Intestine 1 Flashcards
What’s treatment for constipation?
Dietary + lifestyle measures – optimize toileting habits, adequate dietary fluid + fiber intake, regular exercise, discontinue meds, maybe probiotics
Bulk forming laxatives – psyllium, methylcellulose, calcium polycarbophil, guar gum
osmotic laxatives - polyethylene glycol/Miralax or magnesium citrate,
stimulant laxatives (rescue - bisacodyl),
secretagogues (less optimal - lubiprostone),
serotonin 5-HT4-receptor agonist (prucalopride),
opioid-receptor antagonist (for those with opioid-induced constipation that have not responded to other medications)
Also: stool surfactants, enemas
use laxatives for constipation if
not responding to lifestyle changes
what are osmotic constipation treatments
polyethylene glycol/Miralax or lactulose. Purgative laxatives: magnesium citrate or milk of magnesia
how do you treat a fecal impaction
Digital disruption of impaction
Enema to allow digital disruption
– saline, mineral oil, soap suds
What’s treatment for appendicitis
Early, uncomplicated = surgical appendectomy with broad spectrum antibiotics
IV cefoxitin or cefotetan
IV amp/sulb
IV ertapenem
Conservative management w/ antibiotics alone may be considered with non-perforation + surgical CIS or strong preference
Perforation = emergency appendectomy
Contained abscess – Percutaneous CT-guided drainage of abscess w/ IV fluids + abx for inflammation to subside + interval appendectomy after 6 weeks
What’s treatment for peritonitis
Surgical emergency → general or acute care surgery
How do you treat bacterial peritonitis
3rd gen cephalosporin IV 5-10 days
IV albumin for patients at high risk for hepatorenal failure
- Cr >1
- BUN > 30
- Bilirubin > 4
Discontinue beta blockers permanently due to adverse effects in cirrhosis pts (MC pts to get SBP)
for bacterial peritonitis, consider antibiotic prophylaxis if
prior episode or at-risk patients with 1+:
→ low protein ascites, SCr>1.2, decomp. cirrhosis
psychological therapies can be used in IBS like
CBT, relaxation, yoga, hypnotherapy
How do you treat IBS?
Reassurance, education, support
Discuss importance of mind-gut interaction
Pain, bloating, altered bowel habits → anxiety/distress → further exacerbation
Exercise
Dietary therapy – fatty foods, alcohol, caffeine, spicy, grains are poorly tolerated
w/ diarrhea, bloating, or flatulence → lactose intolerance excluded, FODMAPs may exacerbate these symptoms (eliminate fructose, lactose, fructans, wheat, sorbitol, raffinose)
“Beano” can help high galactoside content
Poorly fermentable soluble fiber
Fermentable or insoluble fiber can increase gas/bloating
Utilize drug therapy for IBS with no response –> targeting specific symptoms with what agents?
Antispasmodic = enteric-coated peppermint oil formulations, anticholinergics to treat pain/bloating (hyoscamine, dicyclomine)
Antidiarrheal = loperamide, bile-binding agents (“chole-“)
Anticonstipation agents
Psychotrophic = SSRIs (fluoxetine, paroxetine, citalopram; help constipation), low TCAs (nortriptyline, desipramine, imipramine; help diarrhea)
Nonabsorbable antibiotics = rifaximin (refractory, 2 wks)
Probiotics maybe help
tx of diverticulosis
Increase dietary fiber in diet or with supplements
How do you treat diverticulitis?
Mild + no peritoneal signs = clear liquid diet 2-3 days
Antibiotics ONLY in:
- Immunocompromised
- Significant comorbid disease
- Small pericolonic abscess
For 7-10 days or until afebrile for 3-5 days
– augmentin or metronidazole AND ciprofloxacin or bactrim
Then high fiber diet
If increasing fever, pain, inability to tolerate fluids, immunocompromised or significant comorbid illness, abscess, severe = hospitalization
diverticulitis
IV fluids, NPO, NG tube if ileus, IV antibiotics
Cefoxitin, pip/taz, ticarcillin/clav
Metronidazole or clindamycin PLUS AG or 3rd gen ceph
Severe diverticulitis tx
Surgical consult + repeat abdominal CT in all with severe disease + no improvement in severe disease
If abdominal abscess, percutaneous catheter drain
Emergent surgical management if general peritonitis, large abscesses, deterioration
Severe if high fevers, leukocytosis, or peritoneal signs
how do you treat meckel’s diverticulum
Monitor
Other complications = surgery
