BCPS_Gastrointenstinal Disorders

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BCPS_Gastrointenstinal Disorders
2015-02-05 18:13:47
BCPS Gastrointenstinal Disorders

BCPS_Gastrointenstinal Disorders
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  1. Review and apply national guideline treatment strategies to the following 14 (Fourteen) gastrointestinal (GI) disorders: gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), ulcerative colitis (UC), Crohn disease (CD), viral hepatitis, chronic liver disease, constipation, diarrhea, irritable bowel syndrome (IBS), nausea, vomiting, pancreatitis, and upper GI bleeding, including prevention of stress-related mucosal disease (SRMD)
  2. Recommend appropriate pharmacologic and nonpharmacologic interventions for the management of GERD

    What does the 2013 guideline say about non-pharmacological interventions/lifestyle modification for GERD?
    The AGA guidelines cite insufficient evidence to advocate lifestyle modifications for all patients; rather, they advocate use in targeted populations ONLY eg Weight loss if overweight or recent weight gain; Elevate head of bed/avoid meals 2–3 hours before bedtime if nocturnal symptoms, etc
  3. Differentiate between clinical signs, symptoms, risk factors, and treatment of both Helicobacter pylori– and nonsteroidal anti-inflammatory drug–associated PUD
  4. Discuss the role of pharmacologic intervention in the treatment of nonvariceal upper GI bleeding and the prevention of SRMD
  5. Review the clinical differences in signs, symptoms, and treatment of Chrone's Disease (CD) and Ulcerative Colitis (UC)
  6. Identify the common manifestations of chronic liver disease and Recommend their treatment
  7. Recommend the treatment and prevention of both acute and chronic viral hepatitis
  8. Recognize pertinent information for educating patients and prescribers regarding the appropriate use of pharmacologic agents for various GI disorders
  9. Recommend appropriate pharmacologic and nonpharmacologic interventions for diarrhea and constipation
  10. Review and make recommendations for the treatment and prevention of nausea and vomiting
  11. Discuss the clinical and treatment differences between acute and chronic pancreatitis
  12. Discuss the role of pharmacologic intervention in the treatment of irritable bowel syndrome (IBS)
  13. Understand commonly encountered statistical tests and concepts using GI disorders as examples
  14. "Recommend appropriate pharmacologic and nonpharmacologic interventions for the management of GERD"

    Recommend first-line pharmacologic interventions for GERD and what is the lenght of treatment course?
    • “Step-down” treatment: Starting with maximal therapy, such as therapeutic doses of PPIs, is always appropriate as a first-line strategy in patients with documented esophageal erosion
    • “Step-up” treatment: Start with lower-dose OTC products
    • Erosive esophagitis should be treated with an 8-week course of PPIs
  15. According to the AGA treatment guidleine for GERD; 
    -How do you initiate the first line agents?
    -Can you dose once or twice daily?
    • (i) Initiate PPIs once daily 30-60 minutes before AM meal
    • (ii) Twice-daily PPIs if partial response to once-daily PPIs and/or nighttime symptoms
  16. Pharmacological agents for GERD include PPI, Antacids & H2Receptor antagonists.
    When do you use Antacids as first line?
    When are antacids not appropriate?
    Used as first-line therapy for intermittent (less than twice weekly) symptoms or as breakthrough therapy for those on PPI/histamine-2 receptor antagonist (H2RA) therapy; not appropriate for healing established esophageal erosions
  17. List the four Major Adverse Effects of PPIs and their corresponding Prevention and Management Strategies
    • (i) Fracture-Ensure adequate calcium + Vit D
    • (ii) HypoMagnesemia-Supplementation
    • (iii) C. difficile-Re-evaluate need
    • (iv) CAP- Access for vaccine status