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Clin Med II > GI Therapeutics > Flashcards

GI Therapeutics Flashcards

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1
Q

Celiac Sprue

A

Gluten-free diet

Multivit, iron, folate, calcium, vitamin D

Steroids for severely ill

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2
Q

Whipple’s disease

A 
Trimethoprim-sulfamethoxazole BID x 1 yr
Parenteral penicillin for ill pts
Oral PCN for pts allergic to sulfa
Chloramphenicol for failures
Supplement folate, B 12, fat soluble vitamins and iron as needed
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3
Q

Achalasia

A

nitrates, calcium channel blocker
(inconsistent resp.)

Botox (inconsistent resp.)

Disruption of LES

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4
Q

Eosinophillic Esophagitis

A

dietary modification, topical and oral steroids, dilatation with stricture

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5
Q

Esophageal Spasm

A

If due to acid→ block acid production

If spontaneous → muscle relaxants

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6
Q

Gastroesophageal Reflux

A

Lifestlye modifications (↑ head of bed, diet)

Antacids
H2-receptor antagonist
PPI
Metachlopromide

Surgery

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7
Q

How can you decrease adverse events in NSAID users?

A

PPI and H2 blockers

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8
Q

MOA of PPI

A

Bind the acid-secreting enzyme H+-K+- ATPase, or “proton pump,” permanently inactivating it
Inhibit >90% of 24 hr acid secretion

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9
Q

H2 blockers MOA

A

Block, histamine, one of the first stimuli for acid production
Rapid onset <1 hr lasting for 12 hr

Cimetidine (drug-drug interactions), Ranitidine, Nizatidine, and famotidine

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10
Q

Tx for PUD

A

Pre endoscopy IV PPI

endoscopic hemostasis (cautery, clip or injection)

Followed by feeding and oral PPI for low risk or IV PPI x 72 hr for high risk

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11
Q

Tx for H. Pylori

A

Abx x 2 wks + PPI

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12
Q

Zollinger-Ellison Sundrome

A

High dose PPI and removal of tumor

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13
Q

Gastroparesis

A

Diet
Feeding tube

Anti-emetics

Metoclopramide
Erythromycin
Gastric Pacer

Surgery

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14
Q

When can you use medication to treat obesity?

A

BMI > 30

BMI > 27 with obesity‐related risk
factors

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15
Q

What medications can you use for tx of obesity?

A

Orlistat 3x/day w/ meal (inhib fat abs)

Lorcaserin (appetite control)

Qsymia (dec appetite by inc energy used)

Contrave

Liraglutide/Saxenda (stim insulin secretion)

Sibutramine/Meridia (appetite suppressant)

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16
Q

SE Orlistat

A

diarrhea, gas, and cramping and perhaps reduced absorption of fat‐soluble vitamins

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17
Q

SE Lorcaserin

A

nausea, dry mouth, dizziness

constipation and fatigue

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18
Q

SE Qsymia

A

mood changes, fatigue, increased blood pressure, heart rate and insomnia

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19
Q

Preventative tx for travelers diarrhea

A

Give travelers antimotility agent (Imodium®) and
antibiotics to take on trip

Instruct on when to self-medicate (>24 h)

Bismuth is often sufficient

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20
Q

How do you treat small ileal resection?

<100 cm

> 100 cm

A

<100 cm Cholestyramine

> 100 cm NO Cholestyramine

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21
Q

How do you treat SB bacterial overgrowth?

A

Augmentin, Cipro, Metronidazole, Rifaxamin, etc

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22
Q

Tx for esophageal ca

A

SCC- more sensitive to chemo, chemoXRT and RT

Low stage (Tis & T1) – endoscopic therapy, checmo/surgery if needed

Higher stage (T2 & above) – chemo/XRT then surgery

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23
Q

Gastric ca tx

A

Low stage (Tis & T1) – endoscopic therapy (EMR/ESD)

Higher stage (T2 & above) – chemo/XRT then surgery (morbid)

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24
Q

SB ca tx

A

Surgery + chemo mainstay of therapy

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25
CRC tx
Stage 1 and low-risk stage 2: surgical resection is curative and no chemo All other stages: surgical resection if possible followed by adjuvant chemo
26
Anal Fissure tx
High fiber diet (30-50 grams) Fiber Supplement Warm Baths Nitrates (vasodilator allows more blood to heal) Cachannel Blockers (relax muscle to let heal) steroid Creams Surgical Botox Sphincterotomy Anoplasty Advancement Flap Anal Dilatation
27
Thrombosed External Hemorrhoid
Excision | will have pain for a few days following excision
28
Internal hemorrhoids
Bowel regimen: high fiber diet, ↑ fluids, supplemental fiber Local Destruction: Banding, Heater Probe, Injection Surgery: Transanal Hemorrhoidal Dearterialization (THD), Conventional Hemorrhoidectomy Stage I-II can use endoscopic management Stave III-IV surgical intervention
29
Perianal abscess
I &D Abx- immunocomp, diabetics, cellulitis Seton or fistulotomy palcement Untreated → necrotizing soft tissue infection
30
Cholelithiasis
Ursodoxycholic acid- can dissolve small stones but usually doesn’t work Cholecystectomy- Treatment of choice
31
Cholecystitis
Cholecystectomy If too sick to remove—> cholecystitis you
32
Ascending Cholangitis
ERCP with stone removal/stent, surgery
33
Primary Sclerosing Cholangitis (PSC)
Underlying disorder ERCP only for dominant stricture Admit to hospital and treat with Abx
34
Cholangiocarcinoma
Surgical resection or liver transplantation
35
Gallbadder Cancer
cholecystectomy +/- hepatic resection 5 year prognosis – 0-10%
36
Gastroenteritis
Rehydration (oral) Antimotility agents → loperamide (Imodium®) Zinc & vit A supp (devel world)
37
Bacillus cereus Food Posioning Staphylococcal Food Poisoning Clostridium botulinum Food Posioning
Dilute drink lots of water Antibiotics will not help because it’s it the bacteria it’s the toxin
38
Vibrio cholerae
Rehydration: fluid & electrolytes IV vs. oral (oral rehydration solution – “ORS”) Antibiotics ↓ duration of illness & shedding of organism Doxycycline 300 mg single dose (azithromycin 1 gm single dose for pregnant women)
39
Enterotoxigenic E. coli (ETEC)
Self-limited infection (sx resolve after 2-4 days) Antibiotics ± antimotility (loperamide) agents ↓ duration and severity of illness Fluoroquinonoles (ciprofloxacin 500 mg twice daily X 1- 3 days) Azithromycin 500 mg daily X 1- 3 days Rifaximin (non-absorbed antibiotic) Bismuth subsalicylate Loperamide (antimotility)
40
Rotavirus
vaccine to prevent
41
Giardia duodenalis
Metronidazole 250 mg PO three times daily for 7-10 days or 2 gm PO daily X 3 days (DO NOT DRINK ALC) Tinidazole 2 gm PO once Nitazoxanide 500 mg PO q 12 hours with food X 3 -7 days
42
Shigellosis
Rehydrate, fluoroquinolones – ciprofloxacin 500 mg twice daily X 3-5 days or 2 gm single dose
43
Campylobacter
Azithromycin 500 mg once daily X 3-5 days or ciprofloxicin 500 mg q 12 hours X 5-7 days Resistance to fluoroquinolones in SE Asia Usually self-limited but 10-20% have symptoms > 7 days
44
STEC: Shiga toxin producing E. coli
NO Abx or antimotility bc you want the toxin out as fast as it can go- hydrate and keep stable
45
Nontyphoidal Salmonella (NTS) Enterocolitis
Usually self-limited: diarrhea resolves in 3-7 days Excrete in feces for 4-5 weeks after resolution of diarrhea Abx may prolong carriage but use for those at risk for invasive dz Ceftriaxone 500 mg q 12 hours X 3-7 days (alt. ceftriaxone, cefotaxine, azithromycin, TMP-SMX)
46
Amoebiasis
Metronidazole (acts against trophozoites) 750 mg three times daily X 7-10 days Followed by a “luminal” agent (acts on cysts) Percutaneous drainage not usually required Asymptomatic colonization: Treat with “luminal” agent alone: Paromomycin Lodoquinol
47
Clostridium difficile
D/C inciting antibiotic if possible Metronidazole 500 mg three times daily X 10-14 days for mild to moderate PO Vancomycin for severe (WBC 20-30,000/mm3) 125-500 mg four times daily X 10-14 days
48
Typhoid Fever
Fluoroquinolone (ciprofloxicin), 3rd generation cephalosporin (ceftriaxone)
49
Acute Pancreatitis
IV fluid Bowel rest Pain mgmt Enteral nutrition- try to avoid parenteral Stop offending agent- drug/alcohol Cholecystectomy after pancreatitis recovery Surgical debridement of infected necrosis Can feed again when pain improves & pt devel appetite (start w/ clear liquids) Abx if cholangitis or infected necrosis ERCP if gallstone pancreatits and concurrent cholangitis
50
Chronic Pancreatitis
Pancreatic enzyme replacement therapy (PERT) Pain mgmt Alcohol cessation Diabetes mgmt Endoscopic or surgical tx 50% mortality & ↑ risk pancreatic cancer
51
Hepatitis A
Supportive, dz is self‐limited in the vast majority of cases Active Immunization >1 yo, travelers, MSM Passive Immunization- as soon as exposed w/in 2 wks, <1 yo
52
Hepatitis E
supportive,self‐limited Immunization trial
53
Hepatitis B Virus
Tenofovir, Entecavir, or Lamivudine High risk of HCC (HBeAg+) Pre (HBsAg) and post (HBIG) exposure immunization
54
Hepatitis D
Usuallyself‐limiting infections
55
Hepatitis C
Poor prognosis: alc, HIV coinfection male, older High HCC risk-hispanics & caucasians 45-60
56
Hep A pathophys
"Icosahedralshape Non‐enveloped,single‐strandedRNAvirus"
57
Hep E pathophys
Non‐enveloped, single‐stranded RNA virus
58
Hep B pathophys
Envelope proteins HBsAg (surface) HBcAg, HBeAg (core) Gets into nucleus- hard to cure/treat
59
Hep D pathophys
Dependent on HBV for the production of envelope proteins (‘satellite virus’) Directlycytopathic
60
Hep C pathophys
Replication occurs through RNA‐dependant RNA polymerase Lacks proofreading function → high genetic variability No complete neutralizing immune response
61
Diverticulitis
Bowel rest, antibiotics, Then high-fiber diet. Surgery for complications (abscess, perforation) 30% pt recurrence and 30% recurrent abd pain If complicated IR- percutaneous abscess drainage Surgical resection, debridement, washout
62
Colonic Ischemia
Mild-Moderate: resuscitation, antibiotics Severe: laparotomy
63
Diverticular Hemorrhage
Localize and treat bleeding by colonoscopy or angiography Cauterize
64
Acute Mesenteric Ischemia
Surgical Emergency
65
Irritable Bowel Syndrome
Fiber (30g/day) Probiotic Laxatives (PEG3350 nonabsorbed) Antidiarrheals Antispasmodics (Hyoscyamine, Dicyclomine) SSRI, TCA Rifaximin

Clin Med II (19 decks)

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