Help!
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| SBP paracentesis results | Bacteria on GS
Ascitic ph <7.35
Neutrophil >250 cells /micro litre
WCC >500 cells/micro litre
Fluid lactate >25mg/dl
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| Score for UGIB |
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| 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
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| Lower GIB SIGN admission guidelines | >60
Haemodynamic instability
Evidence of gross rectal bleeding
Those on aspirin or NSAID
significant co-morbidity
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| Grading for chronic liver disease | Child Pugh
- enceph
- ascites
- raised bili
- albumin low
- INR rised
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| 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
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| Blatchford | Anything above zero points= high risk GIB
Urea
Hb
SBP
HR
malaena
Syncope
Hepatic disease
Cardiac failure
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| Drugs that can cause GIB | NSAID
Warfarin
AntiPLTS
SSRI
Steroids
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| Consider admission for Lower GIB | >60
HD disturbance
Gross rectal bleeding evidence
Taking aspirin/NSAID
Sifnif comorb
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| Vomiting red flags | Unexplained weight loss
Early satiety
Chronic GIB
dysphagia
Persistent vomit
FH gastric cancer
Epigastric mass
IDA
hepatomeglay
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| Acute vs chronic diarrhoea | <4 weeks is acute
>4 weeks is chronic
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| Drug causes diarrhoea | PPI
ABx
NSAID
SSRI
Laxatives
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| Causes diarrhoea outside of drugs | Infectious
Appendicitis
Diverticulitis
IBS
IBD
coeliac
Cancer
Food allergy
Etoh Xs
Lymphoma
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| 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
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| Bloody diarrhoea | CHESS
CMV
Schisto
Cancer
IBD
Ischaemic colitis
Doverticular dosease
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| When to stool sample | Travellers
Unwell
Blood/pus
Recent abx/hosp
>1 week
Immunocompromised
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| Stool sample for parasite | 2 tests 3 days apart
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| Paeds gastroenteritis | Rotavirus
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| Adult gastroenteritis | Norovirus
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| Toxins causing gastroenteritis | Staph aureus
Bacilis Cerus
Clostridium perfringens
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| Notifiable gastroenteritis | Cholera
Bloody diarrhoea due to infection
Food poisoning- campylobacter, E. coli 0157H7, salmonella, shigella, giardia, noro
HUS
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| Crohns pathology | Patchy
Transmural
Length of GI Tract
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| UC pathology | Diffuse
Mucosal
Colon only
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| Shared extranintenstinal IBD | Arthritis
Erythema nodosum
Episcleritis
Pyoderma gangrenous
Uveitis
HPB conditions
Metabolic bone disease
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| Severe UC | 6+ blood stools a day
HR 90+ temp 37.8+
Anaemia
ESR 30+
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| UC presents | Tenesmus
Fecal incontience
Pre defecation pain relieved by defecation
Faecal urgency
Bloody diarrhoea
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| Crohns presents | Persistent diarrhoea
Abdo pain
RIF mass
Weight loss
Anorexia fever fatigue
In colitis can get bloody poo urgency and tenesmus
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| IBD shared complications | Toxic mega
Cancer
Bowel perf
Vte
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| Crohns added complication | Fistula
SBO
abscess
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| Dark urine and pale stools | Post hepatic jaundice
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| Liver decompensation marked by | Abnormal bleeding
Ascites
Jaundice
Encephalopathy
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| 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
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| Liver failure mx | Lactilose
AKI Mx
Glucose monitor
Coag correction
PPI if bleeds
?ITU
nutrion bloods
Assess for cerebral oedema
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| Commonest cause of liver failure decompensated mortality | Cerebral oedema
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| Commonest cause liver cirrhosis | Hep b
Hep c
Booze
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| Ascites grading | 1- only detect on US
2- moderate symmetrical distension of abdomen
3- severe distension
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| Management of ascites | Treat cause
Salt restrict
Spiro
Paracentesis
Surgery
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| SBP commonest bugs and threshold to treat | If tap >250 cell/mm3 = treat
E. coli
Strep
Enterococcus
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| When do withdrawal seizures happen | 6-48 hrs after last drink
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| DTs when and what | 3-10 after last drink
Autonomic instability
Hallucinations
Agitation
Disorientation
Acidosis
Deranged electrolytes
Arrythmias
Infections
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| Causes thiamine deficiency | Booze
Hyperemesis gravidarum
Starvation
Malnutrition
CKD
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| Thiamine and glucose | T before Glucose
B1 is thiamine
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|
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