Gastroenterology Flashcards
(31 cards)
Achalasia treatmentC
- Pneumatic dilation and myotomy (may result in reflux or perforation)
- Botulinum toxin injection
- Nitrates and/or dihydroperidine CCB (a/w cardiac SE)
Diffuse esophageal spasm treatment
1) CCB and TCAs
Nitrates my relieve pain but worsen reflux
Zenker diverticulum treatment
Surgery- cricopharyngeal myotomy and diverticulectomy
GERD treatment
Lifestyle modifications
Pharmacotherapy (antacids, H2blockers, PPI)
Surgical management (Nissen fundoplication for refractory)
esophageal cancer treatment
total esophagectomy for early stage disease
radiation and chemo in advanced dz or as adjunct
sliding hiatal hernia tx
PPI to control GERD sxs
Paraesophageal hiatal hernia
surgical repair (more dangerous than sliding b/c a piece of stomach can get encarcerated above the diaphragm and necrose and lead to possible scarring)
gastritis treatment
stop offending medication (ex. NSAIDs)
H. Pylori negative= PPI, H2 blocker
H. Pylori positive= PPI, amoxicillin (or MTZ if allergic to penicillin), clarithromycin for 2 weeks
PUD treatment
- control active bleeding with electrocauterization
- Acid suppression with PPI or H2 antagonist
- Protect mucosa: sucralfate, busmuth, mispprostol (increased protaglandin helps if NSAID induced PUD)
- Eradicate H. Pylori: PPI, Clarithromycin, amox
- Surgery to repair perf
- Severe disease: parietal cell vagotomy or antrectomy
gastric cancer treatment
Distal third of stomach: subtotal gastrectomy
Middle or upper stomach or invasive: total gastrectomy
chemo and rad adjunt
management of pt with acute upper GI bleed
-Access hemodynamic stability #1 (HR, BP, UO)
-Admit to ICU + NPO + Blood type and screen/cross 2 units of PRBCs
-Labs: CBC, PT, PTT, BUN, Cr
-If bleeding source ucnertain, consider NG lavage
-Meds: IV PPI (omeprazole)
if suspected variceal bleeding give octreotide
-EGD!!!!
management of pt with acute lower GI bleed
- Access hemodynamic stability (though usually stable)
- Type and screen 2 unites of PRBCs
- Labs:CBC, PT, PTT, BUN, Cr
- NG lavage and/or EGD to r/o upper GI bleed
- Colonoscopy (MCC in colon)
- If colonoscopy not diagnostic, consider angio (avm), radionucleotide scan (tagged RBC), capsule endoscopy, Technetium 99 (meckles)
SBO management
- NPO (bowel rest)
- IVF
- Correct electrolyte derangement (esp if vomiting)
- NG tube on low intermittent wall suction to relieve distension
- Hospital obs with frequent reassesment
- Avoid pain meds if possible!
- Surgery (laparotomy and lysis of lesions)
whipple disease treatment
IV ceftriaxone (2 weeks) followed by PO TMP-SMX for 12 months to prevent relapse
Tropical sprue treatment
Tetracycline, folic acid (3-6 m), +/- B12 (if deficient)
dermatitis herpetiformis treatment
diet and dapsone
bacillus cereus gastroenteritis treatment
hydration
campylobacter jejuni gastroenteritis treatment
hydration, fluoroquinolone, or azithromycin (severe case)
Clostridium botulinum treatment
monitor and intubate if needed
botulinum antitoxin with penecillin g
C. Diff treatment
1) Metronidazole
2) PO vanco
ETEC treatment
hydration
EHEC treatment
supportive and hydration
*abx can worsen sxs due to toxin release!
Staph aureus gastroenteritis tx
hydration
Salmonella gastroenteritis tx
hydration
*fluoroquinolone only if immunocompromised or severely ill
