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Step 2 CK > Disorder (Disease)/Treatment(s) > Flashcards

Disorder (Disease)/Treatment(s) Flashcards

1
Q

Achalasia

A
  • Pneumatic dilation: effective in more than 80-85% of cases with less than 3% risk of perforation
  • Botulinum toxin injection
  • Surgical sectioning or myotomy: more effective but more dangerous
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2
Q

Nutcracker esophagus

A
  • Calcium channel blockers like diltiazem
  • Trazodone
  • Heller myotomy: an incision to to disrupt the LES and the myenteric plexus that innervates it
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3
Q

Esophageal Candidiasis

A
  • Oral fluconazole
  • If fluconazole does not improve symptoms then endoscopy is performed
  • IV amphotericin is used for confirmed Candida not responding to fluconazole
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4
Q

Zenker diverticulum

A

Surgery

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5
Q

Schatzki rings

A

Pneumatic dilation

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6
Q

Steakhouse syndrome

A
  • Observation for a period of time to see if the food bolus will pass spontaneously. This may be aided by fizzy drinks that release gas (which may dislodge the bolus)
  • Glucagon can be used (relaxes the LES)
  • Endoscopy (for relieving the obstruction and diagnose its cause)
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7
Q

GERD that is not responsive to medical therapy

A
  • Nissen fundoplication: wrapping stomach around the LES
  • Endocinch: using a scope to place a suture around the LES to tighten it
  • Local heat or radiation of LES (causes scarring)
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8
Q

Barret esophagus

A
  • Barret alone (metaplasia): PPIs and rescope every 2-3 years
  • Low-grade dysplasia: PPIs and rescope every 6-12 months
  • High-grade dysplasia: ablation with endoscopy: photodynamic therapy, radiofrequency ablation, endoscopic mucosal resection
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9
Q

H. pylori infection

A
  • PPIs combined with clarithromycin and amoxicillin
  • PPIs combined with metronidazole and tetracycline (in those not responded to initial therapy)
  • Adding bismuth to a change of antibiotic may aid in resolution of treatment resistant ulcers
  • To confirm eradication retest with stool antigen or breath test
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10
Q

Diabetic gastroparesis

A
  • Erythromycin

- Metoclopromide

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11
Q

Antibiotic associated diarrhea

A
  • Metronidazole

- If not effective then oral vancomycin or fidaxomicin

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12
Q

Whipple disease

A
  • Ceftriaxone

- TMP/SMX

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13
Q

Tropical sprue

A
  • TMP/SMX

- Tetracycline

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14
Q

Carcinoid syndrome

A

Octreotide

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15
Q

Irritable bowel syndrome

A
  • Fiber in diet
  • Anti-spasmodic agents like hyoscyamine and dicyclomine
  • Anti-depressants like amitriptyline or SSRIs
  • Anti-motility agents like loperamide for diarrhea
  • Lubiprostone (Cl channel activator that increases bowel movement frequency)
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16
Q

Inflammatory bowel diseases

A
  • Acute exacerbation of both CD and UC are treated with steroids such as predinsone or budesonide (which is specific for IBD)
  • Chronic maintenance of remission is with 5-aminosalicylic acid (5-ASA) also known as mesalamine. Asacol (mesalamine) is used for UC, Pentasa (mesalamine) for CD and Rowasa (mesalamine) is used for UC largely limited to rectum
  • Azathioprine and 6-mercaptopurine are used to wean patients off of steroids
  • All patients need Ca++ and vitamin D
  • Perianal CD is treated with ciprofloxacin and metronidazole
  • Fistulas are treated first with anti-tumor necrosis factor (TNF) agents like infliximab, if no response then surgery
17
Q

Diverticulosis

A

Bran, psyllium, methylcellulose and increased dietary fiber to decrease the rate of progression and complications

18
Q

Diverticulitis

A
  • Ciprofloxacin combined with metronidazole
  • Amoxicillin/clavulanate
  • Ticarcillin/clavulanate or piperacillin/tazobactam
  • Ertapenem
  • Surgery
19
Q

Acute pancreatitis

A
  • NPO (no food)
  • IV hydration at very high volume
  • Analgesia
  • PPIs (decrease pancreatic stimulation from acid entering duodenum)
  • Antibiotics such as imipenem or meropenem if there is more than 30% necrosis on CT or MRI (to decrease development of infective necrotic pancreatitis)
  • If there is severe necrosis do needle biopsy to determine the presence of infection
  • Pseudocysts are drained with a needle if they are enlarging or painful
  • ERCP to remove obstructing stones, dilate strictures and place stents
  • Infected necrotic pancreatitis sould be surgically resected (debridement) to prevent ARDS and death
20
Q

Spontaneous bacterial peritonitis

A
  • Cefotaxime or ceftriaxone

- In ascites when fluid albumin level is quite low, prophylactic norfloxacin or TMP/SMX is used to prevent it

21
Q

Ascites and edema in cirrhosis

A
  • Spironolactone and other diuretics

- Serial paracentesis for large volume ascites

22
Q

Coagulopathy and thrombocytopenia in cirrhosis

A

FFP and/or platelets only if bleeding occurs

23
Q

Encephalopathy in cirrhosis

A

Lactulose and Rifaximin

24
Q

Hypoalbuminemia in cirrhosis

A

No specific therapy

25
Q

Spider angiomata and palmar erythema in cirrhosis

A

No specific therapy

26
Q

Varices in cirrhosis

A
  • Propranolol

- Banding via endoscopy

27
Q

Hepatorenal syndrome in cirrhosis

A
  • Somatostatin (octreotide)

- Midodrine

28
Q

Hepatopulmonary syndrome (hypoxia upon sitting upright [orthodeoxia]) in cirrhosis

A

No specific therapy

29
Q

Primary biliary cirrhosis

A

Ursodeoxycholic acid

30
Q

Primary sclerosing cholangitis

A
  • Ursodeoxycholic acid

- Cholestyramine

31
Q

Hepatitis B

A

One of the following agents:

  • Adefovir
  • Lamivudine
  • Telbivudine
  • Entecavir
  • Tenofovir
  • Interferon
32
Q

Hepatitis C

A

Combination of Interferon, Ribavirin and either Telaprevir or Boceprevir

Step 2 CK (9 decks)

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