Treatments 4 Flashcards
(108 cards)
Celiac sprue
Remove gluten from diet (wheat, barley, rye; can still eat corn, rice)
Corticosteroids for refractory disease
Tropical sprue
Folic acid replacement
Tetracycline or sulfa drugs 3-6 months
Gluten removal from diet has no effect
Lactose intolerance
Remove lactose from diet
Adequate diet Ca, protein, fat, vitamins
May use lactase replacement
Whipple disease
TMP-SMX or ceftriaxone for 12 months
Crohn’s
Azathioprine or Mercaptopurine
Anti-TNFa (infliximab, adalimumab)
Steroids and abx for acute exacerbation
Try to avoid surgical resection
UC
Total colectomy is curative
Sulfasalazine (large bowel), 5-ASA/mesalamine (SB)
Supplemental iron
Steroids (acute exacerbations)
IBS
Diarrhea predominant - TCAs/SSRIs, Lotronex (woman), Loperamide PRN
Constipation pred - Fiber building agents, hydration
Reassurance, possible psychosocial therapy
SBO
NPO, hydration
NG decompression
Surgery if refractory, complete obstruction, strangulation
Large bowel obstruction
NPO, hydration
Colonoscopy
Surgery if refractory
Ischemic colitis
IVF, bowel rest
Antibiotics for GI bacteria
Surgical resection of necrotic bowel
Appendicitis
Appendectomy if symptom onset w/i 24-72 hrs
If >5 days: Abx, IVF, bowel rest + interval appendectomy 8 weeks later
Abscess formation w/ appendicitis
Percutaneous drainage
Ileus
Treat underlying cause
NPO
Colonoscopic decompression if no resolution
Volvulus
Self-limited sometimes
Colonoscopic decompression of sigmoid
Surgical repair or resection if cecal volvulus, failed colonoscopic decompression
Diverticulosis
High-fiber diet
Diverticulitis, mild/early
Bowel rest (liquids only) x 3 days Abx (gram neg + anaerobics): fluoro (cipro) + metronidazole OR TMP-SMX + metro OR amoxicillin-clavulanate
Diverticulitis, surgical indications
Any sign of perforation
(including free air under diaphragm on x-ray)
Severe cases
Peritonitis
Hemorrhoids
Warm (sitz) baths
Increase fiber, avoid prolonged straining
Sclerotherapy, ligation, excision if worsening
Anal fissures
Stool softeners + hydration (first line) Topical nitroglycerine (first line) Topical diltiazem, nifedipine, bethanechol (2nd line) Botox injection (2nd/3rd line) Partial sphincterotomy (recurrent)
Anorectal abscesses
Antibiotics
Surgical I&D
Rectal fistula (fistula in ano)
Fistulotomy
Pilonidal disease
Surgical I&D w/ packing
Surgical closure of sinus tracts may prevent recurrence
Carcinoid tumor
Octreotide, IFN-alpha (if refractory) for symptoms
Cyproheptadine, codine, cholestyramine (diarrhea)
Albuterol, theophylline (bronchospasm)
Surgical resection
Vavulvar surgery if needed
Upper GI bleed, stable
PPI IV (in case PUD) Octreotide/somatostatin (splanchnic VC)