GI 3 + GI 4 treatments Flashcards
Describe the initial management of an SBO
1) Admission & surgical consultation
2) Fluid therapy
3) Diet: NPO
4) Gastrointestinal decompression: NG tube
Indications for surgical therapy with an SBO include what?
1) Immediate surgery for suspected bowel compromise (perforation, necrosis, ischemia)
2) Treating surgical correctable cause of SBO
3) Failure of nonoperative management (3-5 days)
Describe how to manage Celiac disease
1) Gluten free diet
2) Treat micronutrient deficiencies: iron & folate deficiency
3) Osteopenia: obtain bone density, supplemental calcium & vitamin D
4) Hypo splenism: (loss of lymphocytes through inflamed bowel mucosa) need a pneumococcal vaccine
Describe management for mild acute pancreatitis
1) NPO, bedrest, nasogastric suction (severe pain & distension)
2) Morphine for pain
3) Clear liquid diet when pain free & bowel sounds present
4) Advance to low-fat diet, then advance slowly as tolerated
5) 20% have recurrent pain upon refeeding
6) Cholecystectomy before discharge for gallstone-induced pancreatitis
Describe Tx for severe acute pancreatitis (necrotizing pancreatitis)
1) Aggressive fluid resuscitation
2) ICU
3) Vasopressors may be required
4) Enteral nutrition (NG, NJ) if without oral nutrition 7-10 days
5) May require parenteral nutrition (lipids)
Describe how to manage chronic pancreatitis
1) Low-fat diet
2) Absolute cessation from alcohol!
3) Opioids should be avoided
4) Tylenol, NSAIDs, tramadol, TCA, SSRI, gabapentin, pregabalin
5) Exocrine pancreatic insufficiency: chronic diarrhea-need to rx pancreatic enzymes
6) Treat associated diabetes
7) Idiopathic: pain may respond to enzyme replacement
What is a key part of chronic pancreatitis management?
Absolute cessation from alcohol
Describe Endoscopic therapy (50% success rate) for chronic pancreatitis
1) Treat biliary tract disease
2) Drain pseudocysts (symptomatic, > 6 cm)
3) Eliminate obstruction of pancreatic duct
-Stent placement
-dilation
What is important to differentiate before you treat acute appendicitis?
Non-perforated (aka, simple or uncomplicated) vs perforated
How should you manage asymptomatic pts with gallstones?
Cholecystectomy if increased risk of GB cancer (gallbladder adenomas/polyps, Porcelain gallbladder, & large gallstones (particularly if larger than 3 cm.))
Describe management of Biliary colic/pain with gallstones
1) Outpatient pain control (NSAIDs, opioids)
2) Elective cholecystectomy
3) consider referral to GI ?ERCP if needed(elev AST/ALT/ t bili)**
Standard method of Tx for symptomatic gallstones is what?
Laparoscopic cholecystectomy
Cholangitis: List the supportive measures
Admission, IV hydration/correct electrolyte abnormalities, analgesia, observe for organ dysfunction & shock
Cholangitis: Describe how to Tx
1) IV Antibiotics: tailored to culture & susceptibility results
2) Biliary drainage: timing based on severity; most within 24-48 hours
-Procedure of choice: Endoscopic sphincterotomy (ERCP) with stone extraction and/or stent insertion
-ERCP failure or not possible: biliary drain placement (EUS, PTC) or surgical drainage – patient must be hemodynamically stable to undergo procedure.
Choledocholithiasis & Cholangitis: When is ERCP the procedure of choice?
ERCP with sphincterotomy & stone extraction is procedure of choice if a high likelihood that obstruction caused by stone. Or ERCP with stent placement if caused by mass.
Choledocholithiasis: Describe management (incl. both with and without cholecystitis)
Endoscopic (ERCP) sphincterotomy & stone extraction
Cholecystitis: Laparoscopic cholecystectomy within 72 hours
Without cholecystitis: Laparoscopic cholecystectomy within 2 weeks
Gluten intolerance: Describe how to manage it
1) Patient education before gluten-free diet
2) Involve dietician
What is the goal of lactose malabsorption Tx?
Achieve patient comfort
Describe lactose malabsorption Tx
1) Goal is to achieve patient comfort
2) Define “Threshold of intake” at which symptoms occur
-High lactose foods: milk, ice cream, cottage cheese
-Aged cheeses have lower lactose content
-Unpasteurized yogurt contains bacteria that produce lactase & generally well tolerated
3) Spread intake of dairy throughout the day
Lactose malabsorption:
1) What is an OTC Tx?
2) What Tx may increase risk of osteoporosis?
1) Lactase enzyme replacement
2) Restriction or elimination of milk products
List some OTC and lifestyle Txs for lactose malabsorption
1) Widely available milk pretreated with lactase (making it 70-100% lactose-free) and non-dairy milks
2) Lactase enzyme replacement available OTC
3) Restriction or elimination of milk products may increase risk of osteoporosis
-Consider calcium supplementation
What is the main Tx for bacterial overgrowth (SIBO)?
Empiric PO antibiotic x 1-2 weeks:
Rifaximin (xifaxan) 1 PO TID for 14 days
Describe how to Tx bacterial overgrowth (SIBO)
1) Treat underlying anatomic defect, if applicable
2) Empiric PO antibiotic x 1-2 weeks
a) Rifaximin (xifaxan) 1 PO TID for 14 days
b) Ciprofloxacin 500 mg PO BID
c) Amoxicillin clavulanate 875 mg PO BID
d) Metronidazole + Bactrim DS 250mg PO TID + 160/800 BID
3) Recurrent symptoms off antibiotics: Cyclic therapy (1 week out of 4)
What are 2 key parts of managing alcoholic liver disease?
1) Abstinence from alcohol is ESSENTIAL
2) Need vaccination for hepatitis A & B
