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Flashcards in GI treatments Deck (47)
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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