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The Holy Grail (Treatments) > GI > Flashcards

Flashcards in GI Deck (63)
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1
Q

Intestinal Angina due to Abdominal Artery Occlusion

A

Sublingual GTN

2
Q

Abdominal Artery Occlusion

A

PCI

Thrombolysis

3
Q

Chronic Abdominal Artery Occlusion

A
Bypass
Angioplasty (Stent/No stent)
Preventative measures (Antiplatelets)
4
Q

Coeliac disease

(T cell mediated auto-immune disorder
Gluten is viewed as an antigen by the body and exposure to it causes inflammatory response)

A

Life-long gluten-free diet

5
Q

Ulcerative Colitis

Continuous inflammation is confined to the rectum and colon due to an environmental trigger

A
PICAM
Steroids (Prednisolone)
Anti-TNF Therapy (Infliximab)
Surgery (Colectomy)
Immunosuppressants (Azathioprine)
5- ASA (Mesalazine)
6
Q

Crohn’s Disease

Chronic inflammation of the GI tract that can affect anywhere from mouth to anus

A
PISAM
Steroids (Prednisolone)
Anti-TNF Therapy (Infliximab) 
Surgery
Antibiotics
Immunosuppression (Methotrexate)
7
Q

Small Bowel Obstruction (non-strangulation)

A
  • IV Fluids
  • Nasogastric Suction
  • Laparotomy
  • Surgery if doesn’t resolve
8
Q

Acute Mesenteric Ischaemia

This is when the blood supply to the bowel becomes impaired leading to ischaemia and gangrene

A

Heparin
Resuscitate with fluid antibiotics:
- (Metronidazole + Gentamycin)

9
Q

GORD (Gastro-Oesophageal Reflux Disease)

Stomach acidic spill into the oesophagus from the stomach, causing a reddened, inflamed, ulcerated oesophagus

A

GORD
Antacids (Gaviscon)
PPIS (Omeprazole)
H2 Antagonist (Ranitidine)

Dont do stupid things like get fat/alcohol/smoke
Lifestyle change (Lose weight, stop smoking, avoid alcohol)
10
Q

Barret’s Oesophagus

(Prolonged exposure to gastric acid causes metaplasia from squamous stratified epithelium of the oesophagus to columnar epithelium)

A

Cannot be treated

Treat same as GORD with GORD

Gaviscon
Omeprazole
Ranitidine
Dont get fat/ do alcohol/ smoke

11
Q

Oesophageal Cancer

Squamous Cell Carcinoma & Adenocarcinoma

A

Surgery (Low Grade Tumours only)

Palliative:

  • Stenting to allow swallowing
  • Intubation to allow adequate nutrition
12
Q

Mallory-Weiss Tear

(A tear occurs in the oesophageal-gastric junction following prolonged retching and vomiting, usually after a “mad-wan-oot” or drinking bleach/ infection)

A

Resolves on its own

If appropriate tell patient to lay off the “akkahol”

13
Q

Oesophageal Varices

This is an affect of severe liver disease causing high blood pressure in the veins which may break

A

Prophylaxis:

  • Propanolol
  • Treat underlying liver disease (TIPS)
  • Sclerotherapy + Band Ligation

For uncontrolled bleeding:

  • Baloon tamponade with Sengstaken Blakemore Tube (Minnesota Tube)
  • Fresh Frosen Plasma + Vitamin K
  • Terlipressin

Antibiotic (Co-trimoxazole)

14
Q

Peptic Ulcers

Gastric/ Duodenal Ulcers, arising from H.pylori infection and NSAIDS

A

H. pylori eradiaction: OAC / MOC if penicillin allerigic

Clarithromycin, Omeprazole, Amoxicillin / Metronidazole

Antacids (Gaviscon)
H2 Antagonist: Ranitidine

Reduce stomach acid to promote self-healing

15
Q

Achalasia

(This is a motility disorder of the Oesophagus. The oesophageal sphincter doesn’t open properly and there is failure of peristalsis)

A

Blow-up Heller’s Cunt Now

  • Balloon
  • Heller’s Cardiomyopathy

Relax LES:

  • CCB (Nifedipine)
  • Nitrate (Isosorbide dinitrate)
16
Q

Pharyngeal Pouch

This is a pouch caused by unco-ordinated swallowing movements

A

Surgery

NOT ENDOSCOPY

17
Q

Gastric Cancer

An adenocarcinoma in the mucous secreting cells of the gastric pits

A
Chemotherapy
Radiotherapy
Surgery: 
- Resection of the stomach
- Total Gastrectomy for proximal lesions
- Partial Gastrectomy of distal lesions

11% have 5 year survival = RIP

18
Q

Appendicitis

Obstruction of the appendiceal lumen

A

Appendectomy (open or laparoscopically)

19
Q

Colorectal Cancer

A

Surgery
Radiotherapy
Chemotherapy

20
Q

Diverticulitis

Acute inflammation of one or more diverticulum-an outpouching of the mucosa of the large intestine

A

AH Fuck My Colon

Analgesia (Not Morphine)
Hartmann's procedure- resection of colon)
Fluids
Mentronidazole
Co-trimaxazole
21
Q

Haemorrhoids

The swelling and inflammation of the veins of the rectum and anus

A

Sclerotherapy
Band Ligation
Haemorrhoidectomy

22
Q

Asymptomatic Anal Prolapse

A

Advice to stop straining

Take stool softeners

23
Q

Symptomatic Complete Anal Prolapse

This is when the entire muscle wall of the rectum protrudes through the opening of the anus

A

DR

Surgery:

  • Delome’s Procedure
  • Rectopexy
24
Q

Symptomatic Partial Anal Prolapse

This is when the anterior muscle of the rectum protrudes through the opening of the anus

A

Kids:

  • Dietary Advice
  • Treat constipation

Adults:

  • Sclerotherapy and Band Ligation
  • DDD (Don’t do dildos)
25
Q

Anal Fissure

This is a tear in the skin that lines the anus below the dentate line

A
Dietary Advice
Antiseptic Cream
Stool Softener
Botox Injection
Internal Sphincterotomy
26
Q

Anal Fistula

(This is an abnormal communication between two epithelial surfaces - a track between the internal opening and an opening in the perianal skin)

A
Seton Insertion (to drain pus)
Corrective Surgery (Fistulotomy) 
Seton Suture
27
Q

Anal Abscess

Collection of pus on the anus that may be tender, swollen and discharging

A

Surgical Excision

Drainage

28
Q

Large Bowel Obstruction

(Three types:

  • Volvulus (Closed Loop)
  • Incompetent Ileo-Caecal Valve
  • Incomplete Obstruction)
A

All:

  • Nasal Gastric Tube (to decompress)
  • Nil by mouth
  • Fluids
  • IV Access

Volvulus:
- Surgery Resection

29
Q

Meckel’s Diverticulum

This is a diverticulum on the distal ileum that is present from birth)

A

Surgery Resection

30
Q

Intussusception

A

Air enema

31
Q

Cholangitis

Inflammation of the bile duct

A

IV Cephalosporin

Urgent Biliary Drainage

32
Q

Acute Cholecystitis

Inflammation of the gall bladder due to blockage of the cystic duct or the neck of gallbladder

A

Nil by mouth
IV Fluid
Cefuroxime
Cholecystectomy

33
Q

Chronic Cholecystitis

A

Cholecystectomy

34
Q

Pancreatitis

Acute inflammation of the pancreas

A

Supportive

35
Q

Peritonitis

Inflammation of the peritoneum, usually a surgical rupture

A

Mild: Supportive
Severe: AGM
- Antibiotics (Amoxicillin + Metronidazole + Gentamicin)

36
Q

Gastroenteritis

A

Nothing unless systematically unwell or post-antibiotic

Severe:
- Antibiotics (specific to bug)

37
Q

Hypertensive Peristalsis

Excessive amplitude and frequency of peristaltic waves

A

Pain Relief:
- Isosorbide dinitrate

Relax LES:

  • CCB (Nifedipine or Diltiazem)
  • Phosphodiesterase inhibitor (Sildenafil)
38
Q

Gastroparesis

Delayed gastric emptying with no physical obstruction

A

Gastro-prokinetic agents:

  • Domperidone
  • Metoclopramide

Lifestyle changes (stop drugs, change diet, eat little and often, low fat, lots of fibre)

39
Q

Zollinger- Ellison syndrome

Gastrin-secreting tumour, leading to excessive HCL secretion

A

Surgery (resection of tumour)

40
Q

Chronic small bowel ischaemia

Chronic atherosclerotic disease of mesenteric vessels

A

Angioplasty

41
Q

Chronic colonic ischaemia

Inflammation and injury of the large intestine result from inadequate blood supply

A

Fluid replacement
Antibiotics
Angioplasty

42
Q

Small Intestine Cancer

3 types:

  • Lymphoma (coeliac disease)
  • Carcinoid (common in appendix)
  • Carcinoma (Crohn’s + coeliac disease)
A

Surgery and Chemotherapy

43
Q

Irritable Bowel Syndrome

Disturbed GI motility, exaggerated gastro-colic reflex

A

Diet:

  • regular meal times
  • reduce fibre
  • stop drugs

Psychological treatment

44
Q

Liver Disease

Any damage to a previously healthy liver

A

For itch:

  • sodium bicarbonate bath
  • ursodeoxycholic acid
  • cholestyramine

Fluids
No Alcohol
Increase Calories, decrease fatty foods

45
Q

Fulminant Hepatic Failure

(Acute Liver Failure, they gon die, gon die fast)

  • leads to hepatic encephalopathy
  • and failure of kidneys
A

Did someone say transplant?

Supportive
Renal replacement
Manage intra-cranial-pressure

46
Q

Cirrhosis

(Liver cannot function properly due to normal tissue being replaced with scar tissue due to long-term damage

A

Yep definitely transplant

Palliative- RIP

47
Q

Non-fatty alcoholic liver disease

Liver disease not caused by alcohol

A

Weight loss, exercise and hope (we always have hope)

48
Q

Primary Sclerosing Cholangitis

(A disease of the bile ducts that causes inflammation and obliterative fibrosis of bile ducts inside and/or outside of the liver. Impedes the flow of bile to the intestines and can lead to cirrhosis of the liver)

A

Transplant? You guessed it

ERCP with balloon/stenting if you’re lucky

49
Q

Autoimmune hepatitis

(A chronic, autoimmune disease of the liver that occurs when the body’s immune system attacks liver cells causing the liver to be inflamed)

A

Corticosteroids (Prednisolone)

Immunosuppressant (Methotrexate)

50
Q

Haemochromatosis

An increased intestinal absorption of iron, leading to iron depositions in organs

A

Venesection (removal of blood- like donating but this time to save yourself)

51
Q

Wilson’s Disease

(Autosomal recessive disease leading to toxic accumulation of copper in the liver and the CNS

A

Chelation drugs (penicillamine)

52
Q

Alpha 1 anti-trypsin deficiency

Deficiency of A1AT levels in the blood

A

Supportive for liver disease

Supportive for emphysema in lungs

53
Q

Budd-Chiari Syndrome

Occlusion of the hepatic veins by thrombosis or tumour, that drain the liver, leads liver damage

A

Anticoagulants (Heparin or Warfarin)

TIPS

54
Q

Portal hypertension

A

TIPS
(transjugular intrahepatic portosystemic stent shunting) -an artificial channel within the liver that establishes communication between the inflow portal vein and the outflow hepatic vein

55
Q

Acute Viral Hepatitis

Hepatitis:
A- Faecal-oral in shanty town type place (Sam’s gap year)
B- Blood, sex, from mother
C- Sex, from mother (name a more iconic duo, I’ll wait)
D- Presence of B
E- Faecal-oral in tropics

A

No “akkahol”
Supportive
Monitor condition

Turn to religion as spontaneous cure can occur in Hep B

56
Q

Chronic Viral Hepatitis

Hepatitis:
A- Faecal-oral in shanty town type place (Sam’s gap year)
B- Blood, sex, from mother
C- Sex, from mother (name a more iconic duo, I’ll wait)
D- Presence of B
E- Faecal-oral in tropics

A

Anti-virals:

Hep B- IF-alpha (peginterferon), tenofovir, entecavir
Hep C- IF-alpha (peginterferon), ribavirin, sofosbuvir

Screening for hepatocellular carcinoma
Supportive
No alcohol

57
Q

Hepatic tumours

Most common are secondary metastatic tumours

A

Surgical Resection

58
Q

Pancreatic Tumour

A

Pancreatoduodenectomy (Whipple procedure)

59
Q

Hernias

(An abnormal protrusion of a viscus outwith
its normal body cavity)

Types:

  • Inguinal (protrude through Hesselbach’s triangle)
  • Umbilical (near umbilicus- obese/ ascites)
  • Incisional (failed muscle closure after surgery)
  • Femoral (defect in femoral canal)
  • Epigastric (congenital weakness in the linea alba)
  • Paediatric inguinal (pre 1yo- Low Birth Weight)
A

Laparoscopic Surgery

60
Q

Perianal haematoma

A clotted collection of vessels on the anus border

A

Syringe the blood out, then cut around

61
Q

Hydatid Cyst

- From tape worm parasite
Echinococcus granulosus parasite

A

Albendazole

Surgery

62
Q

Encephalopathy

A

Lactulose

slows down bacteria producing ammonia

63
Q

Inflammatory Bowel Disease

A

Mesalanine suppository