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Flashcards in GI treatments Deck (47):
1

Familial adenomatous polyposis treatment

Prophylactic colectomy

2

Treatment of Juvenile polyps

Polyps in children less than 10 years old

Highly vascular and should be removed

3

Treatment of adenomatous polyps

Removal of polyp

4

Treatment of diverticulosis

High fiber foods
Psyllium if can't handle bran

If recurrent bleeding perform segmental colectomy

5

Treatment of diverticulitis

Uncomplicated:
Antibiotics-IV 7-10 days
NPO-IV fluids

Symptoms persist for 3-4 days means surgery may be necessary
Recurrent-surgery

Complicated (abscess, colovesical fistula, obstruction, perforation): surgery indicated

6

Acute mesenteric ishemia treatment

Supportive IV fluids and broad spectrum antibiotics
Direct intra-arterial infusion of papaverine relieves occlusion and vasospasm
Direct intra-arterial infusion of thrombolytics and embolectomy if embolism is etiology
Heparin for venous thrombosis
Surgery if signs of peritonitis develop

7

Chronic meseneteric ischemia treatment

surgical revascularization

8

Pseudomembranous colitis treatment

Discontinue offending antibiotic

Metronidiazole-not in infants or pregnancy
oral vanco

Cholestryamine for adjuvant therapy

Toxic megacolon, colonic perforation, anascarca (generalized edema) or electrolyate disturbances may require surgery

9

Sigmoid and cecal volvulus

Sigmoid: decompression via sigmoidoscopy and elective sigmoid colon resection

cecal: emergent surgery

10

Treatment of portal hypertension

Transjugular intrahepatic portal-system shunt (TIPS)

11

Treatment of esophageal varices

Initially: hemodynamic stabilization with fluids

IV ocreotride: splanchnic vasoconstriction and reduces portal pressure
possible IV vasopressin instead of ocreotride

Variceal ligation/banding: initial treatment of choice
Endoscopic sclerotherapy: (higher rates of rebleeding)
Both after emergent upper GI endoscopy

Prophylactic non selective B blocker and IV antibiotics

12

Treatment of ascites

Bed rest, low-sodium diet, and diuretics (furosemide and spironolactone)
Therapeutic paracentesis if tense ascites, SOB, or early satiety
Peritoneovenous shunt or TIPS to reduce portal HTN

13

Treatment of hepatic encephalopathy

lactulose prevents absorption of ammonia
neomycin: decreases ammonia production by intestinal bacteria
Limit protein to 30-40 g/day

14

Management of cirrhosis

Surveillance of LFTs
Compensated (vague symptoms: weakness, anorexia and fatigue)
ultrasound and aFP every 6 months, EDG, varices surveillance endoscopy)

Decompensated (jaundice, pruritus, upper GI bleed)
Variceal hemorrhage: non selective B blocker-repeat EGD yearly
Ascites: dietary Na restriction, Diuretics, parancentesis, abstinence
Encephalpathy: lactulose

15

Treatment of Wilson's disease

Chelating agents: penicillamine

Zinc: prevents uptake of dietary copper
Can be given prophylactically or pregnant patients

Liver transplantation: if unresponsive to therapy or fulminant liver failure

16

Treatment of hemachromatosis

Repeat phlebotomies

Liver transplantation in advanced cases

17

Treatment of pyogenic liver abscess

Fatal if untreated

IV antibiotics and percutaneous drainage of abscess

Surgical drainage is sometimes necessary

18

Amebic liver abscess treatment

IV metronidazole

Therapeutic aspiration of abscess (image guided percutaneous aspiration) if abscess is large or no response to metro

19

Treatment of budd chiari syndrome

Surgery: balloon angioplasty with stent in IVC
Portocaval shunts

Liver transplantation if cirrhosis is present

20

Treatment of cholelithiasis

No treatment if asymptomatic
Elective cholecystectomy for recurrent bouts of bilary colic

21

Treatment of cholecystitis

Conservative measures of hydration with IV fluids, NPO, IV antibiotics, analgesics, correction of electrolyte abnormalities

Surgery: within first 24-48 hours preferred

22

Treatment of acalculous cholecystitis

Seen in patients with severe iillnesses-trauma, burns, postoperative state, TPN, mechanical ventiation, ischemia, dehydration

Emergent cholecystectomy-if can't do surgery perform percutaneous drainage with cholecystostomy

23

Treatment of choledocholithiasis

endoscopic retrograde cholangiopancreatography with sphincterotomy and stone extraction with stent placement
laprascopic choledocholithotomy

24

Treatment of cholangitis

IV antibiotics and IV fluids
Monitor hemodynamics, BP and urine output
Afebrile for 48 hours perform Percutaneous transheptic cholangriography (with catheter drainage) or endoscopic retrograde cholangiopancreatography(with sphinctertomy) for underlying condition
Lapraprotomy (T-tube insertion)
Perform emergently if patient does not respond to antibiotics

25

Treatment of porcelain gallbladder

Prophylactic cholecystectomy (can develop cancer of the gallbladder)

26

Treatment of primary sclerosing cholangitis

Curative: liver transplantation
dominant stricture causing cholestasis: ERCP with stent placement for biliary drainage can relieve symptoms
Cholestyramine for symptomatic relief (decreases pruritus)

27

Treatment of primary biliary cirrhosis

Symptomatic for pruritus: cholestyramine
Osteoprosis: calcium, vit D, bisphosphonates

Ursodeoxycholic acid slows progression

Liver transplantation is curative

28

Acute appendicitis treatment

Appendectomy within 24 hours

29

Acute pancreatits treatment

NPO
IV fluids-correct electrolytes
Pain-meperidine or fentanyl

30% of pancreas necrotic=antibiotics

3-4 of ransons criteria should be in ICU

30

Treatment of pancreatic pseudocyst

less than 5 cm=observation
greater than 5 cm=drain percutaneously or surgically

31

Treatment of chronic pancreatitis

Nonoperative:
Narcotic analgesiics for pain
NPO
Pancreatic enzymes and H2 blockers
Insulin for endocrince insufficiency
Alcohol abstinence
Frequent, small volume, low fat meals

Surgery:
pancreatiocjejunostomy-decompresses dilated pancreatic duc
Pancreatic resection: distal pancreatectomy, Whipples procedure

32

Upper GI bleed treatment

EGD with coagulation of the bleeding vessel
If bleeding continues repeat endoscopic therapy or proceed with surgical intervention (ligation of vessel)

33

Lower GI bleed treatment

Colonoscopy-polyp excision, infection, laser, cautery
Arteriographic vasoconstrictor infusion
surgical resection of area-last resort

34

Indications for surgery for GI bleed

Hemodynamically unstable who have not responded to IV fluid, tranfusion, endoscopic intevention, or correction coagulopathies

Severe initial bleed or recurrence of bleed after endoscopic treatment

Continued bleeding more than 24 hours

Visible vessel at base of ulcer

ongoing tranfusion requirement (5 units within first 4-6 hours)

35

Achalasia treatment

Chew food to soup like consistency, sleep with trunk elevated, avoid eating before sleeping

Anitmuscarinic dicyclomine-unsatisfactory
Sublingual nitroglycerin, long acting nitrates, CCBs improve swallowing in early stages of achalasia

Injection of botox into LES during endoscopy-must be performed every two years

Forceful dilatation-pneumatic balloon most effective (risk of perforation)

Heller myotomy: surgical incision of circular muslce layer of LES (patients who do not respond to dilation therapy)

36

Diffuse esophageal spasm treatment

Nitrates and CCBs (decrease amp of contractions)
TCAs provide symptomatic relief

Possible esphagomyotomy (controversial)

37

esophageal hiatal hernia treatment

Sliding: anatacids, small meals, and elevation of head after meals
Nissen fundoplication if there no response to medical therapy or evidence of esophagitis

paraesphogeal: elective surgery to avoid complications

38

Mallory weiss tear treatment

Most of the time not necessary

Oversewing the tear or angiographic embolization if bleeding continues
Acid suppression to promote healing

39

Zenker and epiphrenic diverticular treatment

Zenker: cricopharyngeal myotomy

Epiphrenic: esophagomytomy

Diverticulectomy is of secondary importance

40

esophageal perforation treatment

Small perforation into lumen and patient stable: IV fluids, NPO, antibiotics, and H2 blockers

Patient ill and perforation large (communication with pleural cavity): surgery should be performed within 24 hours of presentation

41

Peptic Ulcer Disease Treatment regimens

Supportive: discontinue aspirin/NSAIDs, restrict alcohol and coffee use, stop smoking, decrease emotional stress, avoid eating before bedtime

If positive for H. Pylori: start with triple therapy (amoxicillin, clarithromycin and H2 inhibitor) for 10-14 days and antacids
If comes back use quadruple therapy (PPI, bismuth plus amoxicllin and clarithromycin) for one week

NSAID induced ulcer: switch to acetiminophen, begin with PPI or misoprostol (reduces risk for ulcer formation) continue for 4 to 8 weeks Treat H. pylori if present

H pylori and not NSAID induced treat with H2 blockers or PPIs

Surgery: complications of PUD
Peforation:
Gastric outlet obstruction:
GI bleeding

42

GI perforation treatment

Emergency surgery to close peforation and perform definitive ulcer operation (selective vagotomy or truncal vagotomy/pylorplasty)

Can progress to sepsis and death if untreated

43

Acute gastritis treatment

Epigastric pain is low and not associated with worrisome findings: treat with empiric therapy with acid suppression.
Stop NSAIDs

No response after 4 to 8 weeks consider GI endoscopy and ultrasound (rules out gallstones) and test for H. pylori
treat findings

44

Treatment of small bowel obstruction

Nonopeative if incomplete and no fever, tachycardia, peritoneal signs or leukocytosis
Give IV fluids, potassium, nasogastric tube to empty stomach, antibiotics

Surgery if complete obstruction or persistent pain or strangulation suspected (fever, severe/continuous pain, hemataemesis, shock, gas in the bowel wall or portal vein, abdominal free air, peritoneal signs, and acidosis)
Perform lysis of adhesion and resection of any necrotic bowel

45

Treatment of paralytic ileus

IV fluids, NPO

Electrolyte imbalances (hypokalemia)

nasogastric suction if necessary

Placement of long tube if necessary but generally do not need surgery

46

Treatment of Crohn's disease

Sulfsalazine: antiinflammatory
Metronidazole: if no response to 5-ASA
Prednisone: acute exacerbations
Azathioprine, 6-mercaptopurine: with steroids if no response to other agents
Choelstyramine or colestipol: terminal ileal disease that cannot absorb bile acids
NOT antidiarrheals

Surgery: reserved for SBO, fistula, disabling disease, perforation or abscesss-segmetnal resection of involved bowel

47

Treatment of ulcerative colitits

Systemic corticosteroids for acute exacerbations

Topical application as suppository sulfasalazine maintains remissions

Immunosuppressants for refractory disease

Surgery: total colectomy-curative
indications: debilitating disease, unresponsive to treatment, toxic megacolon, hemorrhage, obstruction, perforation, evidence of colon cancer, failure to thrive in children