Small Intestine + Appendix Flashcards
Appendicitis
IV ceph + met
laparoscopic appendectomy
carcinoid tumor
resect (diarrhoea , facial flushing and tremor = triad)
C Diff diarrhoea
stop abx maintain fluid and food intake metronidazole/vancomycin avoid loperamide cholestyramine can be helpful barrier nursing
bowel obstruction
NGT
IVI fluids
Catheterise for fluid balance
drip n suck
Meckels IX
techtenium scan shows diverticulum
parietal cells take up radio labelled techtenium
IBS success rate
management only works 50% time
IBS treatment
self help, relaxation etc diet, exercise, limit caffeine FODMAP antispasmodics (meberverine) laxatives low dose TCA/SSRI CBT after 12 months --> refractory IBS = 12 months still persisting w/anti depressant treatment
Laxative to avoid in IBS
lactulose-causes bloating
Crohn’s treatment mild attack
oral pred
taper steroid review in clinic
Crohn’s severe attack symptoms
raised temp, raised pulse
high ESR/CRP, low albumin
Crohn’s severe management
NBM, parenteral nutrition IV hydrocortisone Infliximab - refractory non responsive disease transfer to oral pred once improving surgical advice if unable to control
Crohn’s maintenance
Azothiprine
Methotrexate 2nd line/ 1st line if TMPT deficent
Oral metronidazole for anal disease
Mild UC flare (<6 motions a day, systemically well)
topical +/- oral mesalazine (proctitis/proctosigmoiditis)
+ oral pred after 4 weeks
+ tacrolimus after 4-6 weeks
specialist advice for biologics
severe UC flare
MDT
- IV corticosteroids
- assessment by surgeons
- SC heparin
- avoid anti motility drugs (inc opioids)
- IV ciclosporin
- biologics
- use trulove witts score for surgical assessment
UC maintenance
5 ASA derivatives (mesalazine/sulfasalazine)
azothioprine/mecaptopurine
lifelong
Coeliac
life long gluten free
check its working with endomyseal antibody tests
small increased risk of small bowel lymphoma and adenocarcinoma
Chronic pancreatitis
analgesia creon + multivite monitor blood glucose alcohol abstinence low fat diet partial pancreatectomy/pancreajejunostomy if unremitting pain, narcotic abuse/weight loss
PPIs can cause..
achlorhydria leading to campylobacter infection (food poisoning)
