GI.docx

[GI] **H.PYLORI** - Number one cause of PUD - Causes: NSAIDS - Tx: minimum of 3 antibx + PPI for 10-14 days +-----------------------------------------------------------------------+ | **Amoxicillin** | |...

[GI] **H.PYLORI** - Number one cause of PUD - Causes: NSAIDS - Tx: minimum of 3 antibx + PPI for 10-14 days +-----------------------------------------------------------------------+ | **Amoxicillin** | | | | - Rate of resistance is low | | | | - DISRUPTS CELL WALL | | | | - Give antisecretory agent (omeprazole) to enhance antibacterial | | activity | +=======================================================================+ | **Clarithromycin** | | | | - INHIBITS PROTEIN SYNTHESIS | +-----------------------------------------------------------------------+ | **Bismuth** (Pepto-Bismol) | | | | - DISRUPT CELL WALL OF H.PYLORI | | | | - S/e: black discoloration of the tongue and stool | | | | Long term therapy neurologic injury | +-----------------------------------------------------------------------+ | **Tetracycline** | | | | - INHIBITS PROTEIN SYNTHESIS | | | | - Resistance is rare | | | | - Interacts w/ many medications, photosensitivity | | | | - Do not use in pregnancy and young children stains teeth | +-----------------------------------------------------------------------+ | **Metronidazole** | | | | - Effective against sensitive strains | | | | - Avoid alcohol disulfiram-like reaction | +-----------------------------------------------------------------------+ | **Tinidazole** | | | | - Similar to above | +-----------------------------------------------------------------------+ LOOK UP quadruple therapy\*\* **DIARRHEA** - Diphenoxylate + atropine (Lomotil)(opioid) atropine discourages abuse - Difenoxin + atropine (loperamide) (opioid) - Bismuth subsalicylate - Bulk-forming agents - Anticholinergic antispasmodics - Management: - Antibx should only be used for: salmonella, shigella, campy, or clostridium - Traveler's diarrhea: e.coli self-limiting if not cipro, norfloxacin. Azithro in children **IBS** - Dx: present for 12 weeks/3mo over the past year - Specific - Alosetron - Approved for women only - Gi toxicities constipation, perforation, and ischemic colitis risk management program - Eluxadoline - Lubiprostone - Approved for women \>18 - Minimal benefits - Linaclotide - Tx IBS w/ constipation and chronic idiopathic constipation - Works by increasing intestinal fluid secretion **INFLAMMATORY BOWEL DISEASE** \- Crohn disease and Ulcerative colitis +-----------------------------------------------------------------------+ | - Budesonide- Glucocorticoids | | | | - Mild-mod crohns | | | | - Prolong use adrenal suppression cushing synd, osteoporosis, | | inc infection | +=======================================================================+ | - Sulfasalazine- 5-aminosalicylates | | | | - Reduces inflammation | | | | - Mild-mod UC | +-----------------------------------------------------------------------+ | - azathioprine- immunosuppressants | | | | - induce/maintain remission in both UC and crohn | | | | - reserved for pt for those that have not responded to | | traditional therapy | +-----------------------------------------------------------------------+ | - Infliximab- immunomodulators | | | | - Same for reserved pts | | | | - Mod-sev crohn and UC | | | | Inc risk of infection yearly TB | +-----------------------------------------------------------------------+ | - Metronidazole and cipro | | | | - Ineffective for UC | +-----------------------------------------------------------------------+ +-----------------------------------------------------------------------+ | **IRON DEFICIENCY ANEMIA** | +=======================================================================+ | - Imbalance in iron uptake and iron demand | | | | - Causes: pregnancy, infancy, chronic blood loss so find reason | | why! | | | | - Labs: decreased reticulocyte ct, decreased ferritin, increased | | serum iron-binding capacity (IBC) | | | | - Tx | | | | - Ferrous sulfate | | | | - 325mg 2-3x daily! | | | | - Give on empty stomach if can't take w/ a snack | | | | - AE: staining of teeth | | | | - Monitor HH and ferritin in 4 weeks | | | | - These are reduced: vit C and ascorbic acid enhances | | absorption but can increase AE. Do not give w/antacids | | and tetra | | | | - HH levels should rise at least 2 w/in a month, | | reticulocyte will increase w/in a week, therapy should | | continue for 1-2 mo | +-----------------------------------------------------------------------+ | **VITAMIN B12 DEFICIENCY** | +-----------------------------------------------------------------------+ | - Causes: strict vegetarians, impaired absorption disease, and | | alcohol, absence of intrinsic factor: pernicious anemia | | | | - Tx: | | | | - Cyanocobalamin SQ or IM | | | | - \>400 is normal | +-----------------------------------------------------------------------+ | **FOLIC ACID DEFICIENCY** | +-----------------------------------------------------------------------+ | - Women of childbearing age or pregnant women require extra folic | | acid | | | | - 400mcg for non-pregnant/lactating women | | | | - In pregnancy: at least 600mcg! | | | | - Tx | | | | - 1-2 mg/day for deficiency | | | | - IM injection of B12 helps stimulate | | | | - Do not give folic acid routinely can mask B12 deficiency if | | they have it | +-----------------------------------------------------------------------+