Lecture 11

 Treatment of Infectious Esophagitis

o Candida — use Antifunal Agent
 Fluconazole for 10 – 14 days
 Capsofungin for refractory cases
o HSV — acyclovir/valacyclovir for 7 – 10 days
o CMV — ganciclovir for 14 days
 Treatment for Achalasia
o Medication: Nitrates, Calcium Channel Blockers
o Endoscopic: Botox injection, Balloon Dilation
o Surgery: Heller myotomy with Nissan fundoplication

L12,13 did not have any drugs mentioned

L14: Management of Diarrhea & Constipation

 Oral hydration is the best way to treat fluid loss from diarrhea
 If FEVER PLUS EITHER leukocyte -, lactoferrin -, or hemoccult + OR patients with acute dysentery
OR patients with moderate/severe traveler’s diarrhea
o Empiric Treatment: Quinolone (-floxacin). Persistent diarrhea: Flagyl
o Risk of empiric antibiotic therapy:
 Increased risk of HUS in EHEC
 In EHEC, HUS may be facilitated by antimotility agents or worsen
neurological symptoms
 Prolongs shedding of salmonella
 Contraindications: C. difficile colitis, EHEC, salmonella
o Other therapies:
 DOC: loperamide (Imodium) — recommended esp. for immunocompromised
 HIV patients who can’t tolerate — use Tincture of Opium
o Last resort in HIV associated diarrhea: Octreotide
 Diphenoxylate (Lomotil) — not ideal bc of central opiod effects
 Bismuth subsalicylate — effective, but contraindicated in immunocompromised
encephelopathy
 Zn supplements —> decrease duration & need of antibiotics; taken in addition to
ORS
 Scrombroid Poisoning
o Antihistamines + H2 blockers, bronchodilators; cathartics & gastric lavage
 Management of Constipation
o Exercise, hydrate, increase fiber intake. Decrease caffeine & alcohol
o Pharmacologic management
 Laxatives — promote a soft stool
 Cathartics — results in a soft to watery stool with some cramping
 Purgatives — harsh cathartic causing watery stool with abdominal cramping
Lecture 15

 Cholestasis: Anabolic steroids, phenothiazine derivatives, total parenteral nutrition

 Fatty change: steroids
 Acute Hepatitis: INH, Augmentin, Phenytoin
 Fulminant Hepatic Failure: Acetaminophen, Halothane
 Chronic Hepatitis: a-methlyDOPA, Isoniazid (INH)
 Fibrosis/Cirrhosis: Methotrexate
 Granulomatous Hepatitis: Allopurinol, Sulfa drugs
 Hepatic Cell Adenomas: Oral contraceptive pills
 Hepatocellular Carcinoma: Anabolic Steroids

L16

L17

Lecture 18

 Neonatal Cholestasis Management

o Supportive Care (nutritional support, fat soluble vitamins)
o Management of complications (pruritic, portal hypertension, ascites)
o Liver transplant
 Management of Malnutrition
o 120 – 150 cal/kg/day
o Formula with medium chain triglycerides
o Increase caloric density to 1 cal/ml
o Fat soluble vitamin supplementation
o Enteral feeds at night
o Gastrostomy
o Parenteral nutrition
 Management of Biliary Atresia
o Surgical intervention
 For definitive diagnosis: intraoperative cholangiogram
 For therapy: Kasai portoenterostomy
o Definitive treatment: Liver transplant
 Byler’s Syndrome
o Responds to partial biliary diversion
 Progressive familial intrahepatic cholestasis 2 (PFIC 2)
o Some response to ursodeoxycholic acid (same for PFIC 3)
o Partial biliary diversion
 Benign Recurrent Intrahepatic Cholestasis (BRIC)
 o Pruritis
o Plasmapherisis, Nasobiliary drainage, Partial external biliary diversion
o Liver transplant
 Intrahepatic Cholestasis of Pregnancy
o Ursodeoxycholic acid
o Hydroxyzine
 Cholelithiasis/Choledocholithiasis
o Medical dissolution, Endoscopic retrograde cholangiopancreatography (ERCP), Surgery
 Primary Sclerosing Cholangitis
o Ursodeoxycholic acid, Liver transplant
 Primary Biliary Cirrhosis
o Ursodeoxycholic acid, Corticosteroids
o Liver transplant