Gastrointestinal

GI and Liver Notes: Vomiting, Oesophagitis, PU, Bleeding, IBD, Cirrhosis, Hepatitis (Note Sheet)

Compact notes on common GI and hepatology conditions with drugs and brands. Only legible content is recorded; verify before use.

ICD-10: —
Source: OPD handbook pp.215–217 (handwritten student sheets; partly legible)
Status: Draft

Not yet reviewed by a clinician. Check doses and brands against current national guidelines before use.

Symptoms

Treatment

Step 1 of 23

Vomiting

Due to motion sickness / vestibular dysfunction / uraemia: Tab Marzine 50 mg (cyclizine)
Due to other causes: Tab Motilium (domperidone) 10 mg, or Tab Maxolon 10 mg (metoclopramide), before meals

Step 2 of 23

Oesophagitis

Mild: Syp Lasinga (alginic acid) / Gaviscon tab; Film acid suspension (aluminium hydroxide + magnesium + simethicone)
Moderate: Tab Zantac 300 mg OD; Ulsanic (sucralfate) suspension; Tab Motilium 10 mg before meals; Cap Risek / Omega / Teph 20 mg before breakfast
Candida oesophagitis: Susp Nilstat (nystatin) or Daktarin (miconazole); Cap Diflucan 50 mg (fluconazole); Tab Nizoral (ketoconazole) 200 mg

Step 3 of 23

Peptic ulcer

Filmacid suspension 30 mL, 1 hour and 3 hours after meals
Cap Zontac 300 mg at bedtime
Susp Ulsanic 1 hour before meals; Cap Risek 20 mg before meals

Step 4 of 23

Eradication of H. pylori

Triple regimen for 2 weeks: Tab Amoxil 1 g BD + Tab Klaricid (clarithromycin) 500 mg BD + Cap Risek 20 mg BD
Or Tab Amoxil 500 mg + Tab Flagyl 400 mg + Risek (after meals); or add Cap tetracycline 500 mg QID

Step 5 of 23

Upper GI bleeding

Inj Sandostatin (octreotide) 0.5 mg in 250 mL NS at 50 µg/hr (12 drops/min), or Inj Novapressin (terlipressin) 2 mg IV
Endoscopic band ligation; balloon tamponade (Sengstaken–Blakemore tube); TIPS
Prevention of recurrence: Tab Inderal (propranolol); Inj Risek 40 mg infusion; Inj Tagamet (cimetidine) 200 mg to prevent stress ulcers

Step 6 of 23

Ulcerative colitis

Mild: Tab Salazodine (sulfasalazine) 500 mg TDS
Moderate: Tab Prednisolone 5 mg TDS
Fulminant: Inj Solu-Cortef + hospitalisation + Inj Amoxil + gentamicin + Flagyl + ciclosporin / infliximab + colectomy

Step 7 of 23

Distal proctocolitis

Asacol enema (mesalazine), or Colifoam (hydrocortisone) pessary
Maintain on Salazodine 500 mg; Prednisolone 5 mg; Tab Imuran 25 mg (azathioprine)

Step 8 of 23

Crohn's disease

Tab Salazodine 500 mg BD; Tab Masacol (mesalazine) 400 mg TID; Prednisolone 5 mg BD; cholestyramine

Step 9 of 23

Irritable bowel syndrome

Tab Colofac (mebeverine) / No-Spa 135 mg 30 min before meals
Tab Tryptanol (amitriptyline) 10 mg 1 tab at night
Cap Colpermin (peppermint oil) 0.2 mL 30 min before meals
Tab Motilium 10 mg 1 tab 30 min before meals; in case of constipation or distension

Step 10 of 23

Acute cholecystitis (note sheet)

Inj Pethidine 50 mg IV/IM (slow); IV fluids; NG aspiration (nil per oral)
Inj Flagyl + Inj cefuroxime 750 mg

Step 11 of 23

Acute cholangitis

Inj Nalbuphine 10–20 mg slow IV/IM; same as above plus ERCP

Step 12 of 23

Pancreatitis

Acute: Inj Pethidine 50 mg; IV decompression plus antibiotics
Chronic: Tab Trizymal (pancreatic enzymes)

Step 13 of 23

Cirrhosis

Portal hypertension: Tab Inderal 40 mg (heart rate target 25% lower); Tab Coveda (carvedilol) 6.25 mg BD
Ascites / oedema: salt restriction and bed rest; Tab Aldactone (spironolactone) 25 mg 1 tab OD, increased to 100 mg
No response: Tab Spiromide 20/40 (spironolactone + frusemide)
Dilutional hyponatraemia: water restriction
Ascites causing respiratory distress or refractory: tap up to 5 L; human albumin 100 mL IV slowly 2–3 weekly

Step 14 of 23

Spontaneous bacterial peritonitis

Treatment: Inj Cefon 1 g (cefotaxime) IV BD for 10–14 days, modified after culture
Prophylaxis: Tab Novidat (ciprofloxacin) 500 mg once weekly (as read)

Step 15 of 23

Hepatic encephalopathy

Remove the precipitating factor; protein-free diet; IV glucose
Bowel wash; Syp Lactulose; Tab Rifaxamin 200 mg; Tab Flagyl 200 mg
Coagulopathy: FFP, vitamin K injection, Inj Konakion (phytomenadione)

Step 16 of 23

Wilson disease

Tab Vistamin (penicillamine) 250 mg, 1 tab 30 min before meals at bedtime
Tab Vita-6 (pyridoxine) 50 mg OD

Step 17 of 23

Haemochromatosis

Phlebotomy 500 mL per week
Inj Desferal (deferoxamine) SC infusion 500 mg

Step 18 of 23

Pyogenic liver abscess

Drainage with culture/sensitivity
Inj Amoxil + Inj gentamicin + Inj Flagyl; then tablets for 14 days

Step 19 of 23

Amoebic liver abscess

Tab Flagyl 400 mg TID for 7 days; drainage

Step 20 of 23

Chronic viral hepatitis B

Inj pegylated interferon SC for 48 weeks, or Tab Tenofovir / Entecavir (0.5 mg) 1 tab daily for 24–48 weeks
Serology: continue in HBe-positive patients until 3 consecutive HBV DNA tests, 6 months apart, are negative; in HBe-negative patients monitor as read

Step 21 of 23

Chronic viral hepatitis C

Tab Harvoni (sofosbuvir 400 mg + ledipasvir 90 mg) for 12 weeks
Alternatives listed by genotype (I–VI): Tab Simeprevir 150 mg + Cap Ribavirin 1 g; velpatasvir 100 mg; elbasvir + grazoprevir

Step 22 of 23

Autoimmune chronic hepatitis

Tab Prednisolone 5 mg, 8–10 tabs daily, then tapered; Tab Imuran as maintenance (partly illegible)

Step 23 of 23

Acute hepatitis (note sheet)

For vomiting: Inj metoclopramide; 5% dextrose
Syp Lacosil (lactitol); Tab Rifaxamin 200 mg TDS; Tab Flagyl 400 mg TID
Fulminant: FFP, FBT; Mannitol 20% 300 mL if raised intracranial pressure