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Clin Med II > GI Therapeutics > Flashcards

GI Therapeutics Flashcards

1
Q

Celiac Sprue

A

Gluten-free diet

Multivit, iron, folate, calcium, vitamin D

Steroids for severely ill

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2
Q

Whipple’s disease

A 
Trimethoprim-sulfamethoxazole BID x 1 yr
Parenteral penicillin for ill pts
Oral PCN for pts allergic to sulfa
Chloramphenicol for failures
Supplement folate, B 12, fat soluble vitamins and iron as needed
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3
Q

Achalasia

A

nitrates, calcium channel blocker
(inconsistent resp.)

Botox (inconsistent resp.)

Disruption of LES

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4
Q

Eosinophillic Esophagitis

A

dietary modification, topical and oral steroids, dilatation with stricture

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5
Q

Esophageal Spasm

A

If due to acid→ block acid production

If spontaneous → muscle relaxants

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6
Q

Gastroesophageal Reflux

A

Lifestlye modifications (↑ head of bed, diet)

Antacids
H2-receptor antagonist
PPI
Metachlopromide

Surgery

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7
Q

How can you decrease adverse events in NSAID users?

A

PPI and H2 blockers

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8
Q

MOA of PPI

A

Bind the acid-secreting enzyme H+-K+- ATPase, or “proton pump,” permanently inactivating it
Inhibit >90% of 24 hr acid secretion

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9
Q

H2 blockers MOA

A

Block, histamine, one of the first stimuli for acid production
Rapid onset <1 hr lasting for 12 hr

Cimetidine (drug-drug interactions), Ranitidine, Nizatidine, and famotidine

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10
Q

Tx for PUD

A

Pre endoscopy IV PPI

endoscopic hemostasis (cautery, clip or injection)

Followed by feeding and oral PPI for low risk or IV PPI x 72 hr for high risk

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11
Q

Tx for H. Pylori

A

Abx x 2 wks + PPI

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12
Q

Zollinger-Ellison Sundrome

A

High dose PPI and removal of tumor

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13
Q

Gastroparesis

A

Diet
Feeding tube

Anti-emetics

Metoclopramide
Erythromycin
Gastric Pacer

Surgery

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14
Q

When can you use medication to treat obesity?

A

BMI > 30

BMI > 27 with obesity‐related risk
factors

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15
Q

What medications can you use for tx of obesity?

A

Orlistat 3x/day w/ meal (inhib fat abs)

Lorcaserin (appetite control)

Qsymia (dec appetite by inc energy used)

Contrave

Liraglutide/Saxenda (stim insulin secretion)

Sibutramine/Meridia (appetite suppressant)

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16
Q

SE Orlistat

A

diarrhea, gas, and cramping and perhaps reduced absorption of fat‐soluble vitamins

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17
Q

SE Lorcaserin

A

nausea, dry mouth, dizziness

constipation and fatigue

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18
Q

SE Qsymia

A

mood changes, fatigue, increased blood pressure, heart rate and insomnia

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19
Q

Preventative tx for travelers diarrhea

A

Give travelers antimotility agent (Imodium®) and
antibiotics to take on trip

Instruct on when to self-medicate (>24 h)

Bismuth is often sufficient

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20
Q

How do you treat small ileal resection?

<100 cm

> 100 cm

A

<100 cm Cholestyramine

> 100 cm NO Cholestyramine

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21
Q

How do you treat SB bacterial overgrowth?

A

Augmentin, Cipro, Metronidazole, Rifaxamin, etc

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22
Q

Tx for esophageal ca

A

SCC- more sensitive to chemo, chemoXRT and RT

Low stage (Tis & T1) – endoscopic therapy, checmo/surgery if needed

Higher stage (T2 & above) – chemo/XRT then surgery

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23
Q

Gastric ca tx

A

Low stage (Tis & T1) – endoscopic therapy (EMR/ESD)

Higher stage (T2 & above) – chemo/XRT then surgery (morbid)

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24
Q

SB ca tx

A

Surgery + chemo mainstay of therapy

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25
Q

CRC tx

A

Stage 1 and low-risk stage 2: surgical resection is curative and no chemo
All other stages: surgical resection if
possible followed by adjuvant chemo

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26
Q

Anal Fissure tx

A

High fiber diet (30-50 grams)

Fiber Supplement

Warm Baths

Nitrates (vasodilator allows more
blood to heal)

Cachannel Blockers (relax muscle to let heal)

steroid Creams

Surgical
Botox Sphincterotomy
Anoplasty Advancement Flap
Anal Dilatation

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27
Q

Thrombosed External Hemorrhoid

A

Excision

will have pain for a few days following excision

28
Q

Internal hemorrhoids

A

Bowel regimen: high fiber diet, ↑ fluids, supplemental fiber

Local Destruction: Banding, Heater Probe, Injection

Surgery: Transanal Hemorrhoidal Dearterialization (THD), Conventional Hemorrhoidectomy

Stage I-II can use endoscopic management

Stave III-IV surgical intervention

29
Q

Perianal abscess

A

I &D
Abx- immunocomp, diabetics, cellulitis

Seton or fistulotomy palcement

Untreated → necrotizing soft tissue infection

30
Q

Cholelithiasis

A

Ursodoxycholic acid- can dissolve small stones but usually doesn’t work

Cholecystectomy- Treatment of choice

31
Q

Cholecystitis

A

Cholecystectomy

If too sick to remove—> cholecystitis you

32
Q

Ascending Cholangitis

A

ERCP with stone removal/stent, surgery

33
Q

Primary Sclerosing Cholangitis (PSC)

A

Underlying disorder

ERCP only for dominant stricture

Admit to hospital and treat with Abx

34
Q

Cholangiocarcinoma

A

Surgical resection or liver transplantation

35
Q

Gallbadder Cancer

A

cholecystectomy +/- hepatic resection

5 year prognosis – 0-10%

36
Q

Gastroenteritis

A

Rehydration
(oral)

Antimotility agents → loperamide (Imodium®)

Zinc & vit A supp (devel world)

37
Q

Bacillus cereus Food Posioning

Staphylococcal Food Poisoning

Clostridium botulinum Food Posioning

A

Dilute drink lots of water

Antibiotics will not help because it’s it the bacteria it’s the toxin

38
Q

Vibrio cholerae

A

Rehydration: fluid & electrolytes
IV vs. oral (oral rehydration solution – “ORS”)

Antibiotics ↓ duration of illness & shedding of organism

Doxycycline 300 mg single dose (azithromycin 1 gm single dose for pregnant women)

39
Q

Enterotoxigenic E. coli (ETEC)

A

Self-limited infection
(sx resolve after 2-4 days)

Antibiotics ± antimotility (loperamide) agents ↓ duration and severity of illness

Fluoroquinonoles (ciprofloxacin 500 mg twice daily X 1- 3 days)

Azithromycin 500 mg daily X 1- 3 days
Rifaximin (non-absorbed antibiotic)
Bismuth subsalicylate

Loperamide (antimotility)

40
Q

Rotavirus

A

vaccine to prevent

41
Q

Giardia duodenalis

A

Metronidazole 250 mg PO three times daily for 7-10 days or 2 gm PO daily X 3 days (DO NOT DRINK ALC)

Tinidazole 2 gm PO once

Nitazoxanide 500 mg PO q 12 hours with food
X 3 -7 days

42
Q

Shigellosis

A

Rehydrate, fluoroquinolones – ciprofloxacin 500 mg twice daily X 3-5 days or 2 gm single dose

43
Q

Campylobacter

A

Azithromycin 500 mg once daily X 3-5 days or ciprofloxicin 500 mg q 12 hours X 5-7 days

Resistance to fluoroquinolones in SE Asia

Usually self-limited but 10-20% have symptoms > 7 days

44
Q

STEC: Shiga toxin producing E. coli

A

NO Abx or antimotility bc you want the toxin out as fast as it can go- hydrate and keep stable

45
Q

Nontyphoidal Salmonella (NTS) Enterocolitis

A

Usually self-limited: diarrhea resolves in 3-7 days

Excrete in feces for 4-5 weeks after resolution of diarrhea

Abx may prolong carriage
but use for those at risk for invasive dz

Ceftriaxone 500 mg q 12 hours X 3-7 days (alt. ceftriaxone, cefotaxine, azithromycin, TMP-SMX)

46
Q

Amoebiasis

A

Metronidazole (acts against trophozoites) 750 mg three times daily X 7-10 days

Followed by a “luminal” agent (acts on cysts)

Percutaneous drainage not usually required

Asymptomatic colonization:
Treat with “luminal” agent alone:
Paromomycin Lodoquinol

47
Q

Clostridium difficile

A

D/C inciting antibiotic if possible

Metronidazole 500 mg three times daily X 10-14 days for mild to moderate

PO Vancomycin for severe (WBC 20-30,000/mm3) 125-500 mg four times daily X 10-14 days

48
Q

Typhoid Fever

A

Fluoroquinolone (ciprofloxicin),

3rd generation cephalosporin (ceftriaxone)

49
Q

Acute Pancreatitis

A

IV fluid
Bowel rest
Pain mgmt
Enteral nutrition- try to avoid parenteral

Stop offending agent- drug/alcohol

Cholecystectomy after pancreatitis recovery

Surgical debridement of infected necrosis

Can feed again when pain improves & pt devel appetite (start w/ clear liquids)

Abx if cholangitis or infected necrosis

ERCP if gallstone pancreatits and concurrent cholangitis

50
Q

Chronic Pancreatitis

A

Pancreatic enzyme replacement therapy (PERT)

Pain mgmt

Alcohol cessation

Diabetes mgmt

Endoscopic or surgical tx

50% mortality & ↑ risk pancreatic cancer

51
Q

Hepatitis A

A

Supportive, dz is self‐limited in the vast majority of cases

Active Immunization >1 yo, travelers, MSM

Passive Immunization- as soon as exposed w/in 2 wks, <1 yo

52
Q

Hepatitis E

A

supportive,self‐limited

Immunization trial

53
Q

Hepatitis B Virus

A

Tenofovir, Entecavir, or Lamivudine

High risk of HCC (HBeAg+)

Pre (HBsAg) and post (HBIG) exposure immunization

54
Q

Hepatitis D

A

Usuallyself‐limiting infections

55
Q

Hepatitis C

A

Poor prognosis: alc, HIV coinfection male, older

High HCC risk-hispanics & caucasians 45-60

56
Q

Hep A pathophys

A

“Icosahedralshape

Non‐enveloped,single‐strandedRNAvirus”

57
Q

Hep E pathophys

A

Non‐enveloped, single‐stranded RNA virus

58
Q

Hep B pathophys

A

Envelope proteins

HBsAg (surface)
HBcAg, HBeAg (core)

Gets into nucleus- hard to cure/treat

59
Q

Hep D pathophys

A

Dependent on HBV for the production of envelope proteins (‘satellite virus’)

Directlycytopathic

60
Q

Hep C pathophys

A

Replication occurs through RNA‐dependant RNA polymerase
Lacks proofreading function → high genetic variability

No complete neutralizing immune response

61
Q

Diverticulitis

A

Bowel rest, antibiotics,

Then high-fiber diet.

Surgery for complications (abscess, perforation)

30% pt recurrence and 30% recurrent abd pain

If complicated IR- percutaneous abscess drainage
Surgical resection, debridement, washout

62
Q

Colonic Ischemia

A

Mild-Moderate: resuscitation, antibiotics

Severe: laparotomy

63
Q

Diverticular Hemorrhage

A

Localize and treat bleeding by colonoscopy or angiography

Cauterize

64
Q

Acute Mesenteric Ischemia

A

Surgical Emergency

65
Q

Irritable Bowel Syndrome

A

Fiber (30g/day)
Probiotic

Laxatives (PEG3350 nonabsorbed)

Antidiarrheals

Antispasmodics (Hyoscyamine, Dicyclomine)

SSRI, TCA

Rifaximin

Clin Med II (19 decks)

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