Treatment - GI

Question 1

infectious esophagitis - candida

Answer 1

PO FLUCONAZOLE 1st line

voriconazole, caspogungin

Question 2

infectious esophagitis - CMV

Answer 2

GANCICLOVIR 1ST LINE

valganciclovir, foscarnet

Question 3

infectious esophagitis - HSV

Answer 3

ACYCLOVIR 1ST LINE

foscarnet

Question 4

GERD

Answer 4

Stage 1: lifestyle modification
Stage 2: “as needed” pharmacotherapy - antacids, OTC H2 receptor antagonists (famotidine, ranitidine)
Stage 3: scheduled therapy - H2RA, PPI, prokinetic agents
PPI DRUG OF CHOICE IN MOD-SEV DZ; NISSEN FUNDO IF REFRACTORY

Question 5

mallory-weiss syndrome

Answer 5

• SUPPORTIVE, acid suppression promotes healing

- severe bleeding –> epinephrine injection, sclerosing agent, band ligation, hemoclipping or balloon tamponade

Question 6

esophageal varices (active)

Answer 6

Acute/Active

• stabilize w/ 2 large bore IV lines, fluids +/- tranfusion
• if coagulopathy –> +/-FFP +/- Vit K (if inc PT)

1. ENDOSCOPIC INTERVENTION - LIGATION TX OF CHOICE - lower cx/re-bleed
2. PHARM VASOCONSTRICTORS - OCTREOTIDE - vasoconstrict portal venous flow
   - vasopressin - dec portal venous pressure (S/E - vasoconstrict in other areas = MI, cornary spasm, bowel ischemia)
3. baloon tamponade - stabilize not controlled by 1 & 2, fast bleeds or temporary stabilize before surgery
4. SURGICAL DECOMPRESSION - TRANS JUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT (TIPS)

Question 7

esophageal varices (prevent rebleed)

Answer 7

70% rebleed w/in 1st year (1/3 are fatal)

NONSELECTIVE BETA BLOCKERS - TX OF CHOICE
-primary prophylaxis, reduces portal venous pressure, not used in acute bc blunt tachy response to low BP (reduce cardiac output)

Isosorbide - long acting nitrate (vasodilator) reduce pressure

Question 8

esophageal varices (abx prophylaxis)

Answer 8

FLUOROQUINOLONES (ex Norfloxacin) or CEFTRIAXONE to prevent infx complications

Question 9

gastritis (by type)

Answer 9

-H.pylori positive –> “CAP” = clarithromycin + amox + PPI
alt metronidazole
-H.pylori negative –> acid suppresion: PPI, H2 block, antacids
-pharm prohylaxis for pt at high risk for stress-related: IV PPI or H2

Question 10

h.pylori

Answer 10

CAP = clarithromycin + amox + PPI
(metronidazole if PCN allergic)
-alternate: pepto + tetracycline + metronidazole
-quad tx: PPI + pepto + tetracycline + metronidazole

Question 11

encephalopathy

Answer 11

LACTULOSE (converts to lactic acid by bacteria, neutralizes ammonia)

RIFAXIMIN, NEOMYCIN (abx that decrease bacteria producing ammonia)

PROTEIN RESTRICTION (reduces breakdown of protein into ammonia)

Question 12

primary biliary cirrhosis

Answer 12

URSODEOXYCHOLIC ACID 1ST LINE

protects cholangiocytes from the toxic effect of bile acids and stabilizes hepatic inflam

Question 13

diverticulitis & diverticulosis

Answer 13

diverticulitis: clear liquid diet, abx: CIPRO OR BACTRIM + METRONIDAZOLE
diverticulosis: high fiber diet, bleeding stops in 90% (+/-vasopressin if not)

Question 14

volvulus

Answer 14

endoscopic decompression initial tx of choice; surgical 2nd line
(twisting of any part of bowel @ mesenteric attachment site)

Question 15

mesenteric ischemia (acute + chronic)

Answer 15

bowel rest + surgical revascularization (angioplasty w/ stenting or bypass)

Question 16

crohn’s / UC

Answer 16

ACUTE:
aminosalicylates (salfasalazine, mesalamine) - more UC
corticosteroids
immune mod agents / anti-TNF

Question 17

management of diarrhea

Answer 17

• IV FLUID REPLETION - PO preferred
• DIET - BRAT
• ANTI-MOTILITY AGENTS
• indicated: patients <65y w/ mod-sev signs vol depletion
• c/i: DO NOT GIVE TO PT W/ INVASIVE DIARRHEA (may cause toxicity)

Question 18

C.DIFF

Answer 18

METRONIDAZOLE 1ST LINE MILD

-VANCO 2ND LINE (1ST LINE IF SEVERE)

Question 19

campylobacter enteritis

Answer 19

• tx- fluids

severe: ERYTHROMYCIN 1ST LINE, fq, doxy

Question 20

cholera

Answer 20

fluid replacement +/- TETRACYCLINES, FQ

Question 21

shigella

Answer 21

fluids; if severe –> BACTRIM 1ST LINE, FQ

Question 22

salmonella

Answer 22

fluids; if severe –> FLUOROQUINOLONES, ceftriaxone, bactrim

Question 23

ENTEROHEMORRHAGIC E.COLI 0157:H7

Answer 23

FLUIDS; ABX CONTROVERSIAL (inc incidence of hemolytic uremic syndrome in children)

Question 24

whipple’s dz

Answer 24

PCN or tetracycline for 1-2 years