TREATMENT

Acute Pancreatitis-Supportive management: hydration, pain relief, and nutritional support

20ml/kg PLRS/PNSS over 30 minutes then 3 ml/kg for the next 8-12 hours
Analgesics: nonopoid and opoid analgesics: ketorolac, tramadol, not morphine
Nutriotional support: oral feeding resusmes within 24 hours if tolerated an dno n/v and ileus: low residue, low fate, soft
diet: if cant tolerate oral feeding by day 5 nasojejunal enteral feeding may be necessary, elemental /semielemental
formula, Peptamen AF, nasogastric if nasojejunal impossible, parenteral if necessary

Others:
PPI
Antibiotics
Mange predisposing factors: ERCP for gallstone pancreatins and cholangitis, mrcp if wla cholangitis or uncertain
Manage hypertriglyceridemia, alcoholic pancreatitis

Symptomatic cholelithiasis, biliary colic: expectant, surgical, nonsurgical

Surgical, open cholecystectomy or laporoscopic cholecystectomy
Non surgical:
Bile acid pill(ursodiol, ursodeoxycholic acid)
ESWL, fallen out of favor
Percutatenous removal via a catheter to the gb

Ascending cholangitis: Supportive hydration, pain control and correction of electrolyte abnormalities monitoring and
treatment of sepsis with antibiotics coverage and biliary drainage via endoscopic sphincterotomy (EST)
ERCP with ablation of SOO, using sphincterotome or papillotome conntected to a machine
EUS guided cholangiopancratography
If this fails PTBD,, percutaneous transhepatic biliary drainage
Antibiotic: imipenem or ampisul
Pain meperidine Demerol
H2 blocker or PPI iv to avoid GI bleeding

Acute cholecystitis: supportic management with hydration provision, pain control, correction of electoryly
abnormalities and putting the paitnte on ngt if with vomiting ielues and cholecystectomy if indicated

Antibiotics to cover enterbacteriaceae: ecoli, enterococcus, Enterobacter kleb

Laparoscopic or open cholecystectomy

PUD-elimation of the underlying etiology like h. pyolor and nsaid use and use of antisecretory therapy
Triple therapy: 20 mg BID omeprazole, 500 mg BID Clarithor then metro 500 mg or 1g Amox
Quad therapy: omep, bismuth 2 tab QID, metro then tetracycline 500 mg QID

UGIB
BPUD: high dose PPI omep drip 80 mg IV then 8 mg per hour infusion over 72 hours
Thereapeutic endoscopy with of cours treatment of PUD, surgery is indicated if retractable

BEV: vasoactive agent, beta blocker, antibiotics with cirrhosis, endoscopic or surgical ligation,
Somatostatin 275 mcg IV bolus then 3 mg over 12 hr infusion, or ocreaide, 50 mcg per hour the nonselective beta
blocker

GERD: lifestyle modification, antacids, h2 blockers, surface agents and alginates, and PPIS

Mild to moderate symptosm wherein attacks at least twice a week: no evidence of erosive esophagitis or barrets,we use
antacid and or sucralfate or we use low dose h2 blocker then in a steo up patter increase dosage if sympotsm continue
up to minimum 2 weeks and if symptoms still persist we use PPI at low dose at least 8 weeks
In patients with erosive esophagitis evidence of barrets esophagus and frequent episodes more thatn 2 times per week
and sever attacks that impair quality of life we use a step down approach starting with standard dose PP for 8 weeks and
taper

Appendicitis: surgical management is the standard of care within 24 hours especially if there is risk of perforation such as
abdominal pain more thatn 2 days, wbc more 18 , elevated crp, appendicolith on imagin, appendix mor 1.1 cm , based
on clinical rupture signs like diffuse cguro na
Preopcare: fluid therapy, analgesia, correction of electrolyte abnormalities, antibiotic prophylaxis with borad spectrum
antibioitoss like cefoxitin, ceftriaxone and metronidazole, operative management may be lap or open
Post op care: iv antibitotics especially in advanced appendicitis until afebrile and toleartiing oral diet
Pain control..
Nutritional support: ngt if there is persistent vomiting, ileus

Intussusception: nonoperative reduction via hydrostatic or pneumatic pressure by enema under fluoroscopic guidance in
ileocolic intussusception, who is stable no signs of perforation
If with sign of performatin, unstable vitals, surgical reduction is indicated

Volvulus:
Patient with alarm signs of peritonitis and perforation: Hartmann procedure especially if vitals unstable if vitals stable
and nonviable segment; if viable segment resection with primary anastomosis

No alarm signsL flexible sigmoidoscopy to detorse the twisted segment

Diverticulitits:

Uncomplicated (no perforation, obstructitn, abscess bleeding): nonsurgical diet modification

Antibiotics to cover the usuall gram negative normal flora particularly ecoli and bacteroidis fragilis
Ciprofloxacin, 50o mg bid plus metronidazole 500 mg TID

Complicated :
in patient care hartmann procedure, subtotal colectomy in persistent bleeding without documented site of bleeding
Percutatneous or open drainage in diverticulitits with abscess
Haartmann procedure for stage 3 or 4 hinchey stage
Percutaneous drainage in stage 1 and 2 with out diverting stoma and with or without diversion, respectively

Peritonitis: source control and antibiotic coverage

Hernia
Asymptomatic inguinal hernia: elective or watchful waiting
Asymptomatic femoral hernia: elective surgery higher risk of complications
Symptomatic primary unilateral and bilateral inguinal hernia: Mesh repair: Lichtenstein or endoscopic
With out the use of mesh we use shouldice, bassini and mcvay if there is active infection, resource limited
Recurrent injuinal hernia: open preperitoneal mesh or

With mesh: Lichenstein, plug and patch and preperitoneal: kugel, nyhus condon, and read and hives (anterior)
Without mesh: shouldice, bassini, mcvay, preperitoneal na si origina nyhus condon

Hemorrhoids
Initial approach to hermooroihd is conservative management
dietary and lifestyle modification: 20 to 30 g of insoluble fiber per day with plenty of water fiber supplements such as
methylcellulose, over the counter analgesics and antipruritus,
Sitz bath reliveing purirtis, pain
Phlebotonics, steroids topical, antispasmodics,

Office based procedures: Rubber band ligation, schlerotherapy

Surgical: excision hemorroidectomy: park ferguson technique closed or open milligan morgan technique

Typhoid fevr
Empiric: Cetriaxone and azithromycin
Culture and sensitivity: Ciprofloxacin and ofloxacin first choices
If in sensitivity profile: reduced sensitivity: or if di pwede Azithromycine, 3 rd gen cephalosporins or chloramphenicol,
amox, tmp smx
Multidrug resistant or quinolone resistant: azithro and 3 rd gen cepha like ceftriaxone

CAP: Antibiotic