Gastrointestinal: explanation and treatment Flashcards
Appendicitis: management?
- IV fluids (if shock)
- Analgesia
- Antibiotics: IV cef + metro (continue after surgery if complicated)
- Nil by mouth and laparoscopic appendicectomy
IBD: treatment
Bowel obstruction: explanation
- Normal
- What is it/symptoms
- What causes it
GI tract is a tube which starts at your mouth –> foodpipe –> stomach –> small and large intestine
Blockage of that tract. Means that food can’t get past. So can’t poop, extensive vomiting. Air builds up before the blockage, causing abdominal distension.
SBO: adhesions from previous surgery
LBO: cancer
Bowel obstruction: treatment
Diverticular disease
- What is it?
- What causes it?
- Symptoms for diverticulitis and diverticulosis
Diverticulosis management
Diverticulitis management
Gastro management
- Fluids (oral/IV if severe) and electrolytes
- Diet: eat what you can tolerate
- Antiemetics
Pancreatitis
- Normal
- What is it/symptoms
- Causes
Pancreas is an organ in your tummy. When food comes into your intestines, it squirts out juices to help digest it
Pancreatitis is where your pancreas becomes inflammed and angry. It causes stomach pain (worse when you eat), plus nausea and vomiting.
Gallstones and alcohol use can cause it.
Bowel cancer
- What is it/symptoms
- Causes
What is it
- Bowel cancer is when some of the cells in your large bowel begin to grow out of control, forming a lump called a tumour.
- Cancer cells can break off from the tumour and spread
Symptoms
- Change in bowel habit: constipation/diarrhoea, blood/mucus in stool
- Fever, fatigue, night sweats, unexplained weight loss
Causes
Bowel cancer
- Management
Surgery
- If not spread, removal of tumour with clear margins has a good prognosis
- Removal of lymph nodes
- Some metastases can be removed
- Palliative surgery: if bowel obstruction or other complication
Chemotherapy + immunotherapy
Radiation
- Rectal cancer > colon cancer (latter mainly to treat brain and bone mets)
Gall bladder disease
- Explanation + symptoms
Gall bladder disease
- Initial management
- Cholelithiasis
- Cholecodolithiasis
- Cholecystitis
- Cholangitis
Initial management
- Pain relief: paracetamol –> opioids
- Fluids (itis only)
- Antibiotics: IV ceftriaxone and metronidazole (itis only)
Cholelithiasis: lap chole (only if symptomatic)
Cholecodolithiasis: lap chole + bile duct clearance
Cholecystitis: lap chole
Cholangitis: ERCP +- sphincterotomy, placement of drainage stent, stone extraction
GORD management
Lifestyle changes
- Smoking: reduce
- Nutrition: avoid trigger foods, weight loss
- Alcohol: reduce
- Physical activity: weight loss
- Position: don’t eat right before bed, sleep with head up
1-2 months PPI (directly reduces stomach acid production), see if symptoms resolve.
If not, or if risk factors, do endoscopy.
If doesn’t work
- Other medications available
- Surgery: Nissen fundoplication, hiatus hernia repair
Peptic ulcer management
- Lifestyle
- H pylori positive
- H pylori negative
Lifestyle
- Avoid NSAIDs and alcohol
Positive
- PPI + amoxicillin + clarithromycin (1-2 weeks), followed by PPI (4-8 weeks)
Negative
- PPI (8-12 weeks)
Peptic ulcer management
- Bleeding
2x IV
Blood transfusion
Antiemetic
NBM
IV PPI (pantoprazole)
Endoscopy and ulcer repair: clips + adrenaline, fibrin/thrombin, thermal coagulation
