Treatments 4 Flashcards
(108 cards)
1
Q
Celiac sprue
A
Remove gluten from diet (wheat, barley, rye; can still eat corn, rice)
Corticosteroids for refractory disease
2
Q
Tropical sprue
A
Folic acid replacement
Tetracycline or sulfa drugs 3-6 months
Gluten removal from diet has no effect
3
Q
Lactose intolerance
A
Remove lactose from diet
Adequate diet Ca, protein, fat, vitamins
May use lactase replacement
4
Q
Whipple disease
A
TMP-SMX or ceftriaxone for 12 months
5
Q
Crohn’s
A
Azathioprine or Mercaptopurine
Anti-TNFa (infliximab, adalimumab)
Steroids and abx for acute exacerbation
Try to avoid surgical resection
6
Q
UC
A
Total colectomy is curative
Sulfasalazine (large bowel), 5-ASA/mesalamine (SB)
Supplemental iron
Steroids (acute exacerbations)
7
Q
IBS
A
Diarrhea predominant - TCAs/SSRIs, Lotronex (woman), Loperamide PRN
Constipation pred - Fiber building agents, hydration
Reassurance, possible psychosocial therapy
8
Q
SBO
A
NPO, hydration
NG decompression
Surgery if refractory, complete obstruction, strangulation
9
Q
Large bowel obstruction
A
NPO, hydration
Colonoscopy
Surgery if refractory
10
Q
Ischemic colitis
A
IVF, bowel rest
Antibiotics for GI bacteria
Surgical resection of necrotic bowel
11
Q
Appendicitis
A
Appendectomy if symptom onset w/i 24-72 hrs
If >5 days: Abx, IVF, bowel rest + interval appendectomy 8 weeks later
12
Q
Abscess formation w/ appendicitis
A
Percutaneous drainage
13
Q
Ileus
A
Treat underlying cause
NPO
Colonoscopic decompression if no resolution
14
Q
Volvulus
A
Self-limited sometimes
Colonoscopic decompression of sigmoid
Surgical repair or resection if cecal volvulus, failed colonoscopic decompression
15
Q
Diverticulosis
A
High-fiber diet
16
Q
Diverticulitis, mild/early
A
Bowel rest (liquids only) x 3 days Abx (gram neg + anaerobics): fluoro (cipro) + metronidazole OR TMP-SMX + metro OR amoxicillin-clavulanate
17
Q
Diverticulitis, surgical indications
A
Any sign of perforation
(including free air under diaphragm on x-ray)
Severe cases
Peritonitis
18
Q
Hemorrhoids
A
Warm (sitz) baths
Increase fiber, avoid prolonged straining
Sclerotherapy, ligation, excision if worsening
19
Q
Anal fissures
A
Stool softeners + hydration (first line) Topical nitroglycerine (first line) Topical diltiazem, nifedipine, bethanechol (2nd line) Botox injection (2nd/3rd line) Partial sphincterotomy (recurrent)
20
Q
Anorectal abscesses
A
Antibiotics
Surgical I&D
21
Q
Rectal fistula (fistula in ano)
A
Fistulotomy
22
Q
Pilonidal disease
A
Surgical I&D w/ packing
Surgical closure of sinus tracts may prevent recurrence
23
Q
Carcinoid tumor
A
Octreotide, IFN-alpha (if refractory) for symptoms
Cyproheptadine, codine, cholestyramine (diarrhea)
Albuterol, theophylline (bronchospasm)
Surgical resection
Vavulvar surgery if needed
24
Q
Upper GI bleed, stable
A
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
31
Cholelithiasis
Cholecystectomy for symptomatic patients
| Dietary modification, bile salts, shock wave lithotripsy
32
Cholecystitis
Cholecystectomy (frequently delayed 24-48 hrs for hydration, abx)
33
Cholangitis
Hydration, IV abx
ERCP/stent to drain bile ducts
Cholecystectomy (delayed)
34
Gallbladder cancer
Cholecystectomy + LN dissection + partial removal of adjacent hepatic tissue
Adjuvant radiation and chemo
35
PBC
Ursodeoxycholic acid slows damage, increases survival
Liver transplant may be needed
Treat symptoms as needed
36
PSC
Ursodeoxycholic acid, MTX, stseroids
Endoscopic stenting, surgical resection
Liver transplant
37
Gilbert disease
None
38
Crigler-Najjar syndrome Type I
Phototherapy, plasmapheresis
| Liver transplantation
39
Crigler-Najjar syndrome Type II
Phenobarbital (induces hepatic synthesis of UDP-GT)
40
Liver transplant alcohol requirement
None for at least 6 months
41
Varices (hepatic failure)
Prevent w/ BB (propranolol, nadolol)
| Rx w/ vasopressin or sclerotherapy
42
Hepatic encephalopathy
Lactulose
| Maybe rifaximin
43
Budd-Chiari syndrome
```
Thrombolytics
Diuretics
AC
Angioplasty
Shunting
```
44
Cirrhosis
Stop alcohol, hepatotoxins
Treat symptoms
Liver transplant if progressive
45
Ascites
Salt restriction
| Diuretics (furosemide + spironolactone together)
46
Spontaneous bacterial peritonitis
Cefotaxime (or ceftriaxone or other 3rd gen ceph) x 5 d
| Albumin (maintains plasma volume, renal fxn)
47
Portal HTN
Treat symptoms inc dialysis for renal failure
Hepatic shunting (laparotomy/TIPS) (short-term)
Liver transplant usu required in progressive
48
Wilson disease
```
Trientine or penicillamine (chelation)
Lifelong zinc (maintenance)
Restrict dietary copper
Supplementary vitamin B6
May need liver transplant
```
49
alpha-1-antitrypsin
May need liver or lung transplant
50
HCC
Surgical resection of small tumors + chemo
Transplant for limited disease
Radiofrequency ablation and chemoembolization if unresectable
51
Benign liver neoplasms (eg adenoma)
D/C OCP
Serial imaging and aFP (10% malignant transformation)
Resection if >5 cm, growing, etc.
52
TEF
Surgical repair
53
Pyloric stenosis
Pyloromyotomy
54
Necrotizing enterocolitis
TPN
IV broad-spectrum antibiotics
NG decompression
Surgical resection of affected bowel if necrosis
55
Hirschsprung disease
Colostomy and resection of affected area
56
Intussusception
Barium enema may reduce defect
| Surgery if refractory
57
Meckel diverticulum
Surgical resection if symptomatic
58
Glaucoma
Acetazolamide
| Mannitol (acute)
59
Altitude sickness
Acetazolamide
60
Metabolic alkalosis
Acetazolamide
61
CHF, diuretics
Loop diuretic + aldosterone antagonist
| Thiazide if mild/early
62
Increased ICP, diuretic
Mannitol
63
Acute renal failure, diuretic
Mannitol
64
HTN, diuretic
Thiazide (first line)
| Other K sparing (to replace K)
65
Pulmonary edema, diuretic
Loop
66
Hypercalcemia, diuretic
Loop
67
Hypercalciuria, diuretic
Thiazide
68
Nephrogenic DI
Thiazide
69
Acne, PCOS; diuretic
Spironolactone
70
Uric acid kidney stones
Alkalinize urine (K citrate / bicarb)
71
Dietary treatment kidney stones
Hydration
Normal dietary Ca
Reduce dietary Na, protein, oxalate
72
Kidney stones that pass (size)
< 4 cm all (8-12 days)
5-7 mm (60%)
8-9 mm (50%)
>10 mm (<25%)
73
Expectant management kidney stones
Strain urine, 3L fluid daily
Tamsulosin facilitates passage
Pain meds (NSAIDs, Vicodin)
CT repeat in 4 weeks
74
Hospitalization required for kidney stones
```
No PO intake b/c nausea
Intractable pain
Acutely elevated BUN, creatitine
Anuria
Fever, pyelonephritis, urosepsis
```
75
Surgical treatment for kidney stones
If unable to pass stone after 4-6 wks, obstruction, impairment of renal fxn, persistent infection
ESWL if stone in renal pelvis or upper ureter
Ureterorenoscopy w/ possible lithotripsy/stent for ureter stones
Percutaneous nephrostolithotomy for staghorn / >3 cm
76
Hydronephrosis
Drainage via nephrostomy tube
| Treat underlying obstruction (maybe balloon dilation or stent)
77
ADPKD
Vasopressin antagonists + amiloride (prevent fluid collection in cysts)
Treat UTI and HTN
Drain large cysts for pain control
May need dialysis or transplant
78
Interstitial nephropathy (AIN)
Stop offending agent
Supportive care until renal recovery
Steroids may help in refractory cases
79
ARF
```
Prevent fluid overload
Stop drugs causing ATN
Dietary protein restriction
Steroids
Dialysis
```
80
CKD
```
Stop smoking
Aggressive BP control (ACE/ARB, BB, loop diuretic, DHP CCP, clonidine, minoxidil)
Aggressive DM control (<70 is better)
Iron/Epo (Anemia Hgb goal 11-12)
Vitamin D
Phophate binders
ASA 81 daily
```
81
RTA Type I
Oral HCO3, K
| Diuretics
82
RTA Type II
Oral HCO3, K
| Diuretics
83
RTA Type IV
Fludrocortisone
| K restriction
84
SIADH
Fluid restriction
Loop diuretics or hypertonic saline if severe (correct Na slowly)
Demeclocycline (last resort)
85
Hypernatremia
Gradual hydration w/ normal saline (<12 meq/24 hrs)
| Too fast = cerebral edema
86
Hyperkalemia
Calcium gluconate/Cl (treats cardiotoxicity)
NaHCO3 or insulin+glucose or albuterol (shift K)
Sodium polystyrene sulfonate (kayexalate) binds K and removes through GI tract
Furosemide/loop diuretic
Dialysis in severe cases
87
Hypokalemia
```
Replace K (oral or IV)
(Too fast = arrhythmias)
```
88
Hypercalcemia
```
Hydration
Treat underlying disorder
Calcitonin and bisphosphonates
Steroids decrease intestinal absorption
Surgery for hyperPTH or neoplasm
```
89
Hypocalcemia
Replace Ca (oral or IV) if needed
Treat underlying disorder
Vitamin D supplementation if needed
90
UTI
Amoxicillin, TMP-SMX, fluoroquinolones x3-5 days
91
UTI, pregnant
Amoxicillin, Ampicillin, Cephalosporin
| Nitrofurantoin x 7d
92
Urge incontinence
Anticholinergics (oxybutynin, tolterodine, solifenacin)
Imipramine
Bladder training
93
Stress incontinence
```
Conservative therapy (weight loss, Kegel exercises)
Surgery (midurethral sling, etc)
```
94
Overflow incontinence
Decompress bladder w/ Foley initially
Treat underlying obstruction (surgery), detrusor underactivity (sacral nerve stimulation) as needed
May need intermittent self-catheterization
95
Bladder cancer
Transurethral cystoscopic resection (superficial)
Partial or total cystectomy (invasive)
Adjuvant intravesical chemo and radiation (try to prevent recurrence), regional radiation and systemic chemo for large/metastatic
96
Urethritis
One dose IM ceftriaxone +
Doxycycline or Azithromycin x 10 days
Treat sexual partners
97
Prostatitis
TMP-SMX or fluoro x 4-6 weeks
| Treat STD if needed
98
BPH
Saw palmetto (alternative)
alpha-1-receptor blockers (tamsulosin, selective; terazosin, non-selective, less frequent)
5-alpha-reductase inhibitors (finasteride)
TURP, needle ablation for refractory
99
Prostate cancer
Radical prostatectomy
Radiation (external beam/brachytherapy)
F/U w/ PSA posttreatment
Antiandrogen esp high-grade/metastatic (luprolide / flutamide)
Older / low life expectancy may not be treated (or active surveillance if caught early)
100
Epididymitis
< 35: Ceftriaxone + Doxycycline/Azithromycin
| > 35 or anal sex: Fluoro or TMP-SMX
101
Testicular torsion
Manual detorsion
| Surgical detorsion + bilateral orchiopexy w/i 6 hrs
102
Testicular cancer
Eradicate Ball Cancer (etoposide, bleomycin, cisplatin)
Radical orchiectomy
+/- chemo and radiation (seminomas)
+/- retroperitoneal LN dissection, chemo (nonseminomas)
103
Impotence
Phosphodiesterase-5 inhibitors
| Androgen replacement if hypogonadal
104
Wilm's tumor
Surgical resection or nephrectomy + chemo
| Possible radiation
105
Urethral displacement (epispadias/hypospadias)
Surgical correction (don't circumcise before surgery)
106
Enuresis
Enuresis alarm (most effective long-term)
Behavioral/motivational therapy
Restrict fluids, nighttime chaperone/wakening
Imipramine (up to 6 weeks)
Desmopressin, indomethacin (short term)
107
Cryptorchidism (undescended testes)
```
Exogenous hCG (encourage spontaneous descent)
Orchiopexy before age 5 (should be brought into scrotum by 6-12 months for +function)
```
108
Posterior urethral valves
Cystoscopic transurethral ablation of abnormal tissue
| If sick, temporary Foley or urinary diversion (vesicostomy)
