GI treatments Flashcards
Familial adenomatous polyposis treatment
Prophylactic colectomy
Treatment of Juvenile polyps
Polyps in children less than 10 years old
Highly vascular and should be removed
Treatment of adenomatous polyps
Removal of polyp
Treatment of diverticulosis
High fiber foods
Psyllium if can’t handle bran
If recurrent bleeding perform segmental colectomy
Treatment of diverticulitis
Uncomplicated:
Antibiotics-IV 7-10 days
NPO-IV fluids
Symptoms persist for 3-4 days means surgery may be necessary
Recurrent-surgery
Complicated (abscess, colovesical fistula, obstruction, perforation): surgery indicated
Acute mesenteric ishemia treatment
Supportive IV fluids and broad spectrum antibiotics
Direct intra-arterial infusion of papaverine relieves occlusion and vasospasm
Direct intra-arterial infusion of thrombolytics and embolectomy if embolism is etiology
Heparin for venous thrombosis
Surgery if signs of peritonitis develop
Chronic meseneteric ischemia treatment
surgical revascularization
Pseudomembranous colitis treatment
Discontinue offending antibiotic
Metronidiazole-not in infants or pregnancy
oral vanco
Cholestryamine for adjuvant therapy
Toxic megacolon, colonic perforation, anascarca (generalized edema) or electrolyate disturbances may require surgery
Sigmoid and cecal volvulus
Sigmoid: decompression via sigmoidoscopy and elective sigmoid colon resection
cecal: emergent surgery
Treatment of portal hypertension
Transjugular intrahepatic portal-system shunt (TIPS)
Treatment of esophageal varices
Initially: hemodynamic stabilization with fluids
IV ocreotride: splanchnic vasoconstriction and reduces portal pressure
possible IV vasopressin instead of ocreotride
Variceal ligation/banding: initial treatment of choice
Endoscopic sclerotherapy: (higher rates of rebleeding)
Both after emergent upper GI endoscopy
Prophylactic non selective B blocker and IV antibiotics
Treatment of ascites
Bed rest, low-sodium diet, and diuretics (furosemide and spironolactone)
Therapeutic paracentesis if tense ascites, SOB, or early satiety
Peritoneovenous shunt or TIPS to reduce portal HTN
Treatment of hepatic encephalopathy
lactulose prevents absorption of ammonia
neomycin: decreases ammonia production by intestinal bacteria
Limit protein to 30-40 g/day
Management of cirrhosis
Surveillance of LFTs
Compensated (vague symptoms: weakness, anorexia and fatigue)
ultrasound and aFP every 6 months, EDG, varices surveillance endoscopy)
Decompensated (jaundice, pruritus, upper GI bleed)
Variceal hemorrhage: non selective B blocker-repeat EGD yearly
Ascites: dietary Na restriction, Diuretics, parancentesis, abstinence
Encephalpathy: lactulose
Treatment of Wilson’s disease
Chelating agents: penicillamine
Zinc: prevents uptake of dietary copper
Can be given prophylactically or pregnant patients
Liver transplantation: if unresponsive to therapy or fulminant liver failure
Treatment of hemachromatosis
Repeat phlebotomies
Liver transplantation in advanced cases
Treatment of pyogenic liver abscess
Fatal if untreated
IV antibiotics and percutaneous drainage of abscess
Surgical drainage is sometimes necessary
Amebic liver abscess treatment
IV metronidazole
Therapeutic aspiration of abscess (image guided percutaneous aspiration) if abscess is large or no response to metro