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First Year Revision > GI Treatment Pathways > Flashcards

GI Treatment Pathways Flashcards

1
Q

What is the maintenance therapy for Crohn’s disease?

A

Azathioprine or methotrexate (immunosuppression).

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2
Q

What is used to treat an exacerbation of Crohn’s disease?

A

Steriods (high dose then taper off). If severe IV and if mild-moderate oral.

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3
Q

When would you give anti-TNF (infliximab, adalimumab) in Crohn’s disease?

A

To induce remission and as maintenance in refractory disease.

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4
Q

What is the maintenance treatment for UC?

A

5ASA e.g. mesasalazine (topical).

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5
Q

What are the side effects of 5ASAs?

A

Diarrhoea, idiosyncratic nephritis.

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6
Q

What is used to treat an exacerbation of UC?

A

Steroids (high dose then taper off).

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7
Q

What is the purpose of azathioprine or methotrexate in UC?

A

Steroid sparing.

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8
Q

When would you use anti-TNF in UC?

A

If intolerant of immunomodulation or developing symptoms despite immunomodulation.

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9
Q

When is surgery indicated in UC?

A

If medically unresponsive, intolerable, dysplasia/malignancy, growth retardation in children, attempted resolution of extra-intestinal disease.

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10
Q

What is the emergency surgery for UC?

A

Sub-total colectomy.

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11
Q

What are the 2 elective surgeries for UC?

A

Proctocolectomy with end ileostomy.

Proctocolectomy with ileorectal anastomosis.

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12
Q

When is surgery indicated in Crohn’s disease?

A

If stenosis causing obstruction, enterocutaneous fistula, intra-abdominal fistulas, abscesses, bleeding, free perforation.

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13
Q

How would you manage constipation in IBS?

A

Increase fibre intake but only soluble fibre, simple laxatives (not lactulose).

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14
Q

What tests should you carry out if IBS is expected?

A

FBC, ESR, CRP and coeliac serology.

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15
Q

How would you manage diarrhoea in IBS?

A

Avoid sorbitol, alcohol and caffeine. Reduce fibre intake. Loperamide.

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16
Q

How would you manage colic/bloating in IBS?

A

Antispasmodics e.g. mebeverine or hyoscine.

17
Q

How would you manage psychological symptoms/visceral hypersensitivity in IBS?

A

Consider CBT and tricyclics e.g. amitryptiline.

18
Q

What are the parts of the Glasgow criteria for assessing severity of acute pancreatitis?

A

PaO2 low, Age>55, Neutrophilia (WBC>15), calcium low, renal function (urea high), enzymes (LDH and AST high), albumin low, sugar high.

19
Q

What are the 6 steps in the management of acute pancreatitis?

A
  1. Fluid resuscitation.
  2. Correct electrolytes.
  3. Careful fluid balance.
  4. Oxygen.
  5. Analgesia.
  6. Treat underlying cause e.g. gallstones.
20
Q

What are the 2 surgeries used for chronic pancreatitis?

A

Pustow procedure - cut open pancreas and stick jejunum in. .

Frey procedure.

21
Q

What are the 5 steps in liver failure management?

A
  1. Rest up to 3 months.
  2. Fluids, no alcohol.
  3. High protein diet with lots of calories.
  4. Sodium bicarbonate bath, colestyramine or ursodeoxycholic acid for itch.
  5. Observe for fulminant hepatic failure.
22
Q

How would you treat the complications of liver failure?

A

Ascites - restrict fluid, low salt diet, weight daily, diuretics (spironolactone first).
Bleeding - IV vit K and platelets, FFP and blood as needed.
Infection - ceftriaxone.
Hypoglycaemia - IV glucose.
Encephalopathy - lactulose, maybe rifamixin (antibiotic).

23
Q

How would you diagnose spontaneous bacterial peritonitis?

A

Do an ascitic tap in all ascites. Neutrophil count >250cells/mm3.

24
Q

What is the treatment for spontaneous bacterial peritonitis?

A

Piperacillin and tazobactam, alba (albumin), terlipressin if vascular instability.

25
Q

What would you do to manage variceal bleeding?

A
  1. Terlipressin IV.
  2. Broad spectrum antibiotics (piperacillin/tazobactam).
  3. Banding.
  4. If banding fails, insert Sengstaken-Blakemore tube.
26
Q

When would you refer someone with dyspepsia for an upper GI endoscopy?

A

If dysphagia or over 55 with persistent symptoms or alarm signs.

27
Q

What would you do with someone who has dyspepsia first?

A

Stop exacerbating factors and review in 4 weeks.

28
Q

If no improvement after changing lifestyle, what would you do next in dyspepsia?

A

Test for H.pylori (urease breath test or faecal antigen test).

29
Q

What would you do if the test for H.pylori was negative?

A

Prescribe a PPI or ranitidine and see them in 4 weeks.

30
Q

What would you do if the test for H.pylori was positive?

A

Give PPI, amoxicillin (metronidazole if penicillin allergic) and clarithromycin for 1 week.

31
Q

What would you do after H.pylori eradication therapy?

A

Wait 4 weeks, retest and if +ve try again.

32
Q

What would you do if H.pylori test was positive after 2 lots of eradication therapy?

A

Refer to a specialist.

33
Q

What is the initial GORD management?

A
  1. Lifestyle advice.
  2. Antacids to relieve symptoms.
  3. PPI.
34
Q

What would you do if GORD was still symptomatic after initial treatment?

A

Add ranitidine.

35
Q

What is SEPSIS 6?

A 
B - blood cultures, septic screen, U&Es.
U - urine output - monitor hourly. 
F - fluid resuscitation. 
A - antibiotics IV.
L - lactate measurement. 
O - Oxygen to correct hypoxia.

First Year Revision (31 decks)

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