49.3 🩺 內科專科考前版

49.3.0.1 📌 䞀頁重點

  • 22EFMT for refractory CDI、bezlotoxumab、microscopic colitis 認可
  • IBS-D 新藥 (eluxadoline, rifaximin)
  • Constipation 新藥 (linaclotide, plecanatide, prucalopride)
  • Taiwan: 健保 antibiotic 限制

49.3.0.2 💊 進階

49.3.0.2.1 CDI
  • Severe risk factors (WBC > 15k, Cr > 1.5)
  • Severe-complicated: vanco PO + IV metronidazole
  • FMT > 90% efficacy in recurrent
  • Bezlotoxumab + standard treatment
49.3.0.2.3 IBS Refractory
  • Eluxadoline (mu agonist + delta antagonist) for IBS-D
  • Rifaximin (low absorbed antibiotic)
  • TCA / SSRI for visceral hypersensitivity
49.3.0.2.4 Pancreatic Insufficiency
  • Pancrelipase enzyme replacement
49.3.0.2.5 Microscopic Colitis
  • Budesonide
  • Avoid trigger drug (NSAID, PPI, SSRI)

49.3.0.3 🌟 Pearls (8)

  1. FMT for recurrent CDI standard
  2. Bezlotoxumab for high-risk recurrent
  3. Microscopic colitis budesonide responsive
  4. EHEC HUS avoid antibiotic + monitor renal
  5. Carcinoid syndrome flushing + diarrhea + R heart valve
  6. VIPoma: WDHA syndrome (watery diarrhea, hypokalemia, achlorhydria)
  7. Linaclotide / plecanatide / prucalopride for chronic constipation
  8. Diabetic enteropathy: severe diarrhea + autonomic neuropathy

49.3.0.4 📍 Taiwan Context

  • 健保 vancomycin 郚分限制
  • FMT 有條件 + 限定䞭心
  • IBD 治療生物補劑 健保
  • 高 resistance ETEC 旅遊

49.3.0.5 🎓 內專重點

  1. CDI severity stratification + 治療階梯
  2. IBS subtypes + drug
  3. Microscopic colitis
  4. Chronic constipation new drugs
  5. Functional GI disorders Rome IV

⚠ AI 草皿。