What Treatments would you discuss with them? Flashcards
GORD
Proton Pump inhibitors are the first line treatment (often life long). They reduce acid production (prazoles)
Then surgical management if they fail to respond to medical therapy/ preference
called fundoplication
Peptic Ulcer
lifestyle changes e.g. smoking, alcohol, weight loss, no NSAIDs
PPI’s to reduce acid
surgery is rare unless emergency e.g. perforation
if H. pylori positive then:
PPI + Amoxicillin + either clarithromycin or metronidazole
Acute GI bleed
IV fluids
blood transfusion to treat shock
oxygen
?endoscopic clipping once stable
Ulcerative Colitis
Mild- moderate= topical/ oral Aminosalicylates e.g. Mesalazine then add oral prednisolone if not working
in acute flare IV steroids and then IV ciclosporin if not working
IBS
first line advice and reassurance, regular physical activity
second line: laxatives if constipated- loperamide if diarrhoea
Infective Gastroenteritis
rehydration
education to prevent future episodes
abs if old/ immunosuppressed
Acute Pancreatitis
no curative management so treat underlying cause
IV fluid resuscitation
Nasogastric tube if vomiting
catheterisation to monitor output
opioid analgesia
e.g. if gallstones- ERCP to remove gallstones/ bladder
Chronic Pancreatitis
treat any reversible underlying cause e.g. alcohol cessation
analgesia is main line for most cases
enzyme replacement for malabsorption
insulin for secondary diabetes
Gallstones
no treatment unless symptomatic
offer laparoscopic cholecystectomy if symptomatic/ acute
Acute Hepatitis
conservative as it will settle in a few weeks
monitor for fulminant liver failure
Appendicitis
laparoscopic appendicectomy is the gold standard
bowel obstruction
dependant on cause
Drip and Suck:
- IV fluids/ electrolytes (drip)
- nil-by-mouth and insert NG tube to suck the bowel
surgical intervention if suspected intestinal ischaemia/ closed loop obstruction- may result in resection and stoma insertion
Femoral hernia
high risk of strangulation so surgery within 2 weeks of presentation
low approach:
incision below inguinal ligament
high approach:
preferred in emergency due to easy access but can interfere with inguinal structures
Inguinal hernia
low risk of strangulation but surgical intervention still recommended if symptomatic
open mesh repair preferred for primary inguinal hernias and are cheap but laparoscopic is better
crohn’s
in flare up: Prednisolone, can add immunosuppressant e.g. azathioprine
to maintain remission: azathioprine/ methotrexate if contraindicated
