Gi treatments

Question 1

Malignant Tumours of the Oesophagus

Answer 1

surgery - resection (curative)
palliative - stenting and intubation

Question 2

peptic ulcer disease

Answer 2

h.pylori positive = PPI + amoxycillin (/metronidazole) + clarithromycin

h.pylori negative = PPI and withdraw NSAIDs

If signs of recent haemorrhage at endoscopy = Endoscopic treatment - adrenaline injection, heater probe coagulation, clips, haemospray

Question 3

malabsorption

Answer 3

• Treat the underlying cause
• Replace the deficiency
• Support Nutritionally

Question 4

oral cancer

Answer 4

resection +/- adjuvant therapy

Question 5

treatment of intestinal failure

Answer 5

pareantral nutrition

Question 6

malnutrition

Answer 6

enteral tube feeding
- Delivery of nutritionally complete food through tube in stomach, duodenum or jenunum

parental nutrion
- The administration of nutrient solutions via a central or peripheral vein

Question 7

gastroenteritis

Answer 7

• Oral rehydration (at home)
• Antibiotics rarely indicated - can precipitate HUS

C diff:
- Less severe - PO metronidazole
- Severe - PO vancomycin +/- PO metronidazole

Question 8

Crohn’s

Answer 8

PO prednisolone
Azathioprine (immunosuppressant)
Anti-TNF
Colectomy (resection)

Question 9

UC

Answer 9

5ASA - sulphasalazine or mesalazine
corticosteroid
immunosuppression
anti-TNF
surgery

Question 10

IBS

Answer 10

dietary advice
low formal diet

• IBS-D - anti-diarrhoeals (loperamide)
• IBS-C - osmotic laxatives (avoid stimulant laxatives)

Question 11

acute appendicitis

Answer 11

• Appendicectomy
• IV antibiotics for those who are unable to undergo surgery

Question 12

acute diverticulitis

Answer 12

Simple diverticulitis
- Fluids (oral or IV)
- Antibiotics (oral)

Complicated diverticulitis - associated abscess formation, fistula, obstruction, frank perforation

• Hartmann’s procedure - sigmoid colon removed, and colostomy inserted
• Abscess - drainage (percutaneous, laparoscopic lavage and drainage)

Question 13

alcoholic liver disease hepatitis

Answer 13

• Abstinence of alcohol
• Nutritional support with vitamins (particularly thiamine) and a high protein diet
• Steroids improve short term outcomes (over 1 month) in severe alcoholic hepatitis
• Treat complications of cirrhosis
• Referral for liver transplant in severe disease (must abstain from alcohol for 3 months prior to treatment)

Question 14

acute cholecystitis

Answer 14

• Initial management - IV antibiotics, fluids, nil by mouth
• Once confirmed - cholecystectomy (urgent or interval)

Question 15

acute pancreatitis

Answer 15

• Fluid ‼️
• Supportive - fluid resuscitation, O2, broad spectrum prophylactic antibiotics in confirmed pancreatic necrosis
• treat underlying cause once stabilised

Question 16

Cholangiocarcinoma

Answer 16

• Surgery - bile duct and liver resection
• Palliative - biliary stent

Question 17

hepatitis

Answer 17

Antivirals
- Surpressive therapy -
Tenofovir, Entecavir

Question 18

GORD

Answer 18

lifestyle
anti-acids
PPI
H2 receptor antagonists eg. Ranitidine

Question 19

benign peptic stricture in oesophagus

Answer 19

oesophageal balloon dilation (rapid relief)

Question 20

Hiatus hernia

Answer 20

lifestyle
PPI
surgery

Question 21

coeliac disease

Answer 21

main test = anti-TGG

treatment = gluten free diet

Question 22

diverticular disease

Answer 22

mild - IV fluids, Co-amoxiclav, drainage
perforation - Hartmann’s procedure (resection of rectosigmoid colon)

Question 23

ascites

Answer 23

• reduce salt intake
• diuretics (spironolactone)
• paracentesis
• TIPPS

Question 24

Encephalopathy

Answer 24

lactulose
antibiotics - rifaximin, neomycin

Question 25

primary biliary cholangitis

Answer 25

ursodeoxycholic acid
azathioprine + prednisolone