Treatments 4 Flashcards Preview

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Flashcards in Treatments 4 Deck (108)
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1

Celiac sprue

Remove gluten from diet (wheat, barley, rye; can still eat corn, rice)
Corticosteroids for refractory disease

2

Tropical sprue

Folic acid replacement
Tetracycline or sulfa drugs 3-6 months
Gluten removal from diet has no effect

3

Lactose intolerance

Remove lactose from diet
Adequate diet Ca, protein, fat, vitamins
May use lactase replacement

4

Whipple disease

TMP-SMX or ceftriaxone for 12 months

5

Crohn's

Azathioprine or Mercaptopurine
Anti-TNFa (infliximab, adalimumab)
Steroids and abx for acute exacerbation
Try to avoid surgical resection

6

UC

Total colectomy is curative
Sulfasalazine (large bowel), 5-ASA/mesalamine (SB)
Supplemental iron
Steroids (acute exacerbations)

7

IBS

Diarrhea predominant - TCAs/SSRIs, Lotronex (woman), Loperamide PRN
Constipation pred - Fiber building agents, hydration
Reassurance, possible psychosocial therapy

8

SBO

NPO, hydration
NG decompression
Surgery if refractory, complete obstruction, strangulation

9

Large bowel obstruction

NPO, hydration
Colonoscopy
Surgery if refractory

10

Ischemic colitis

IVF, bowel rest
Antibiotics for GI bacteria
Surgical resection of necrotic bowel

11

Appendicitis

Appendectomy if symptom onset w/i 24-72 hrs
If >5 days: Abx, IVF, bowel rest + interval appendectomy 8 weeks later

12

Abscess formation w/ appendicitis

Percutaneous drainage

13

Ileus

Treat underlying cause
NPO
Colonoscopic decompression if no resolution

14

Volvulus

Self-limited sometimes
Colonoscopic decompression of sigmoid
Surgical repair or resection if cecal volvulus, failed colonoscopic decompression

15

Diverticulosis

High-fiber diet

16

Diverticulitis, mild/early

Bowel rest (liquids only) x 3 days
Abx (gram neg + anaerobics): fluoro (cipro) + metronidazole OR TMP-SMX + metro OR amoxicillin-clavulanate

17

Diverticulitis, surgical indications

Any sign of perforation
(including free air under diaphragm on x-ray)
Severe cases
Peritonitis

18

Hemorrhoids

Warm (sitz) baths
Increase fiber, avoid prolonged straining
Sclerotherapy, ligation, excision if worsening

19

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)

20

Anorectal abscesses

Antibiotics
Surgical I&D

21

Rectal fistula (fistula in ano)

Fistulotomy

22

Pilonidal disease

Surgical I&D w/ packing
Surgical closure of sinus tracts may prevent recurrence

23

Carcinoid tumor

Octreotide, IFN-alpha (if refractory) for symptoms
Cyproheptadine, codine, cholestyramine (diarrhea)
Albuterol, theophylline (bronchospasm)
Surgical resection
Vavulvar surgery if needed

24

Upper GI bleed, stable

PPI IV (in case PUD)
Octreotide/somatostatin (splanchnic VC)

25

FAP

Prophylactic subtotal colectomy <25 yo

26

Pancreatic pseudocyst

Possibly self-resolving
Treat (drain) if lasting >6 wks, painful, rapidly growing

27

Exocrine pancreatic cancer

Whipple procedure for non-metastatic cancer limited to head of pancreas
Lesions in body or tail rarely resectable if found early
Adjuvent chemo for resectable cancer
Enzyme replacement therapy
Stenting of ducts, duodenum = palliative

28

Insulinoma

Octreotide or diazoxide
Surgical resection if you can

29

Glucagonoma

Octreotide, IFN-a, chemo
Surgical resection if you can
Embolization in metastatic

30

VIPoma

IVF + electrolyte replacement
Octreotide, corticosteroids, chemo
Surgical resection if you can
Embolization in metastatic