GI

Question 1

TX of intussusception

Answer 1

IV fluids
IV antibiotics - Amoxicillin , gentamicin , metronidazole
if needed decompensated with gas or contrast enema
might need surgery

Question 2

Tx of mesenteric adenitis

Answer 2

symptomatic

ample fluids and paracetamol

Question 3

Management of patients with small AAA

Answer 3

• lifestyle changes
• smoking cessation
• pharmacotherapy ( beta blockers , statins , antihypertensive)
• ongoing surveillance

Question 4

management of drug induced acute retention of urine ( eg - from anticholinergics)

Answer 4

• withdraw drug
• leave a catheter in for 48 hours , with empiric antibiotics
• remove the catheter and give a trial or prazosin or terazosin

Question 5

Management oF Acute Appendicitis

Answer 5

• surgery

- if perforated - cefotaxime and metronidazole

Question 6

Management of Small bowel obstruction

Answer 6

• IV fluids and bowel decompression with NG tube

- laparotomy or hernia repair

Question 7

Management of Large Bowel Obstruction

Answer 7

drip and suction

surgical referral

Question 8

Management of biliary colic

Answer 8

morphine IV
fentanyl IV
ketorolac IM
cholecystectomy

Question 9

Management of acute cholecystitis

Answer 9

• IVF
• analgesics
• antibiotics
  Cholecystectomy

If septic - amoxicillin /ampicillimm IV plus gentamicin IV
when afebrile - Amoxicillin + clavulanate

Question 10

Management of Acute pancreatitis

Answer 10

• IVF
• Analgesics (morphine , fentanyl )
  ERCP if obstructive LFTs

Question 11

Management of Chronic pancreatitis

Answer 11

• Paracetamol or codeine

pancreatic enzyme supplements

Question 12

Antibiotics in Acute Diverticulitis

Answer 12

Mild
Amoxicillin+ Clavulanate
OR
Metronidazole + Cephalexin

Severe
Ampicillin + Gentamicin + Metronidazole
OR
Metronidazole + Ceftriaxone

Question 13

Tx of peritonitis

Answer 13

Iv cephalosporin or amoxy/ampicillin

+ gentamicin + metronidazole.

Question 14

Tx of anal fissure

Answer 14

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

Question 15

Side effect of Glyceryl trinitrate

Answer 15

Headache.

Question 16

Tx of proctalgia fugax (levator ani spasm)

Answer 16

hot drink 
salbutamol inhaler 
glyceryl trinitrate spray 
antispasmodics 
CCBs and clonidine

Question 17

tx of solitary rectal ulcer

Answer 17

high residue diet and avoidance of constipation

Question 18

Tx of Perianal hematoma

Answer 18

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

Question 19

prevention of perianal hematoma

Answer 19

• increased fiber intake and avoidance of straining

Question 20

Tx of perianal abscess

Answer 20

drain via cruciate incision
if recalcitrant or spreading with cellulitis use
- Metronidazole + Cephalexin

Question 21

Tx of ischiorectal abscess

Answer 21

surgical incision and drainage ASAP under deep general anesthesia

Question 22

Tx of pilonidal sinus and abscess

Answer 22

surgical drainage , excise pits and remove all ingrown hair

+ antibiotics ONLY if there is severe surrounding cellulitis

Question 23

Tx of skin tags

Answer 23

elliptical excision

Question 24

tx of perianal warts

Answer 24

Podophyllin or Imiquimod

Question 25

Tx of hemorrhoids

Answer 25

rubber band ligation - most effective
cryotherapy
sphincterectomy

hemmorhoidectomy for large strangulated piles

prevent - eat fiber foods

Question 26

Tx of fecal incontinence

Answer 26

• direct sphincter repair
• direct injections of collagen or silicone
  -artificial sphincter
  Last resort - colostomy

Question 27

Tx of pruritus Ani

Answer 27

treat underlying condition
use aqueous cream to wash anus
pharm 
- methylprednisolone aceponate 
OR
- hydrocortisone 1%
OR
- hydrocortisone 1% + clioquinol/clotrimazole% 

if resistant - triamcinolone intradermally
if really severe - fractionated X-ray