomy: removal of colon and rectum + formation of an ileostomy
Small bowel overgrowth
Rotating antibiotics (each for 2 weeks)
- metronidazole
- tetracycline
- amoxycillin
+ vitamins and nutritional supplements
Acute GI Bleed
resuscitation
IV fluids
Blood transfusion
Stop anticoagulant therapy
Colorectal cancer
Surgical procedure depends of site, stage and size of tumour.
Duke A (confined to submucosa): endoscopic/local resection
Adjuvant (after surgery) chemotherapy
Radiotherapy: rectal cancer only
Palliative: Chemotherapy, colonic stenting
Ulcerative Colitis
medical
- 5ASAs (aminosalicyclates)
- Steroids: prednisolone/budenoside (decreasing dosage over 4-8 weeks)
- Thiopurines (Immunomodulators)
- Biologics: infliximab (immunosuppression)
Surgery
Gastro-oesophageal reflux disease (GORD)
Proton pump inhibitors (omeprazole)
H2 Antagonists (ranitidine)
Alginates e.g. Gaviscon (forms a protective barrier on top of acid, preventing reflux)
Anti-reflux surgery: fundoplication (fundus is wrapped around lower oesophagus, reinforcing LOS
Ulcerative colitis
surcigal
Protocolectomy + ileostomy
Colectomy - ileum attached to rectum (pouch surgery)
Colectomy + ileostomy
Achalasia
Nitrates/CCBs
Myotomy
Balloon dilatation
Eosinophilic oesophagitis
Oral/topical corticosteroids
Dietary elimination
Endoscopic dilatation
Oesophageal cancer
Oesophagectomy (only potential cure, however few patients are fit)
Palliative: Endoscopic stent, radio/chemotherapy
Hypermotility
Smooth muscle relaxants
Helicobacter pylori eradication therapy
Triple therapy for 7 days
- Clarithromycin (500mg bd)
- Amoxicillin (1g bd) / Metronidazole (400mg bd) (tetracycline if penicillin allergic)
- PPI (e.g. omeprazole 20mg bd)
Peptic ulcer
H. pylori eradication therapy PPIs/ H2 inhibitors Stop NSAIDs etc. Endoscopic therapy (to stop bleeding) - Clip - haemospray - thermal contact - adrenaline injection
Surgery if complicated
Gastritis
H. pylori eradication therapy
PPIs
Gastric cancer
Surgery (laparoscopic or open):
Subtotal gastrectomy (if tumour is distal)
Total gastrectomy
Chemotherapy
Gastric outlet obstruction
Endoscopic balloon dilatation
Surgery
Pancreatic cancer
Surgery:
Pylorus preserving pancreaticoduodenectomy (PPPD)
Kausch-Whipple - pancreaticoduodenectomy
Palliation:
Stenting/ bypass of bile duct
Duodenal stenting
Acute pancreatitis
Management of precipitating factors (gallstones, alcohol…)
Antibiotics (if evidence of bacterial infection)
Nutrition (by NG feeding)
Supportive care:
Analgesia
IV fluids
Chronic pancreatitis
Conservative management: Alcohol abstinence Opiate analgesia Low fat, low protein diet Pancreatic supplementation (Diabetes treatment)
Surgery: Kausch-Whipple pancreaticoduodenectomy PPPD Pancreatic sphincterotomy/ dilatation Common bile duct stenting/bypass Celiac plexus block
Barrett’s Oesophagus
Endoscopic mucosal resection
Radiofrequency ablation
Oesophagectomy
Acute abdomen resuscitation
Analgesia Decompress gut IV fluids Ensure tissue perfusion Treat sepsis
Spontaneous bacterial peritonitis
IV Antibiotics
Ascitic fluid drainage
IV albumin infusion
Haemorrhoids
Elective surgical intervention
Varices
To stop bleeding:
Band ligation (oesophageal)
Glue injection
IV terlipressin (splanchnic vasoconstrictor)
Non-alcoholic fatty liver disease
Lifestyle measures:
- diet, weight loss and exercise
- weight reduction surgery
- Liver transplant
Alcohol-related liver disease
Supportive treatment
Alcohol abstinence
Treat alcohol withdrawal, hepatic encephalopathy, infection etc.
Steroids (if severe, Glasgow alcoholic hepatitis score >9)
Nutrition
Gallstones
Dissolution (ursodeoxycholic acid)
Lithotripsy (focused ultrasound waves)
Cholecystectomy NOTES surgery (natural orifice transluminal endoscopic surgery)
Viral Hepatitis
A&B - vaccination
B - Pegylated interferon (promotes immune function)
B&C - Antiviral drugs (e.g. lamivudine, adefovir)
Irritable bowel syndrome
Dietetic review FODMAP diet - IBS-D Laxatives Antispasmodics for pain Psychological interventions
Hepatocellular carcinoma
Hepatic resection
Liver transplant
Radiofrequency ablation (“burns” tumour out)
Palliation
- chemotherapy
- hormonal therapy (tamoxifen)
- tyrosinase kinase inhibitors
