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Clin Med > GI: treatments for all DZ > Flashcards

GI: treatments for all DZ Flashcards

1
Q

Esophageal atresia

A

surgical repair

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2
Q

infantile hypertrophic pyloric stenosis

A

surgical pyloromyotomy

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3
Q

infantile GERD
1st
2nd
3rd

A

1st: mom + baby dietary changes
2nd: H2 blockers and antacids
3nd or mod-severe: PPI

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4
Q

Dysphagia

A
  • eat small meals
  • drink fluid with meals
  • eat slowly
  • sleep with head upright to prevent regurg and aspiration
  • tx underlying etiology
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5
Q

Esophageal stricture

A
  1. goals of therapy for benign strictures: relief of dysphagia and prevention of stricture recurrence
  2. esophageal dilation
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6
Q

Gastroparesis

A

TX

  • motility agents
  • gastric “pacemaker”
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7
Q

Mallory-Weiss Syndrome

A

TX:

  1. not actively bleeding: supportive TX (PPIs, anti-emetics). Most resolve on their own
  2. Severe bleeding
    * thermal coagulation
    * hemoclips
    * endoscopic band ligation (w or w.o epinephrine)
    * balloon tamponade
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8
Q

Boerhaave Syndrome

A

TX:

  1. Small and stable: IV fluids, NPO, BS ABX, H2 rec Blockers
  2. Large or severe: surgical repair
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9
Q

medication/pill induced esophagitis

A

TX:

  • take pills with at least 4 ounce of water
  • avoid laying down for 30-60 mins after taking pill
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10
Q

Infectious esophagitis

A

TX:

  • *tx underlying cause**
    1. Candida–PO fluconazole
    2. CMV–Ganciclovir
    3. HSV–Acyclovir
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11
Q

Caustic esophagitis

A

tx

  • supportive–pain meds, fluids
  • very very severe– with necrotic tissue +edema present on endoscopy–ICU*****
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12
Q

eosinophilic esophagitis

A
  • Remove foods that cause allg response
  • PPIs PRN
  • inhaled topical cortcosteroids WITHOUT spacer so it can penetrate
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13
Q

Barretts esophagus

A

Follow up TXs:
1. Barretts esophagus only (metaplasia): PPIs + rescope every 3-5 yrs

  1. Low-grade dysplasia: PPIs and rescope every 6-12 MO
  2. High grade dysplasia: ablation with endoscopy or mucosal resection
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14
Q

Achalasia

A

TX:

  1. decrease the LES pressure–botulinum toxin injections, nitrates, surgery is most effective
  2. Pneumatic dilation of LES
  3. Esophagomyomectomy (definitive) but LAST resort
  4. adaptive measures–chewing food fully b4 swallowing etc
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15
Q

Zenker’s diverticulum

A

TX:

  • Observation if small and asympto
  • diverticulectomy, cricopharyngeal myotomy
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16
Q

Distal/Diffuse esophageal spasm

A

TX:
1st line: CCBs, nitrates, Triclylic antidepressants–all anti-spasmatics
2nd line: botulinum toxin injection or pneumatic dilation
3rd: peroral endoscopic myotomy–refractory to meds

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17
Q

Hypercontractile (nutcracker) esophagus

A

TX:
-need to lower the esophageal pressure with:
CCBs, nitrates, botulinum toxin injection

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18
Q

esophageal web

A

TX:

  • endoscopic dilation of area if symptomatic
  • PPI therapy after dilation may decrease risk of recurrence
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19
Q

Shatzki Ring

A

TX:

  • symptomatic: dilation, obliteration with biopsy forceps
  • If reflux present– anti-reflux surgery
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20
Q

Squamous Cell Esohpageal CA

Pretreatment and tx

A

Pre-treatment:

  1. endoscopic US to look at LNs around eso–STAGING
  2. Preoperative bronchoscopy–to see if it MET to lungs

TX:

  • esophageal resection with chemo
  • ADANCED: palliative stentint to improve dysphagia
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21
Q

Adenocarcinoma Esophageal CA

*pre tx and tx

A

Pre-treatment:

  1. endoscopic US to look at LNs around eso–STAGING
  2. Preoperative bronchoscopy–to see if it MET to lungs

TX:

  • esophageal resection with chemo
  • ADANCED: palliative stentint to improve dysphagia
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22
Q

Esophageal Varies

  • acute bleed tx
  • prophylaxis
A

TX:

  • FIRST: stabilize patient: 2 large bore IV lines fluids/packed RBCs/FFP***
  • *THEN, move onto one of the four mainstay tx options:
  1. endoscopic ligation intervention–initial tx of choice–
  2. Pharmacologic:
    Octreotide 1st line–MC to use this and endoscopy together
    * vasopressin 2nd line
  3. Balloon tamponade: (Temporary) stabilizes bleeding refractory to endoscopic tx
  4. Surgical decompression: transiugular intrahepatic portosystemic shunt (TIPS)
    - refractory to all other tx
    - can cause encephalopathy

***also give them ABX to prevent infections

prophylaxis
*nonselective BB (Nadolol or Propranolol)

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23
Q

BeriBeri or Vit B1 deficiency

A

TX:

  1. IV thiamine
  2. PO thiamine
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24
Q

B12 def

A

TX:

  • B12 replacement: PO, SL, Nasal, IM, deep SQ
    1. mild-moderate: PO B12
    2. Symptomatic anemia and/or neuro findings
    a) IM dose weekly until def is corrected.. then monthly
    b) PT can switch to a monthly PO dose after s/s resolve

PERNICIOUS ANEMIA PT:
**LIFE LONG IM TX

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25
Q

Vit C def

A

TX:

  • replacment
  • general s/s improve in days
  • hematologic s/s take weeks
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26
Q

Vit D def

A

TX

  • PO ergocalciferol
  • supplementation for dialysis PT is calciferol (active form)
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27
Q

PKU

A

TX:

  • lifetime dietary restriction of PHE
  • tyrosine supp
  • avoid food high in PHE: milk cheese nuts fish chicken meats eggs legumes aspartame
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28
Q

Acetominophen OD

A

Antidotes:

  1. N-acetylcysteine–gluthione substitue
  2. activated charcoal if drug ingested in last hour
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29
Q

Salicylates OD

A
  1. Resusciation–ABCs
  2. GI decontamination— either gastric lavage or activ charc
  3. Alkalinization–sodium bicarb
  4. Glucose helps with CNS s/s
  5. IV fluids
  6. Hemodialysis if severe
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30
Q

acute gastritis

A

TX:

  • if HP+: treat with quad therapy (metronidazole, tetracycline, pepto, PPI)
  • stop the offending agent(s)
  • IV PPIs and H2 blockers as prophylaxis with ICU patients
31
Q

autoimmune metaplastic atrophic gastritis

A

Diagnosis:

  • Upper endoscopy with biopsy–shows thick, edematous erosions
  • HP testing

TX:

  • if HP+: treat with quad therapy (metronidazole, tetracycline, pepto, PPI)
  • stop the offending agent(s)
  • IV PPIs and H2 blockers as prophylaxis with ICU patients
32
Q

PUD

  1. +HP infection
  2. -HP infection
  3. refractory
A

Pos HP:
-QUAD tx: Pepto, tetracycline, metronidazole and PPI x14 days
-concomitant tx: clarithromycin, amox, tetracycline
OR
-TRIPLE: Clarithromycin, Amoxicillin and PPI x10-14 days

  • Neg HP:
  • goal is to suppress acid–PPI, H2 blockers, antacids, pepto, sucralfate

Refractory:

  • parietal cell vagotomy
  • Bilroth II (
33
Q

Zollinger-Ellison Syndrome

A

TX

  • Local=tumor ressection
  • Mets or unresectable= lifelong high dose PPI
34
Q

gastric carcinoma

A

TX

  1. resection if possible
  2. Gastrectomy
  3. Chemo
    * poor prognosis since PT usually presents late in the DZ*
35
Q

carinoid tumors/carcinoid syndrome

A

TX:

  • dep on location
  • often surgicla incision
36
Q

Cholestasis

A

TX:

  • asympto– no tx
  • sympto: cholecystectomy if recurrent s/s
37
Q

Acute Cholecystitis

A

TX:

  1. admit and NPO
  2. IV hydration, pain meds, electrolytes
  3. IV ABX: Ceftriazone covers gram- & Metronidazole covering anaerobics
  4. cholecystectomy w/in 72 hours
  5. recurrance rate with nonsurgical tx is very high– almost 70%—why we counsel PTs to do surgery!
38
Q

Choledocholithiasis

A

TX:

*ERCP with stone extraction

39
Q

Choledocholithiasis

A

TX:

ERCP with stone extraction** vs choledocholithotomy aka surgery

40
Q

Cholangitis

A

Initial Management:

  1. IV ABX followed by CBD decompression & stone extraction once stable
  2. ABX= Ampicillin/Sulbactam, Piperacillin/tazobactam, Ceftriaxone + metronidazole, fluroroquinolone + metronidazole, ampicillin + gentamycin
    * anything to cover gram neg and anaerobes**
  3. ERCP:
  4. PTC–drainage with catheter
  5. open surgical decompression and T-tube insertion for drainage
  6. Eventually, PT should undergo elective cholycstectomy
41
Q

Primary Biliary Cholangitis/Cirrhosis (PBC)

A

TX:
1st line: Ursodeoxycholic acid–can slow progression of the dz by preventing synthesis and absoprtion of cholesterol
2nd. Obeticholid acid
*for pruritis—cholestyramine and UV light
*vit D calcium to prev osteoporosis
Curative—liver transplant

42
Q

Primary Sclerosing Cholangitis

A

Management:

  • stricture dilation for sympto tx
  • cholestyramine for pruritis
  • definitive= liver transplant
43
Q

Nonalcoholic Fatty liver Dz

A

fix underlying cause

44
Q

Fulminant Hepatitis

*whats defintive tx ?

A

Supportive: IV fluids, electrolyte repletion
Mannitol if ICP elevation (elevated ammonia, direct toxin–>edema)
PPI stress ulcer prophylaxis
Platelets, FFP for coagulation factors if bleeding

Definitive=transplant

45
Q

cirrhosis

A

TX:

  • avoid ETOH and hepatoxic drugs
  • weight reduction
  • vaccinations for Hep A and B to prevent additional insult
  • tx underlying causes when possible
  • liver transplant is definitive
46
Q

hepatic encephalopathy

A

lactulose ***or rifaximin first lines

second: Neomycin

47
Q

ascities

A

sodium restriction
diruetics (spironolactone, furosemide)
paracentesis

48
Q

Wilson dz

A

Tx:

  • copper chelating agents:
    1. Trientine or D-penicillamine with B6
    2. zinc supplements help to prevent uptake of dietary copper
    3. liver transplant if unresp to therapy or liver failure
49
Q

Acute Pancreatitis

A

TX:

  • 90% recover in 3-7 days w/o complications + need supportive care only
  • ->NPO
  • –>IV LR
  • –>analgesics

**Advancing diet once pain resolved, clinically improved–>patient directed leads to improved outcomes

50
Q

Duodenal Atresia

A

TX:

  • decompression of GI tract, electroylte and fluid replacement
  • duodenoduodenostomy
51
Q

volvulus-intial TOC?

A

TX:
-endoscopic decompression via proctosigmoidoscopy– initial TOC

  • rectal tube is left in place to decrease acute reccurence/decr distention
  • decompression often followed by elective surgery due to high rate of reccurence
  • immediate surgical correction in PTs with +peritonititis +gangrene or endoscopic decompress unsuccessful
52
Q

Meckel Diverticulum

A

TX:

-surgical incision is symptomatic

53
Q

Intussusception

A

Maagment:

  1. fluid and electrolyte replacement most imp initial steps
  2. NG decompression
  3. Intussusception reduction: pneumati (air) or hydrostatic (saline or gastrografin) decompression
  4. admitted for observation—10% recurrance in 1st 24 hrs of tx
  5. Surgical resection if refractory to above
54
Q

Diarrhea

A
  1. fluid repletion mainstay
    - ->PO preferred
  2. Diet
    -bland low reside diet
    “BRAT” Bananas, rice, Applesauce, toast
  3. anti-motility drugs
    –>PT <65YO with moderate signs of volume depletion
    DO NOT GIVE TO PT WITH INVASIVE DIARRHEA
55
Q

Norovirus

A

supportive

56
Q

Rotavirus

A

TX:

*oral rehydration mainstay

57
Q

Staph A.

A

TX:
*fluid replacement PO preferred
IV if cannot tolerate PO

58
Q

Bacillus Cereus

A

TX:
fluid replacement PO pref
IV if cant do PO

59
Q

Enterotoxigenic E. coli

A

TX:

  • oral rehydration 1st line—usually self limiting
  • Loperamide
  • Bismuth subsalicylate
60
Q

Vibrio Cholerae

-tx: mild, severe (1st, 2nd, 3rd), prevention

A

TX:

  1. PO rehydration and electrolyte replacement***** usualy self limiting
  2. If severe
    * *1st: Tetracycline
    * *2nd: Fluoroquinolones
    * *3rd: Azithromycin
  3. prevention: use bottled waters, wash hands, use chemical toilets and cook food well
61
Q

C diff

A

TX::

  1. discontinue offending ABX— INITITAL STEP
  2. contact precautions + hand hygiene (spores resistant to alcohol based sanitizers)
  3. PO PO PO PO PO PO PO vancomycin or Fidaxomicin
  4. recurrance— fecal transplant
62
Q

Yersinia Enterocolitica

A

TX:

  • fluid and electrolyte replacement 1st line
  • severe=fluoroquinolones
63
Q

Campylobacter Jejuni

A

TX:

  1. fluid and elec. repalcemet=mainstay (MC mild and self lim)
  2. Severe or high risk PT:
    * **macrolides=1st line—Azithromycin
64
Q

Enterohemorrhagic E. coli 0157:H7

A

TX:

  • fluid replacement main stay— supportive measures
  • *****AVOID ANTI MOTILITY
  • *****AVOID ABX!!!!! —-lysogenic phase: if given ABX… it lyses the cell and these cells ahve the potent toxin in them– can actually directly release the toxin into the BS– making PT more sick
65
Q

Salmonella Typhi

A

TX

  1. oral rehydration + electrolytes– first line
  2. ABX
    * 1st: Fluoroquinoloines (-xacin)
    * 2nd: macrolides
    3rd: ceftriaxone
66
Q

Giardia Lamblia

A

tx

  • rehydration mainstay of tx
  • Metronidazole DOC
67
Q

Shigellosis

A

TX:

  • oral rehydration and electrolyte mainstay
  • ABX for severe: Ciprofloxacin Or Ceftriaxone (3rd gen cephalosporins)
  • if isole is susceptilble— Trimethoprim-sulfamethoxazole or Arithromycin
68
Q

amebiosis

A

TX

1) Colitis– metronidazole + intraluminel parasitic (Paromomycin)
2) Liver Abscess: metronidazole + intraluminal antiparasitic + chloroquine

ASYMPO: must be tx alone with intraluminal tx

69
Q

fecal impaction

A

Disempaction–colon evacauation–routnie bowel regimen to reduce recurence

  1. Digital disimpaction followed by warm water enema with mineral oil
    2) polyethylene glycol post disimpaction
70
Q

Anorectcal abscess and fistuals

A 
TX: 
I/D: mainstay of tx followed by WASH 
W: warm water cleaning
A: analgesics
S: sitz bath
H: high fiber diet

ABX not usually requried in simple cases

71
Q

hemorrhohids

A

Conservative = high fiber diet, increased fluids, warm Sitz baths & topical rectal corticosteroids & analgesics to help pruritis and discomfort or thrombosis.
If refractory to conservative management or debilitating pain or strangulation:
Rubber band ligation is MC; sclerotherapy or infrared coagulation
Excision of thrombosed external hemorrhoids
Hemorrhoidectomy - for stage IV or refractory

72
Q

diverticulosis

A

In most cases, the bleeding stops spontaneously
If serious bleeding, resuscitation may be needed
Endoscopic therapy can be utilized to help control bleeding (epinephrine injection, tamponade)

Asymptomatic diverticulosis can be followed - recommend high fiber diet, use bran or psyllium.

73
Q

diverticulitis

A

tx:
1) uncomplicated: tx as outpatient– with PO Metronidazole + ciprofloxacin or levofloxacin
- clear diet

2) surgery for complicated:

Clin Med (52 decks)

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