GI pt 2 Flashcards

1
Q

acute upper GI bleed

EVALUATION AND TREATMENT
- UGI bleeding is _____ in the majority of cases
o Even high-risk patients are more likely to die from underlying cause rather than “bleeding out”
- MUST identify those patients who are in need of emergent therapies (ex. bleeding varices)
- ABCs!
- Hematocrit may take 24-72 hours to equilibrate with the extravascular fluid so NOT a reliable indicator of the severity of acute bleeding
- Assess the patient’s _____ status FR
o In hemodynamically stable patients  aggressive _____ management or _____ replacement can be delayed until further evaluation is completed
o Elevated _____ (>100) and low SBP suggest a more significant hemorrhage
o In patients with hemodynamic compromise  more urgent situation!
 Start _____, type and screen for blood product replacement, stat _____ (CBC, electrolytes, PT/PTT/INR, LFTs, BUN/Cr)
 Prep for upper _____
- UGI bleed endoscopy – early therapeutic endoscopy
o Varices  band ligation or sclerotherapy
o Non-variceal etiologies  sclerotherapy, electrocoagulation, heater probes, and lasers
- _____ or longer acting derivative _____ – used for both varices and PUD either before endoscopy or when it is unsuccessful, contraindicated, or unavailable
- 5 variables that are independent predictors of adverse outcomes in upper GI bleeding
o Initial hematocrit < 30%
o Initial systolic BP < 100mgHg
o Red blood in the nasogastric lavage
o History of cirrhosis or ascites on examination
o History of vomiting red blood

A
self-limited
hemodynamic
fluid
blood product
HR
IV fluids
labs
endoscopy
Somatostatin
octreotide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

acute lower GI bleed

TREATMENT
• Triage similarly to UGI bleed
• Discontinue _____ and _____

A

antiplatelet

anticoagulants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

PUD

TREATMENT
-	\_\_\_\_\_ agents
o	TOC = \_\_\_\_\_
o	2nd LINE = H2 blockers 
-	Mucosal agents – \_\_\_\_\_, misoprostol, antacids
-	Eradication of H. pylori if present
o	H. PYLORI ERADICATION CALLS FOR “QUADRUPLE THERAPY” – TREAT PATIENTS WITH 14 DAYS OF 
1.	\_\_\_\_\_ BID
2.	\_\_\_\_\_ QID
3.	\_\_\_\_\_ QID
4.	\_\_\_\_\_ TID
-	Stop NSAIDs &amp; STOP smoking
-	Ulcers refractory to treatment (very rare) may require surgery
A
Acid-antisecretory
PPIs
bismuth sucralfate
PPI
bismuth subsalicylate
tetracycline
metronidazole
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

gastric cancers/tumors
ZOLLINGER-ELLISON (ZE) SYNDROME(GASTRINOMA)

TREATMENT

  • Cure can only be achieved if gastrinoma(s) can be _____ prior to metastatic spread
  • In patients with metastatic liver disease, treatment is focused on controlling acid hypersecretion with _____ (these patients will be on massive doses of PPIs)
  • PPIs end in -prazole (ex. omeprazole, esomeprazole)
A

resected

PPIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

gastric cancer (gastric adenocarcinoma)

TREATMENT

  • Curative _____ & post-op _____ or chemoradiation
  • Palliative Modalities: resection, surgical diversion, laser or stent therapy, radiation therapy, chemotherapy
A

surgical resection

chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

celiac disease

TREATMENT: remove all _____ from diet (all wheat, rye, barley)

  • Need to work with dietician b/c many products (including meds) have gluten
  • Most people with celiac disease are also lactose intolerant
  • Short term dietary supplements needed (___, ___, ___, ___)
  • **if disease is not responding to gluten free diet (but they have good compliance as seen by IgA)  poor prognosis
  • Consider the development of T Cell lymphoma in patients who have appeared to relapse (weight loss, abdominal pain, malabsorption)
A

gluten

A, B12, D, E

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

whipples disease

TREATMENT: goal = prevent progression to _____ symptoms (b/c they can be permanent)
- ABX therapy shows dramatic improvement in several weeks w/ complete clinical response in 1-3 months
o _____ aka _____ double strength = first line (need meds that cross the BBB)
o Untreated = fatal
- discontinuation of tx  relapse in 1/3 (follow closely for signs of relapse)  treat for 1 year
- After TX, repeat _____ at 6 & 12 months for histology to follow healing process

A

neuro
TMP-SX
BACTRIM
duodenal biopsies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

SIBO (small intestinal bacterial overgrowth)

TREATMENT: treat underlying cause
- diet of high _____, low _____ and low _____ may reduce s/s
- 1-2 weeks of broad spectrum abx (_____ 500 mg)
o _____ for 7-10 days is better but more expensive
- If symptoms recur  use cyclic tx
- If motility disorder  use agents to ↑ motility
o Prokinetic agents = metoclopramide (REGLAN)
o _____ (SandoSTATIN) - also used for portal HTN (not FDA approved for use for SIBO but works)
- ***avoid continuous ABX to prevent resistance, d/c narcotics, minimize PPI use

A
fats
carbs
fiber
CIPRO
RIFAMPIN
Octreotide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

lactase deficiency

TREATMENT  achieve pt _____
- Patients need to find out how much they can tolerate before they get s/s
o High lactose foods = milk, ice cream, cottage cheese, unpasteurized yogurt (bacteria produces lactase, but it’s well tolerated)
o Milk can be pre-treated with lactase  70-100% lactase free
- Limit lactose to < 12 g day (equivalent to 1 cup of milk)
- OTC lactase enzyme replacement = _____ (caplets that can be taken with milk products)

A

comfort

LACTAID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

ileus

TREATMENT: tx medical or surgical condition that caused the problem

  • restrict _____ intake and slowly enhance diet as bowel function returns
  • severe, prolonged ileus  __ suction, _____ & electrolytes
A

oral
NG
parenteral fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

bowel obstruction

TREATMENT:
 non-surgical tx will result in complete resolution in 75% of partial obstructions and 16-36% of complete obstructions
***any pt with suspected bowel osntruction  admitted to hospital
- aggressive _____ resuscitation (IV fluid and electrolyte replacement, ___)
- bowel decompression (usually w/ _____)  to manage nausea and emesis
- Broad spectrum abx (covering gram – and anaerobes)  _____
- Surgical consult (if complicated  go to OR for abdominal exploration)
 early surgical evaluation for strangulation/ischemia “never let the sun set on a bowel obstruction”
o Patients for immediate surgery:
 Free air on plain xrays or CT indicating bowel perforation
 Signs of ischemia
 Complete or closed loop obstruction

A

fluid
NPO
NG tube
2nd gen cephalosporin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

OGILVIE SYNDROME

TREATMENT: address underlying condition (get the colon working again)
- NC or _____ tube for decompression
- Increase pt mobility to promote colonic movement
- Avoid opioids and anticholinergics
- Can use _____ but avoid oral laxatives (can increase perforation)
- Patients who fail conservative management can be treated more aggressively
o _____ injection and colonic decompression via colonscopy

A

rectal
enemas
Neostigmine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

appendicitis

TREATMENT = surgical _____ (laparoscopic approach if early & uncomplicated)
 need pre-op _____ prophylaxis to cover gram – and anaerobic bacteria

A

appendectomy

abx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

hernias

TX OF HERNIAS = _____ hernia repairs (place a _____ patch over the hole/weak spot)

A

laparoscopic

mesh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly