Gastrointestinal Flashcards
Inguinal Hernia
Incarcerated or Strangulated = Surgical Repair + Cefazolin and Vancomycin (Prophylactic)
Asymptomatic = Watch and Wait until symptomatic
Large or Symptoms = Open-mesh or laparoscopic repair + Cefazolin and Vancomycin (Prophylactic)
Non-Surgical = Truss Support
Achalasia
Surgical Candidate
- Pneumatic Dilation of LOS
- Laparoscopic Cardiomyotomy
Non-Surgical Candidate
- Pharmacological to relax LOS
- Isosorbide dinitrate
- Nifedipine (CCB)
- Verapamil (CCB)
- Botulinum Toxin A injection into LOS
- Gastrostomy
Anal Fissure
Conservative Treatment
- High Fibre
- Adequate Fluid
- Sitz Bath
- Topical Analgesia
- Stool Softners
Pharmacological
- Topical GTN to relax sphincters (headache)
- Topical Diltiazem (CCB) to relax sphincters (itching)
Surgical (resistant fissures)
- Botulinum Toxin injection (paralyse sphincters)
- Surgical Sphincterectomy (faecal leak)
- Anal advancement Flap
Anorectal Abscess
Surgical Drainage
- Postop Care
- ? Fistulotomy
- Broad Spec Abx (Ampicillin (G-ve) + Metronidazole (anaer))
- Aminoglycoside Gentamycin
Appendicitis
Fit for Surgery
- Supportive treatment
- Appendicectomy
- Prophylactic Abx (Amoxicillin + Metronidazole
Not Fit for Surgery
- Supportive Treatment
- ABx (Ampicillin + Metronidazole)
Perforation = everything emergency
Crohn’s Disease
Acute Exacerbation
- Oral Corticosteroids (Prednisolone)
- ?Azathiprine (purine synth i)
- ?Management of extra-intestinal
- ?ABx
- Surgery
- Manage extra-GI
- ABx
Upper GI Disease
- PPI (lansoprazole or omeprazole)
- ?Prednisolone
- ?Azathioprine
- ?TNF-a Infliximab or Adalimumab
- ?Surgery or Dilation of stricture
- ?Extra-GI symptoms
GORD
PPI (omeprazole or lansoprazole)
- Lifestyle Changes (weight loss, head of bed raise, avoid late night eating, no caffeine, alcohol, spice
PPI Responsive
- Continue PPI
- Fundoscopy
Incomplete Response to PPI
- High dose PPI + Further investigation
- ?H2RA (cimetidine or ranitidine)
Haemorrhoids
All Patients
1. Dietary and Lifestyle modification (fibre and fluid)
Grade 1 - Topical corticosteroid hydrocortisone rectal
Grade 2 - Rubber band ligation above dentate line to prevent pain or Sclerotherapy (phenol) to destruct
Grade 3 Prolapsing internal - Rubber band ligation above dentate line
Grade 4 - int, ext, mixed - Surgical haemorrhoidectomy
Hiatus Hernia
Symptomatic GORD
- PPI (omeprazole or lansoprazole)
- Lifestyle Changes
- Med Review avoid CCBs, nitrates, b blockers to prevent decrease LOS tone.
Type 1 (sliding) 1. Surgical repair
Types 2,3,4
1. Surgical Repair
Upper GI haemorrhage and/or obstruction and/or volvulus
1. Resuscitation and urgent surgical repair
Malignant Oesophageal Stricture
Stage Dependent
- Endoscopic Resection
- Chemotherapy (cisplatin + fluorouracil
- Radiotherapy
- Oesophagectomy
- Endoscopic Ablation
- Stenting
Colorectal Cancer
TNM Stage Dependent
Medical
- Pain relief
- Chemotherapy
- Radiotherapy
- Palliative Anticipatory
Surgical
- Local excision or radial removal of colon.
Ruptured Viscus (Bowel Perforation)
- Urgent Evaluation + Monitoring + Endoscopy + Omeprazole or Cimetidine.
- Surgical Intervention (Laparoscopy)
Treat bacterial peritonitis with antibiotics.
Ascending Cholangitis
- A-E + SEPSIS 6 (if criteria met)
2. Biliary Decompression and Drainage with lithotripsy and analgesics
Acute Pancreatitis
- A-E + Sepsis 6 (if criteria met)
- Glasgow Score
- ERCP if cholangitis or bile duct obstruction or cholecystectomy if gallstone cause but no cholangitis or obstruction.
Vitamin replacement and alcohol abstinence if alcohol cause.
Alcoholic Liver Disease
Conservative
- Alcohol abstinence with withdrawal management
- Weight management
- Smoking cessation
- Nutritional support
Medical
- Immunisation (flu, pneum, hep A if IgG neg, Hep B if surface antibody neg)
- Prednisolone
Surgical
- Liver Transplant
