GI Flashcards
TX of intussusception
IV fluids
IV antibiotics - Amoxicillin , gentamicin , metronidazole
if needed decompensated with gas or contrast enema
might need surgery
Tx of mesenteric adenitis
symptomatic
ample fluids and paracetamol
Management of patients with small AAA
- lifestyle changes
- smoking cessation
- pharmacotherapy ( beta blockers , statins , antihypertensive)
- ongoing surveillance
management of drug induced acute retention of urine ( eg - from anticholinergics)
- withdraw drug
- leave a catheter in for 48 hours , with empiric antibiotics
- remove the catheter and give a trial or prazosin or terazosin
Management oF Acute Appendicitis
- surgery
- if perforated - cefotaxime and metronidazole
Management of Small bowel obstruction
- IV fluids and bowel decompression with NG tube
- laparotomy or hernia repair
Management of Large Bowel Obstruction
drip and suction
surgical referral
Management of biliary colic
morphine IV
fentanyl IV
ketorolac IM
cholecystectomy
Management of acute cholecystitis
- IVF
- analgesics
- antibiotics
Cholecystectomy
If septic - amoxicillin /ampicillimm IV plus gentamicin IV
when afebrile - Amoxicillin + clavulanate
Management of Acute pancreatitis
- IVF
- Analgesics (morphine , fentanyl )
ERCP if obstructive LFTs
Management of Chronic pancreatitis
- Paracetamol or codeine
pancreatic enzyme supplements
Antibiotics in Acute Diverticulitis
Mild
Amoxicillin+ Clavulanate
OR
Metronidazole + Cephalexin
Severe
Ampicillin + Gentamicin + Metronidazole
OR
Metronidazole + Ceftriaxone
Tx of peritonitis
Iv cephalosporin or amoxy/ampicillin
+ gentamicin + metronidazole.
Tx of anal fissure
initial - high fiber diet , stool softeners, topical application of local anesthesia and topical Glyceryl trinitrate.
Botulinum toxin can be injected for temporary relief over 3 months
if recurrent issue - lateral internal sphincterotomy
Side effect of Glyceryl trinitrate
Headache.
Tx of proctalgia fugax (levator ani spasm)
hot drink salbutamol inhaler glyceryl trinitrate spray antispasmodics CCBs and clonidine
tx of solitary rectal ulcer
high residue diet and avoidance of constipation
Tx of Perianal hematoma
If presents 1) <24 hours of onset - aspirate without anesthesia 2)24 hours to 5 days - inscise , deroof and squeeze out the thrombosis under local anesthesia 3) day 6 onwards best left alone
prevention of perianal hematoma
- increased fiber intake and avoidance of straining
Tx of perianal abscess
drain via cruciate incision
if recalcitrant or spreading with cellulitis use
- Metronidazole + Cephalexin
Tx of ischiorectal abscess
surgical incision and drainage ASAP under deep general anesthesia
Tx of pilonidal sinus and abscess
surgical drainage , excise pits and remove all ingrown hair
+ antibiotics ONLY if there is severe surrounding cellulitis
Tx of skin tags
elliptical excision
tx of perianal warts
Podophyllin or Imiquimod
