GI part 1 Flashcards
How do you treat mild to moderate travellers diarrhea
(up to 3 BM per day, no fever no blood)
first line: Loperamide 4mg stat then 2mg after each lose stool, max 16mg/day
how do you treat moderate travellers diarrhea
(3-5 BM per day no blood or fever)
Norfloxacin 1-3 days
Ciproflaxacin 1-3 days
Levofloxacin 500mg 1-3 days
Azithro 1g single dose or 500mg 1-3 days
rifampin (not used in kids less than 12)
When treating travellers diarrhea with fluoroquinolones what special considerations should we make with children
children less than 18 should not take fluoroquinolones
Therefore the alternative is Azithromycin
IIIFF!! kids are allergic to azithromycin (macrolides) they may use a small dose of fluoroquinolones
how do you treat severe travellers diarrhea (fever and blood 3-5 movements per day)
same as moderate
first line fluoroquinolones
or azithromycin
or rifampin
When would you recommend Dukorol?
its an oral inactivated travellers diarrhea
The vaccine may be considered for selected high risk travellers like
young children greater than.2
patients with chronic illness
increased risk of acquiring travellers diarrhea (immunocompromised)
or those whom a brief illness cannot be tolerated
when would you advise an anti-motility agent in someone with diarrhea?
anti-motility can prolong invasion with shigella, salmonella, and campylobacter.
They should only be considered in combo with an antibiotic if the traveller has poor access to toliet
dont use in children less than 3
what antibiotic would you recommend in moderate - severe diarrhea in thailand india and nepal
AZITHROMYCIN because its where campylobacter is resistant to quinolones so you need a macrolide
What is considered mild to moderate c.diff and how do you treat it in adults
mild to moderate c.diff is WBC less than 15 and SCR less than 1.5
first line oral vancomycin 125mg 10-14 days
Metronidazole 500 mg TID or 250mg QID for 10-14 days
What is considered severe c.diff and how do you treat it
WBC greater than 15 and SCR greater than 1.5
oral vancomycin 125mg QID 10-14 days
or Fidaxomicin 200 mg BID for 10 days
what is a risk factor for c.diff
receiving an extended spectrum cephalosporin or fluoquinolone is a major risk factor fo c.diff
-clindamycin as well
-using PPI
what is chronic diarrhea
3 or more loose stools DAILY for 4 weeks
jesus
what bacteria causes travellers diarrhea
Most commonly E.coli
less common: salmonella, campylobacter, shigella
the routine use of antibiotics to prevent travellers diarrhea is NOT recommened due to the risk of adverse events
true. and probiotics have limited evidence
when would you perform a stool culture in somone who has travellers diarrhea?
in health care workers, immunocompromised, and those not improving in supportive care
and consider stool parasitology for diarrhea persisting more than 2 weeks
what medications can be used to treat chronic diarrhea (greater than 28 days)
bulking agents like Psyllium and Cholestramine
Alpha Adrenergic Agonists: Clonidine (opiod withdrawl diarrhea)
Somatostatin analouges: oxtreitide, somatostatin
What medications can cause constipation
anticholingergics: antipsychotics
what is chronic constipation and what are the 5 treatment steps?
chronic constipation is greater than 3 months
step 1: increase dietary fiber and exercise
step 2: add bulk forming laxative (psyllum)
step 3: add osmotic laxative (PEG and lactulose)
step 4: add prn suppository or stimulant (senna, bisacodyl)
step 5: prucalopride daily
how do you decrease laxative useasge?
slowly over 3-4 weeks
how can you treat fecal impaction
manually disimpact with 2% lidocaine
enemas daily for up to 3 days
would you use stool softners docusate sodium or calcium to treat any type of constipation
no it doesnt work no evidence
what is your first line for opiod induced constipation
stimulants like
biscadoly - strong
or sennosides - mild
this is your third line for chronic constipation
when would you use prosecretory agents?
use these in individuals who are suffering from constipation despite trying everything (all 5 steps)
what medictions of constipation to avoid during pregnancy
docusate
linaclotide
prucalopride
caterol oil and mineral oil
what is the first line treatment for IBS constipation?
water solube fibre (psyllium, calcium polycarbophil)
what is the first line for IBS diarrhea
first line is loperamide
also:
water soluble fibre (psyllium, calcium polycarbophil)
eluxadoline
cholestyamine
ondans
