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Medicine > Gastro Management > Flashcards

Gastro Management Flashcards

1
Q

A patient with acute upper GI bleeding , whats your first step in management as a doctor ?

A

Gain IV Access

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2
Q

A patient with a high risk of ulcer after endoscopy , what will you do ?

A

Intravenous ppi infusion

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3
Q

What is the first line step in Diverticular disease ?

A

Endoscopic clipping ( Either alone or after the injection of dilute adrenaline ( Epinephrine )

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4
Q

What is the treatment of choice in Angiodysplasia?

A

Endoscopic thermal ablation

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5
Q

What is the next step in management in Angiodysplasia if it bleeds even after endoscopic thermal ablation?

A

Resection of the affected segment of bowel

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6
Q

Fluid of choice in case of upper GI bleeding in hameodynamically unstable patients ?

A

IV crystalloid fluid should be given to raise the blood pressure ,with a 500 ml bolus is recommended over less than 15 minutes.

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7
Q

What is the scoring system to assess Acute upper GI bleeding ?

A

Modified blatchford score

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8
Q

What clue you may found in CBC report that indicates hypersplenism in CLD ?

A

Thrombocytopenia

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9
Q

How ppi works in upper GI bleeding ?

A
  1. Reduce gastric acid secretion
  2. Neutralise intragastric pH
  3. Promoting clot stability by reducing pepsin induced clot lysis & increasing platelet aggregation
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10
Q

How will you confirm successful eradication of H.pylori following treatment ?

A

Urea breath test or faecal antigen test

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11
Q

A patient with profuse red or maroon diarrhoea & Hypovolaemic shock . CT angiography is done & bleeding point is identified . What is your next step?

A

Catheter angiography with embolisation .

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12
Q

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?

A

Colonoscopy

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13
Q

Most common site of Angiodysplasia in older people ?

A

Caecum

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14
Q

What is the investigation algorithm in case of GI bleeding ?

A

Endoscopy , Colonoscopy , CT angiography > Wireless capsule endoscopy > Enteroscopy > Laparotomy with on table endoscopy

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15
Q

Rx option for Aphthous ulcer ?

A

Topical glucocorticoid ( such as 0.1% triamcinolone in orabase ) or choline Salicylate (8.7%) gel .

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16
Q

Rx option for oral thrush ?

A

Topical miconazole or nystatin . Resistant case requires oral fluconazole

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17
Q

A patient came with painful parotid swelling with abscess . How will you manage?

A

Surgical drainage + Broad spectrum antibiotics

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18
Q

First line drug in case of GERD ?

A

Antacids / Alginates

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19
Q

Treatment option for high grade dysplasia or intramucosal carcinoma of esophagus ?

A

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 .

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20
Q

Treatment of choice for esophageal carcinoma ?

A

Oesophagectomy

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21
Q

Mainstay of treatment of esophageal perforation ?

A

Surgery

22
Q

Treatment of pharyngeal pouch?

A

Cricopharyngeus myotomy (Diverticulotomy) with or without resection of the pouch.

23
Q

Treatment of Achalasia ?

A

Surgical myotomy ( Heller’s operation ) accompanied by partial fundoplication anti reflux procedure .

24
Q

Advanced endoscopic technique for the mx of Achalasia ?

A

POEM (Peroral endoscopic myotomy)

25
Q

Treatment of Menetrier’s disease ?

A

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 .

26
Q

Mx option for Z-E syndrome ?

A

Unifocal tumour : Resection
Multifocal tumor / Metastasis : Continuous therapy with PPI in high dose / Somatostatin analogue

27
Q

Gold standard treatment for Gastric carcinoma ?

A

Surgery is the gold standard and total gastrectomy with lymphadenectomy is the operation of choice.

28
Q

Treatment of Gastroparesis ?

A

Small ,frequent, low fat meals and the use of metoclopramide and domperidone. In severe case , long term jejunostomy feeding or TPN is required .

29
Q

Aim of mx of Coeliac disease ?

A

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.

30
Q

Most common cause of treatment failure in Coeliac disease ?

A

Accidental or Unrecognized gluten ingestion

31
Q

Treatment of Dermatitis herpetiformis?

A

Rash usually responds to gluten free diet , but some patients require additional treatment with dapsone .

32
Q

Treatment of choice for Tropical sprue?

A

Tetracycline 250mg 4 times for 28 days.

33
Q

First line treatment for Small intestinal bacterial overgrowth ?

A

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 .

34
Q

Initial treatment of Whipple’s disease ?

A

Intravenous ceftriaxone (2 gm daily for 2 weeks ) followed by co-trimoxazole for at least 1 year.

35
Q

Treatment of Bile acid diarrhoea ?

A

Bile acid sequestrant , such as Cholestyramine or colesevelam , which binds bile salt in intestinal lumen .

36
Q

Treatment of Radiation enteropathy ?

A

Sucralfate enema and hyperbaric oxygen.
Diarrhoea in acute phase is treated with codeine phosphate, diphenoxylate or loperamide. Antibiotic for bacterial overgrowth .

37
Q

Treatment of intestinal lymphangiectasia?

A

Low fat diet with medium chain triglyceride supplement .

38
Q

Intitial strategy in mx of Eosinophilic gastroenteritis ?

A

Dietary manipulation

39
Q

Cornerstone of treatment for Colorectal cancer ?

A

Surgery

40
Q

Treatment of Hirschsprung disease ?

A

Resection of the affected segment

41
Q

Treatment of anal fissure ?

A
  1. Bulk forming laxative and increased fluid intake
  2. Nitric oxide and 0.2% glyceryl trinitrate to relax the internal sphincter
  3. In resistant case : Botulinum toxin injection
  4. If all above measures fail , then lateral internal anal sphincterotomy or advancement anoplasty.
42
Q

Initial treatment of active ulcerative colitis ?

A

Topical or oral 5-aminosalicylic acis ( 5-ASA) therapy

43
Q

Mainstay of treatment of Active crohn’s disease ?

A

Glucocorticoid

44
Q

Drug of first choice in patients with ileal disease ?

A

Budesonide

45
Q

Maintenance therapy in crohn’s disease ?

A

Immunosuppression treatment with thiopurine (Azathioprine and mercaptopurine )

46
Q

Drug that must be stopped 6 months before conception in IBD?

A

Methotrexate

47
Q

Drugs that are,safe in pregnancy in a patient with IBD ?

A

Aminosalicylate and Azathioprine

48
Q

Most important step in mx of IBS ?

A

To make a positive diagnosis as well as educating and reassuring the patient.

49
Q

Treatment of Autoimmune pancreatitis ?

A

Glucocorticoid

50
Q

Only method of effective cure in case of Adenocarcinoma of pancreas?

A

Surgical resection

Medicine (9 decks)

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