Gastro Flashcards
(232 cards)
Common causes of GI bleed?
Chronic/acute peptic ulcer Drugs Mallory-Weiss Varices Gastric erosions Erosive oesophagitis
Bloods in GI bleed?
FBC, U+E, LFT, amylase, glucose, clotting
Urea raised due to increased protein load
G+S if low risk, X-match if high risk
Investigations besides bloods in upper GI bleed?
Erect CXR/ECG
OGD - identification of cause and permits treatment
What does Glasgow Blatchford Score assess?
Assesses likelihood that patient will need transfusion or endoscopic intervention.
Results and management from GBS?
0/1 and stable - LOW RISK - discharge with O/P OGD or discuss with gastro reg
> 2 and stable - INTERMEDIATE RISK - discuss with reg and routine OGD (24 hours)
> 2 and unstable or varices suspetred - HIGH RISK - urgent review by gastro reg and emergency OGD
What does Rockall Score assess?
Identifies patients at risk of adverse outcome following GI bleed
Contains diagnosis (MW, malignancy etc) so can assess outcome
Results of Rockall score?
<3 = good prognosis, low risk of mortality/rebleeding
> 8 = high risk of mortality, high risk of mortality/rebleeding
What can you give in variceal bleed?
Terlipressin
Constipation + rectal bleeding = ?
Constipation + distenstion + active BS = ?
Constipation + menorrhagia = ?
- cancer
- stricture/GI obstruction
- hypothyroidism
Mnemonic for causes of constipation?
OPENED IT
Obstruction, pain, endocrine, neuro, elderly, diet/dehydration, IBS, toxins
Cause of chronic constipation in kids?
Hirschsprung’s
Investigations for constipation in elderly?
Bloods - exclude metabolic causes (hypothyroid, hypercalcaemia)
Review drug history
Sigmoidoscopy/barium enema to exclude cancer or diverticulitis
Name a bulk forming laxative and how they work?
Bran powder, fybogel (ispaghula husk), methylcellulose, sterculia granules
↑Faecal mass –> stimulate peristalsis – must be taken with plenty of fluid and take a few days to act.
Name a softener laxative and when you use them?
Liquid paraffin, arachis oil, sodium docusate (also has a simulant action)
Useful when managing painful anal conditions (fissure)
Name an osomotic laxative and how they work and side effects?
Lactulose, macrogol (movicol)
Retain fluid in the bowel
SE = bloating
Name stimulant laxatives and how they work and side effects?
Bisacodyl, senna (pure stimulant)
Docusate sodium, danthron (stimulant and softening)
Increase intestinal motility, so don’t use in obstruction or acute colitis. Avoid prolonged use as may cause colonic atony and hypokalaemia.
SEs = abdominal cramps
What can you do for rapid bowel evacuation prior to procedures?
Phosphate enema
Bloods in diarrhoea?
FBC - ↓MCV/Fe deficiency (coeliac/colon ca), ↑MCV if alcohol abuse or ↓B12 absorption (coeliac/Crohn’s)
ESR/CRP - Raised in infection, Crohn’s/UC, cancer
U+E - ↓K+ = severe D+V
TFTs - ?hyper
Coeliac serology
Investigations in diarrhoea?
Bloods
Stool MC+S
Rigig sigmoidoscopy + biopsy (Crohn’s)
Colonoscopy/barium enema - ?malignancy ?colitis
General management of diarrhoea?
Treat Causes
Food handlers – no work until stool samples are -ve. If hospital outbreak, isolation/ward closure may be necessary.
Avoid abx unless infective diarrhoea causing systemic upset.
Rehydration in diarrhoea?
Oral rehydration better than IV, but if impossible –> 0.9% saline + 20mmol K+/L IV.
ORS in children
Anitmotility agents in diarrhoea?
Codeine phosphate 30mg TDS PO or loperamide 2mg PO after each loose stool (max 16mg/day) –> ↓stool frequency
Avoid in colitis (may precipitate toxic megacolon)
Little evidence to suggest their use in acute diarrhoea increases risk of colonic dilatation
Should not be given to children
Risk factors and treatment of C.diff?
> 70 yrs, past C.diff infection, use of antiperistaltic drugs
Stop abx. Treatment not usually needed. Metronidazole or vanc 10 days if severe.
Complication –> toxic megacolon
Screening tool for malnutrition?
MUST (Malnutrition universal screening tool)
BMI score
Weight loss score
Acute disease effect score
0 = low risk 1 = medium risk 2 = high risk