Disorder (Disease)/Treatment(s) Flashcards
Achalasia
- 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
Nutcracker esophagus
- Calcium channel blockers like diltiazem
- Trazodone
- Heller myotomy: an incision to to disrupt the LES and the myenteric plexus that innervates it
Esophageal Candidiasis
- Oral fluconazole
- If fluconazole does not improve symptoms then endoscopy is performed
- IV amphotericin is used for confirmed Candida not responding to fluconazole
Zenker diverticulum
Surgery
Schatzki rings
Pneumatic dilation
Steakhouse syndrome
- 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)
GERD that is not responsive to medical therapy
- 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)
Barret esophagus
- 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
H. pylori infection
- 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
Diabetic gastroparesis
- Erythromycin
- Metoclopromide
Antibiotic associated diarrhea
- Metronidazole
- If not effective then oral vancomycin or fidaxomicin
Whipple disease
- Ceftriaxone
- TMP/SMX
Tropical sprue
- TMP/SMX
- Tetracycline
Carcinoid syndrome
Octreotide
Irritable bowel syndrome
- 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)
Inflammatory bowel diseases
- 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
Diverticulosis
Bran, psyllium, methylcellulose and increased dietary fiber to decrease the rate of progression and complications
Diverticulitis
- Ciprofloxacin combined with metronidazole
- Amoxicillin/clavulanate
- Ticarcillin/clavulanate or piperacillin/tazobactam
- Ertapenem
- Surgery
Acute pancreatitis
- 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
Spontaneous bacterial peritonitis
- Cefotaxime or ceftriaxone
- In ascites when fluid albumin level is quite low, prophylactic norfloxacin or TMP/SMX is used to prevent it
Ascites and edema in cirrhosis
- Spironolactone and other diuretics
- Serial paracentesis for large volume ascites
Coagulopathy and thrombocytopenia in cirrhosis
FFP and/or platelets only if bleeding occurs
Encephalopathy in cirrhosis
Lactulose and Rifaximin
Hypoalbuminemia in cirrhosis
No specific therapy
Spider angiomata and palmar erythema in cirrhosis
No specific therapy
Varices in cirrhosis
- Propranolol
- Banding via endoscopy
Hepatorenal syndrome in cirrhosis
- Somatostatin (octreotide)
- Midodrine
Hepatopulmonary syndrome (hypoxia upon sitting upright [orthodeoxia]) in cirrhosis
No specific therapy
Primary biliary cirrhosis
Ursodeoxycholic acid
Primary sclerosing cholangitis
- Ursodeoxycholic acid
- Cholestyramine
Hepatitis B
One of the following agents:
- Adefovir
- Lamivudine
- Telbivudine
- Entecavir
- Tenofovir
- Interferon
Hepatitis C
Combination of Interferon, Ribavirin and either Telaprevir or Boceprevir
