Gastro Management Flashcards
A patient with acute upper GI bleeding , whats your first step in management as a doctor ?
Gain IV Access
A patient with a high risk of ulcer after endoscopy , what will you do ?
Intravenous ppi infusion
What is the first line step in Diverticular disease ?
Endoscopic clipping ( Either alone or after the injection of dilute adrenaline ( Epinephrine )
What is the treatment of choice in Angiodysplasia?
Endoscopic thermal ablation
What is the next step in management in Angiodysplasia if it bleeds even after endoscopic thermal ablation?
Resection of the affected segment of bowel
Fluid of choice in case of upper GI bleeding in hameodynamically unstable patients ?
IV crystalloid fluid should be given to raise the blood pressure ,with a 500 ml bolus is recommended over less than 15 minutes.
What is the scoring system to assess Acute upper GI bleeding ?
Modified blatchford score
What clue you may found in CBC report that indicates hypersplenism in CLD ?
Thrombocytopenia
How ppi works in upper GI bleeding ?
- Reduce gastric acid secretion
- Neutralise intragastric pH
- Promoting clot stability by reducing pepsin induced clot lysis & increasing platelet aggregation
How will you confirm successful eradication of H.pylori following treatment ?
Urea breath test or faecal antigen test
A patient with profuse red or maroon diarrhoea & Hypovolaemic shock . CT angiography is done & bleeding point is identified . What is your next step?
Catheter angiography with embolisation .
A patient with profuse red or maroon diarrhoea & Hypovolaemic shock . CT angiography is done & source of bleeding is not identified . What is your next step?
Colonoscopy
Most common site of Angiodysplasia in older people ?
Caecum
What is the investigation algorithm in case of GI bleeding ?
Endoscopy , Colonoscopy , CT angiography > Wireless capsule endoscopy > Enteroscopy > Laparotomy with on table endoscopy
Rx option for Aphthous ulcer ?
Topical glucocorticoid ( such as 0.1% triamcinolone in orabase ) or choline Salicylate (8.7%) gel .
Rx option for oral thrush ?
Topical miconazole or nystatin . Resistant case requires oral fluconazole
A patient came with painful parotid swelling with abscess . How will you manage?
Surgical drainage + Broad spectrum antibiotics
First line drug in case of GERD ?
Antacids / Alginates
Treatment option for high grade dysplasia or intramucosal carcinoma of esophagus ?
Oesophagectomy or endoscopic therapy, with a combination of endoscopic resection of any visibly abnormal areas and radiofrequency ablation (RFA) of the remaining barret’s mucosa ,as an organ preserving alternative to surgery .
Treatment of choice for esophageal carcinoma ?
Oesophagectomy
Mainstay of treatment of esophageal perforation ?
Surgery
Treatment of pharyngeal pouch?
Cricopharyngeus myotomy (Diverticulotomy) with or without resection of the pouch.
Treatment of Achalasia ?
Surgical myotomy ( Heller’s operation ) accompanied by partial fundoplication anti reflux procedure .
Advanced endoscopic technique for the mx of Achalasia ?
POEM (Peroral endoscopic myotomy)
Treatment of Menetrier’s disease ?
Antisecretory drugs ,such as PPI with or without or octreotide may reduce protein loss , H. pylori eradication may be effective but unresponsive patients need partial gastrectomy .
Mx option for Z-E syndrome ?
Unifocal tumour : Resection
Multifocal tumor / Metastasis : Continuous therapy with PPI in high dose / Somatostatin analogue
Gold standard treatment for Gastric carcinoma ?
Surgery is the gold standard and total gastrectomy with lymphadenectomy is the operation of choice.
Treatment of Gastroparesis ?
Small ,frequent, low fat meals and the use of metoclopramide and domperidone. In severe case , long term jejunostomy feeding or TPN is required .
Aim of mx of Coeliac disease ?
Aims are to correct existing deficiency of micronutrients, such as iron, folate, calcium/vitamin D and to achieve mucosal healing through life long gluten free diet.
Most common cause of treatment failure in Coeliac disease ?
Accidental or Unrecognized gluten ingestion
Treatment of Dermatitis herpetiformis?
Rash usually responds to gluten free diet , but some patients require additional treatment with dapsone .
Treatment of choice for Tropical sprue?
Tetracycline 250mg 4 times for 28 days.
First line treatment for Small intestinal bacterial overgrowth ?
A course of broad spectrum antibiotic for 2 weeks .
Example : Rifampicin ( which is not absorbed from the gut after oral administration ), as well as systemic antibiotics such as ciprofloxacin, Metronidazole and Amoxicillin .
Initial treatment of Whipple’s disease ?
Intravenous ceftriaxone (2 gm daily for 2 weeks ) followed by co-trimoxazole for at least 1 year.
Treatment of Bile acid diarrhoea ?
Bile acid sequestrant , such as Cholestyramine or colesevelam , which binds bile salt in intestinal lumen .
Treatment of Radiation enteropathy ?
Sucralfate enema and hyperbaric oxygen.
Diarrhoea in acute phase is treated with codeine phosphate, diphenoxylate or loperamide. Antibiotic for bacterial overgrowth .
Treatment of intestinal lymphangiectasia?
Low fat diet with medium chain triglyceride supplement .
Intitial strategy in mx of Eosinophilic gastroenteritis ?
Dietary manipulation
Cornerstone of treatment for Colorectal cancer ?
Surgery
Treatment of Hirschsprung disease ?
Resection of the affected segment
Treatment of anal fissure ?
- Bulk forming laxative and increased fluid intake
- Nitric oxide and 0.2% glyceryl trinitrate to relax the internal sphincter
- In resistant case : Botulinum toxin injection
- If all above measures fail , then lateral internal anal sphincterotomy or advancement anoplasty.
Initial treatment of active ulcerative colitis ?
Topical or oral 5-aminosalicylic acis ( 5-ASA) therapy
Mainstay of treatment of Active crohn’s disease ?
Glucocorticoid
Drug of first choice in patients with ileal disease ?
Budesonide
Maintenance therapy in crohn’s disease ?
Immunosuppression treatment with thiopurine (Azathioprine and mercaptopurine )
Drug that must be stopped 6 months before conception in IBD?
Methotrexate
Drugs that are,safe in pregnancy in a patient with IBD ?
Aminosalicylate and Azathioprine
Most important step in mx of IBS ?
To make a positive diagnosis as well as educating and reassuring the patient.
Treatment of Autoimmune pancreatitis ?
Glucocorticoid
Only method of effective cure in case of Adenocarcinoma of pancreas?
Surgical resection
