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SAQ Gastro
Question | Answer |
---|---|
SBP paracentesis results | Bacteria on GS Ascitic ph <7.35 Neutrophil >250 cells /micro litre WCC >500 cells/micro litre Fluid lactate >25mg/dl |
Score for UGIB | |
SIGN guidelines for allowing to discharge lower GIB | <60 No evidence of haemodynamic instability No evidence of gross rectal bleeding An obvious source of bleeding on PR or siogmoidoscopy |
Lower GIB SIGN admission guidelines | >60 Haemodynamic instability Evidence of gross rectal bleeding Those on aspirin or NSAID significant co-morbidity |
Grading for chronic liver disease | Child Pugh - enceph - ascites - raised bili - albumin low - INR rised |
Pre endoscopy rockall - mort prior to endo | Age- 60-79-1; 80+ =2 Shock: tachy =1; low BP=2 Comorbidities: • HF/IHD/any major= 2 • renal/liver failure or dissem malignancy= 3 Consider discharge if score zero |
Blatchford | Anything above zero points= high risk GIB Urea Hb SBP HR malaena Syncope Hepatic disease Cardiac failure |
Drugs that can cause GIB | NSAID Warfarin AntiPLTS SSRI Steroids |
Consider admission for Lower GIB | >60 HD disturbance Gross rectal bleeding evidence Taking aspirin/NSAID Sifnif comorb |
Vomiting red flags | Unexplained weight loss Early satiety Chronic GIB dysphagia Persistent vomit FH gastric cancer Epigastric mass IDA hepatomeglay |
Acute vs chronic diarrhoea | <4 weeks is acute >4 weeks is chronic |
Drug causes diarrhoea | PPI ABx NSAID SSRI Laxatives |
Causes diarrhoea outside of drugs | Infectious Appendicitis Diverticulitis IBS IBD coeliac Cancer Food allergy Etoh Xs Lymphoma |
Diarrhoea red flags | Blood Recent abx/hospital stay Persistent vomitinubg ? Overflow Weight loss Painless watery and high volume= dehydrates Nocturnal sx 60+ with >6/52 of diarrhoea FHx bowel or ovarian cancer Mass Unexplained anaemia Raised inflam markers |
Bloody diarrhoea | CHESS CMV Schisto Cancer IBD Ischaemic colitis Doverticular dosease |
When to stool sample | Travellers Unwell Blood/pus Recent abx/hosp >1 week Immunocompromised |
Stool sample for parasite | 2 tests 3 days apart |
Paeds gastroenteritis | Rotavirus |
Adult gastroenteritis | Norovirus |
Toxins causing gastroenteritis | Staph aureus Bacilis Cerus Clostridium perfringens |
Notifiable gastroenteritis | Cholera Bloody diarrhoea due to infection Food poisoning- campylobacter, E. coli 0157H7, salmonella, shigella, giardia, noro HUS |
Crohns pathology | Patchy Transmural Length of GI Tract |
UC pathology | Diffuse Mucosal Colon only |
Shared extranintenstinal IBD | Arthritis Erythema nodosum Episcleritis Pyoderma gangrenous Uveitis HPB conditions Metabolic bone disease |
Severe UC | 6+ blood stools a day HR 90+ temp 37.8+ Anaemia ESR 30+ |
UC presents | Tenesmus Fecal incontience Pre defecation pain relieved by defecation Faecal urgency Bloody diarrhoea |
Crohns presents | Persistent diarrhoea Abdo pain RIF mass Weight loss Anorexia fever fatigue In colitis can get bloody poo urgency and tenesmus |
IBD shared complications | Toxic mega Cancer Bowel perf Vte |
Crohns added complication | Fistula SBO abscess |
Dark urine and pale stools | Post hepatic jaundice |
Liver decompensation marked by | Abnormal bleeding Ascites Jaundice Encephalopathy |
Grade encephalopathy | 1= sleep disordered, irritable, mild confusion, mood change 2= drowsy, inappropriate behaviour, personality chance, poor memory 3= sleepy, marked confusion, agitation, disorientated, incomprehensible speech 4= coma |
Liver failure mx | Lactilose AKI Mx Glucose monitor Coag correction PPI if bleeds ?ITU nutrion bloods Assess for cerebral oedema |
Commonest cause of liver failure decompensated mortality | Cerebral oedema |
Commonest cause liver cirrhosis | Hep b Hep c Booze |
Ascites grading | 1- only detect on US 2- moderate symmetrical distension of abdomen 3- severe distension |
Management of ascites | Treat cause Salt restrict Spiro Paracentesis Surgery |
SBP commonest bugs and threshold to treat | If tap >250 cell/mm3 = treat E. coli Strep Enterococcus |
When do withdrawal seizures happen | 6-48 hrs after last drink |
DTs when and what | 3-10 after last drink Autonomic instability Hallucinations Agitation Disorientation Acidosis Deranged electrolytes Arrythmias Infections |
Causes thiamine deficiency | Booze Hyperemesis gravidarum Starvation Malnutrition CKD |
Thiamine and glucose | T before Glucose B1 is thiamine |