Alimentary Management

Question 1

Coeliac disease

Answer 1

Gluten free diet

Must be referred to a state registered dietician

Question 2

Chron’s disease

medical

Answer 2

1. 5ASAs (aminosalicyclates)
2. Steroids: prednisolone/ budenosine (used over 4-8 weeks with decreasing dosage
3. Thiopurines (immunomodulators)
4. Biologics e.g. infliximab (immunomodulators)

Surgery

Question 3

Chron’s disease

surgical

Answer 3

Resection: Part of the bowel is removed

Colectomy: Entire colon is removed (rectum can be connected to ileum - pouch surgery)

Protocolectomy: removal of colon and rectum + formation of an ileostomy

Question 4

Small bowel overgrowth

Answer 4

Rotating antibiotics (each for 2 weeks)

1. metronidazole
2. tetracycline
3. amoxycillin

+ vitamins and nutritional supplements

Question 5

Acute GI Bleed

resuscitation

Answer 5

IV fluids
Blood transfusion
Stop anticoagulant therapy

Question 6

Colorectal cancer

Answer 6

Surgical procedure depends of site, stage and size of tumour.
Duke A (confined to submucosa): endoscopic/local resection
Adjuvant (after surgery) chemotherapy
Radiotherapy: rectal cancer only

Palliative: Chemotherapy, colonic stenting

Question 7

Ulcerative Colitis

medical

Answer 7

1. 5ASAs (aminosalicyclates)
2. Steroids: prednisolone/budenoside (decreasing dosage over 4-8 weeks)
3. Thiopurines (Immunomodulators)
4. Biologics: infliximab (immunosuppression)

Surgery

Question 8

Gastro-oesophageal reflux disease (GORD)

Answer 8

Proton pump inhibitors (omeprazole)
H2 Antagonists (ranitidine)
Alginates e.g. Gaviscon (forms a protective barrier on top of acid, preventing reflux)

Anti-reflux surgery: fundoplication (fundus is wrapped around lower oesophagus, reinforcing LOS

Question 9

Ulcerative colitis

surcigal

Answer 9

Protocolectomy + ileostomy
Colectomy - ileum attached to rectum (pouch surgery)
Colectomy + ileostomy

Question 10

Achalasia

Answer 10

Nitrates/CCBs
Myotomy
Balloon dilatation

Question 11

Eosinophilic oesophagitis

Answer 11

Oral/topical corticosteroids
Dietary elimination
Endoscopic dilatation

Question 12

Oesophageal cancer

Answer 12

Oesophagectomy (only potential cure, however few patients are fit)

Palliative: Endoscopic stent, radio/chemotherapy

Question 13

Hypermotility

Answer 13

Smooth muscle relaxants

Question 14

Helicobacter pylori eradication therapy

Answer 14

Triple therapy for 7 days

1. Clarithromycin (500mg bd)
2. Amoxicillin (1g bd) / Metronidazole (400mg bd) (tetracycline if penicillin allergic)
3. PPI (e.g. omeprazole 20mg bd)

Question 15

Peptic ulcer

Answer 15

H. pylori eradication therapy
PPIs/ H2 inhibitors
Stop NSAIDs etc.
Endoscopic therapy (to stop bleeding)
 - Clip
 - haemospray
 - thermal contact
 - adrenaline injection

Surgery if complicated

Question 16

Gastritis

Answer 16

H. pylori eradication therapy

PPIs

Question 17

Gastric cancer

Answer 17

Surgery (laparoscopic or open):
Subtotal gastrectomy (if tumour is distal)
Total gastrectomy

Chemotherapy

Question 18

Gastric outlet obstruction

Answer 18

Endoscopic balloon dilatation

Surgery

Question 19

Pancreatic cancer

Answer 19

Surgery:
Pylorus preserving pancreaticoduodenectomy (PPPD)
Kausch-Whipple - pancreaticoduodenectomy

Palliation:
Stenting/ bypass of bile duct
Duodenal stenting

Question 20

Acute pancreatitis

Answer 20

Management of precipitating factors (gallstones, alcohol…)
Antibiotics (if evidence of bacterial infection)
Nutrition (by NG feeding)

Supportive care:
Analgesia
IV fluids

Question 21

Chronic pancreatitis

Answer 21

Conservative management:
Alcohol abstinence
Opiate analgesia
Low fat, low protein diet
Pancreatic supplementation
(Diabetes treatment)

Surgery:
Kausch-Whipple pancreaticoduodenectomy
PPPD
Pancreatic sphincterotomy/ dilatation
Common bile duct stenting/bypass
Celiac plexus block

Question 22

Barrett’s Oesophagus

Answer 22

Endoscopic mucosal resection
Radiofrequency ablation
Oesophagectomy

Question 23

Acute abdomen resuscitation

Answer 23

Analgesia
Decompress gut
IV fluids
Ensure tissue perfusion
Treat sepsis

Question 24

Spontaneous bacterial peritonitis

Answer 24

IV Antibiotics
Ascitic fluid drainage
IV albumin infusion

Question 25

Haemorrhoids

Answer 25

Elective surgical intervention

Question 26

Varices

Answer 26

To stop bleeding: Band ligation (oesophageal) Glue injection IV terlipressin (splanchnic vasoconstrictor)

Question 27

Non-alcoholic fatty liver disease

Answer 27

Lifestyle measures: - diet, weight loss and exercise - weight reduction surgery - Liver transplant

Question 28

Alcohol-related liver disease

Answer 28

Supportive treatment Alcohol abstinence Treat alcohol withdrawal, hepatic encephalopathy, infection etc. Steroids (if severe, Glasgow alcoholic hepatitis score >9) Nutrition

Question 29

Gallstones

Answer 29

Dissolution (ursodeoxycholic acid) Lithotripsy (focused ultrasound waves) ``` Cholecystectomy NOTES surgery (natural orifice transluminal endoscopic surgery) ```

Question 30

Viral Hepatitis

Answer 30

A&B - vaccination B - Pegylated interferon (promotes immune function) B&C - Antiviral drugs (e.g. lamivudine, adefovir)

Question 31

Irritable bowel syndrome

Answer 31

``` Dietetic review FODMAP diet - IBS-D Laxatives Antispasmodics for pain Psychological interventions ```

Question 32

Hepatocellular carcinoma

Answer 32

Hepatic resection Liver transplant Radiofrequency ablation ("burns" tumour out) Palliation - chemotherapy - hormonal therapy (tamoxifen) - tyrosinase kinase inhibitors