GI and Lung Disease Flashcards
Gilbert’s syndrome
hepatic cause of indirect (unconjugated) hyperbilirubinemia - dec. activity of glucuronosyltransferase (enzyme in conjugation pathway)
Common, hereditary, benign
Treatment for Hep B
yearly U/S and AFP (CT of liver - HCC) if inc. risk (African >20, Asian>40, FHH of HCC)
First line: nucleoside analog: entecavir (Baraclude), tenofovir (Viread)
Hep A vaccine, avoid hepatotoxins
Note: if LFTs are normal with chronic Hep B, so indication to medicate; should get yearly screens if high risk
Treatment for Hep C
must do RNA viral load and genotype to diagnose and determine best tx
Medication: involves ribavirin in combo with nucleoside analogue (sofosbuvir, ledipasvir)
Imagining: fibroscan or biopsy for staging of liver disease
- U/S q 6 mo; CT annually –> HCC
Avoid hepatotoxins (Etoh NSAIDS)
dysphagia - what is most common management
EGD to determine cause
H. Pylori treatment
combo of 2 ABX plus PPI or H2 blocker (ranitidine)
- PPI BID + 2 ABX and probiotics for 10-14 days
- continue PPI QD for 2 months
cholecystitis
4 F’s: female, forty, fat, fertile
Note: quit narcotic pain meds prior to HIDA scan
Note: do NOT need cholecystectomy if gallstones or sludge found on U/S and not symptomatic
Criteria for IBS
at least 3 months of continuous/recurrent sxs:
- abd pain received by defecation or accompanied by change in stool AND
- 2 characteristics of disturbed defecation
Treatment for IBS
Reassurance and education
Avoid irritants: cabbage, beans, beer/red wine, brussels, raisins, coffee
Trial: high fiber diet
Medications: only if conservative does not work
- antispasmotic: dicylomine
- psychotropoic: amitriptyline, SSRIs
- Imodium: for diarrhea (beware of cycle of constipation and diarrhea)
treatment for IBD (Crohn’s disease and ulcerative colitis)
anti-inflamatories:
- mainstay: aminosalicylates
- corticosteroids: for ST use (acute attacks)
immune-mudulating agents (suppress)
- murcaptopurine, azathioprine, methotrexate
biological agents (TNF blockers) - remicade and humira
diverticulosis - imagining and treatment
imaging:
- plain film: free air
- CT: abscess
- Colonoscopy
Treatment:
- high fiber diet (10-25 g.day)
- hematochezia: erosion of fecalith in sac
- vasoconstrictive drugs to stop bleeding once located
diverticulitis - imaging and treatment
imaging:
- plain film (r/o free air)
- CT: abscess
colonoscopy CONTRAINDICATED
Treatment
- broad spectrum ABX
- NPO (bowel rest)
- surgical consult if failure to respond
Abscess or peritoneal signs: IV ABX and CT/US guided drainage b/f urgent surgery
smoking cessation medications
nicotine replacement therapy (NRT)
buproprion (Zyban): atypical antidepressent
- can still use patch
varenicline (Chantix): blocks pleasure of smoking (works on nicotine receptor)
- can NOT use patch
SABAs ad SAMAs for COPD
- Albuterol (ProAir, Proventil, Ventolin) - SABA
- Levalbuterol (Xopenex)
- Ipratropium (Atrovent) - SAMA
- Ipratropium/Albuterol (Combivent) - Combo
LABAs and LAMAs for COPD
- Tiotropium (Spiriva) - LAMA
- Aclidinium (Tudorza)
- Salmeterol (Serevent) - LABA
- Formoterol/Arformoterol (Foradil/Brovana)
- Indacaterol (Arcapta)
- Vilanterol
Other treatments beyond triple therapy (LABA, ICS, LAMA)
Azithromycin 250 mg daily: macrolide antibiotic, increases time to next exacerbation
• Beware CV effects/QT prolongation
• Increased bacterial resistance but less likely to become colonized
Roflumilast 500 mcg daily: phosphodiesterase-4 inhibitor
• Reduces exacerbations in 3/4 pts with a history of exacerbations and chronic bronchitis
• GI symptoms (diarrhea and weight loss) may lead to intolerance of medication
