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SAQ Gastro

QuestionAnswer
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
Created by: Ciaranmegoran
 

 



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