ALARMS2
Anaemia (IDA or bleeding) Loss of wt (unexplained) A mass (epigastric) Recurrent/persistent vomiting Melaena/haematemesis Swallowing difficulty Suspicious barium meal
*ALARMS referral for endoscopy regardless of age *
RUP
Recent onsent (cf. reccurent)
Unexplained (no precipitant)
Persistent (4-6 weeks; not self limiting)
Referral for endoscopy if older than 55
PPI1 TTI13
PPI for 1 month (trial; full dose)
Test and Treat Initiative (C-13 urea test or stool ANTIGEN test)
Treatment for dyspepsia which does not meet referral criteria
PAC My BAD PUG
PPI \+ Amoxicillin \+ Clarithromycin \+- Metronidazole (replaces amoxicillin) B-cell lymphoma of MALT Atrophic gastritis Duodenal ulcer PU disease Gastric Cancer
*Mx and associations of H.Pylori *
TABaCco TIPPS Proper
Terlipressin
Abx (prophylaxis)
Band ligation (oesophageal; 2-weekly intervals, PPI cover)
Cyanacrylate injections (gastric bleeding)
TIPS (last resort)
Sengstaken-Blakemore tube (if current heavy bleed)
Propanolol (prophylaxis)
Mx of variceal bleeding-
GooD GoD
Gastric Ca.
Dieulafoys lesion (tortuous arteriole)
Gastric ulcer
Diffuse erosive gastritis
Gastric bleeding causes
KIDAPPAT
Koilynchia Dimorphic picture Angular stomatitis Poikilocytes Post-cricooid webs Atrophic glossitis Target cells
- Iron deficiency anaemia*
P2AS2
Periodic Acid Schiff (granules in macrophages)
Pericarditis
Pleurisy
Arthritis
Skin changes (hyperpigmentation/photosensitivity)
Seizures (neurological signs)
Whipple’s disease
STUN 7.3
Staggered intake (over 1hr)
Treatment line above
Unknown time of ingestion
N-acetylcysteine
- 3 (pH: treat if arterial is below)
* Paracetamol OD*
A C
Abx --> ERCP (obstruction) Charcots triad (Fever, RUQ pain, Jaundice)
Ascending Cholangitis
GET SMASHED
Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpions Hypercalcaemia/chylomicron/TAGS/hypothermia ERCP Drugs
Causes of acute pancreatitis
FED PaSCaL
Faecal Elastase DM (develops 20yrs later) Pain (on eating) Steatorrhoea Calcification of pancreas Lipase levels (more specific than amylase)
Chronic Pancreatis
Sulfa = MORH -salazine = HAPIG
Megaloblastic anaemia
Oligospermia
Rashes
Headaches/Heinz-body anaemia
Headache Agranulocytosis Pancreatitis Interstitial nephritis GI upset
SEs of of sulfasalazine and mesalazine
SLAR2D
Schirmers test +ve Lymphocyte ca. risk x60 ANA +ve (70%) Ro +ve (70%) RhF +ve (99%) Dry mucosal surfaces