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Yr3 - General Medicine > Gastro > Flashcards

Gastro Flashcards

1
Q

Basic advice for a healthy diet

A

BMI - 18.5-25
Base meals on starch - slower release carbohydrates
5 fruit and veg a day
Eat food high in fat, salt or sugar infrequently
Eat some meat, fish, eggs and beans - 2 portions of fish a week and reduce intake of red or processed meat
Eat some milk and dairy products
Moderate alcohol - less than 14 units over 3 or more days

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2
Q

Advice for taking supplements

A

Scant evidence for those able to follow a balanced diet
Women attempting to conceive - 400mcg/day folic acid from pre-conception to 12wks
Vitamin D (10mcg/day) for breast-feeding, over 65yrs old, dark skinand those not exposed to sun

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3
Q

Risks of too much sugar

A 
Caries
Diabetes
Obesity 
- osteoarthritis
- cancer
- hypertension
- increased oxidative stress
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4
Q

Best approach for weight loss

A

Motivational therapy

  • referral to dietitian
  • exercise and diet strategies
  • targeted weight loss - psychotherapy
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5
Q

Treatment for obestiy

A

Primary prevention
Orlistat - lowers fat absorption
Surgery - potential for significant weight loss but also significant mortality

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6
Q

Define leucoplakia

A

Oral mucosal white patch that will not rub off and not attributable to other known disease
Premalignant lesion

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7
Q

Cause of oral hairy leucoplakia

A

Caused by EBV - seen in HIV

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8
Q

Define apthous ulcers

A

Shallow, painful ulcers on tongue or oral mucosa that heal without scarring

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9
Q

Causes of severe ulcers

A 
Crohn's disease
Coeliac disease
Behcet's
Trauma
Erythema multiforme
Lichen planus
Pemphigus
Pemphigoid
Infections - herpes simplex, syphilis
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10
Q

Treatment of minor ulcers

A

Avoid oral trauma - hard toothbrush and foods
Avoid acidic foods and drinks
Tetracycline or antimicrobial mouthwashes (chlorhexidine)
Topical steroids - triamcinolone gel
Topical analgesia

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11
Q

Treatment of severe ulcers

A

Systemic corticosteriods - oral prednisolone 30-60mg/d PO for a week
Thalidomide - contraindicated in pregnancy
Biopsy if not healing after 3wks to exclude malignancy

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12
Q

Features of oral candidiasis

A

White patches or erythema of the buccal mucosa

Patches hard to remove and may bleed if scraped

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13
Q

Risk factors for oral candidiasis

A

Extremes of age
DM
Antibiotics
Immunosuppression - long-term corticosteriods (inhalers), cytotoxics, malignancy, HIV

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14
Q

Treatment for oral candidiasis

A

Nystatin suspension 400 000u (4ml swill and swallow/6hr)

Fluconazole - for oropharyngeal thrush

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15
Q

Define cheilitis

A

Angular stomatitis

Fissuring of the mouth’s corners

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16
Q

Causes of cheilitis

A

Denture problems
Candidiasis
Deficiency or iron or riboflavin (vitamin D)

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17
Q

Define gingivitis

A

Gum inflammation +- hypertrophy

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18
Q

Causes of gingivitis

A 
Poor oral hygiene
Drugs - pheytoin, ciclosporin, nifedipine
Pregnancy
Vitamin C deficiency
Acute myeloid leukaemia
Vincent's angina
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19
Q

Define microstomia

A

Mouth is too small

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20
Q

Causes of microstomia

A

Thickening and tightening of perioral skin after burns
Epidermolysis bullosa - destructive skin and mucous membrane blisters +- ankyloglossia
Systemic sclerosis

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21
Q

Causes of oral pigmentation

A

Peutz-Jehers’ - perioral brown spots
Addisons’ disease - pigmentation anywhere in mouth
Malignant melanoma
Telangiectasia - systemic sclerosis
Fordyce glands - creamy yellow spots at the border of the oral mucosa and lip vermilion
Sebaceous cysts
Aspergillus niger - black tongue

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22
Q

Sign of lead poisoning

A

Blue line at gum-tooth margin

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23
Q

Causes of yellow-brown discolouration of teeth

A

Prenatal or childhood tetracycline exposure

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24
Q

Causes of furred or dry tongue

A

Dehydration
Drug therapy
After radiotherapy
Crohn’s disease

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25
Q

Define glossitis

A

Smooth, red, sore tongue

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26
Q

Causes of glossitis

A

Iron, folate or B12 deficiency

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27
Q

Define macroglossia

A

Tongue is too big

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28
Q

Causes or macroglossia

A

Myxoedema
Acromegaly
Amyloid

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29
Q

Features of tongue cancer

A

Raised ulcer with firm edges

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30
Q

Risk factors of tongue cancer

A

Smoking

Alcohol

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31
Q

Pathway of spread of tongue cancer

A

Anterior 1/3 drains to submental node
Middle 1/3 to submandibular nodes
Posterior 1/3 to deep cervical nodes

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32
Q

Treatment for tongue cancer

A

Radiotherapy

Surgery

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33
Q

Causes of white intra-oral lesions

A 
Idiopathic keratosis
Leucoplakia
Lichen planus
Poor dental hygiene
Candidiasis
Squamous papilloma
Carcinoma
Hariy oral leucoplakia
Lupus erythematosus
Smoking
Ahthous stomatitis
Secondary syphilis
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34
Q

Indications for upper GI endoscopy

A 
Diagnostic
- haematemesis/malaena
- dysphagia
- dyspepsia
- duodenal biopsy
- persistent vomiting
- iron deficiency
Therapeutic
- treatment of bleeding lesions
- variceal banding and sclerotherapy
- argon plasma coagulation for suspected vascular abnormality
- stent insertion, laser therapy
- stricture dilation, polyp resection
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35
Q

Pre-procedure for upper GI endoscopy

A

Stop PPIs 2wks prior
Nil by mouth 6 hrs before
Don’t drive for 24hrs if sedation used

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36
Q

Upper GI endoscopy procedure

A

Sedation optional - midazolam 1-5mg slowly IV
Nasal prong O2 - 2L/min + monitor sats
Spray pharynx with local anaesthetic
Continuous suction - prevent aspiration

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37
Q

Complications of upper GI endoscopy

A

Sore throat
Amnesia - sedation
Perforation
Bleeding - aspirin, clopidogrel, warfarin or DOACs stopped if therapeutic

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38
Q

Uses of duodenal biopsy

A

Gold standard for coeliac disease
Whipple’s disease
Giardiasis
Lymphoma

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39
Q

Uses of sigmoidoscopy

A

Views rectum + distal colon - to splenic flexure
Flexible has replaced rigid - 25% cancers still out of reach
Therapeutic - decompression of sigmoid volvulus

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40
Q

Sigmoidoscopy procedure

A

Do PR exam first

Biopsies

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41
Q

Indications of colonscopy

A 
Diagnostic
- rectal bleeding
- iron-deficiency anaemia
- persistent diarrhoea
- positive faecal occult blood test
- assessment or suspicion of IBD
- colon cancer surveillance
Therapeutic
- haemostasis - clipping vessels
- bleeding angiodysplasia lesion
- colonic stent deployment
- volvulus decompression
- pseudo-obstruction
- polypectomy
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42
Q

Colonoscopy preparation

A

Stop iron 1wk prior

Discuss bowl preparation and diet required

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43
Q

Colonoscopy procedure

A

Do PR first

Sedation and analgesia

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44
Q

Complications of colonoscopy

A

Abdominal discomfort
Incomplete examination
Haemorrhage after biopsy or polypecotmy
Perforation

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45
Q

Post-procedure of colonoscopy

A

No alcohol

No operating machinery for 24 hrs

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46
Q

Indications of video capsule endoscopy (VSE)

A

Evaluate obscure GI bleeding

Detect small bowel pathology

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47
Q

Pre-procedure for VSE

A

Small bowel imaging (contrast) or patency capsule test - if pt has abdo pain or symptoms suggesting obstruction
Clear fluids only evening before
Nill by mouth from morning till 4hr after capsule swallowed

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48
Q

VSE procedure

A

Capsule swallowed
Transmits wirelessly to capture devise worn by pt
Normal activities take place during day

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49
Q

Complications of VSE

A

Capsule retention - endoscopic or surgical removal
Obstruction
Incomplete exam - slow transit, achalasia

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50
Q

Problems with VSE

A

No therapeutic options
Poor localisation of lesions
May miss more subtle lesions

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51
Q

Routes for liver biopsy

A

Percutaneous - if INR in range

Transjugular - with FFP

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52
Q

Indications for liver biopsy

A

Increased LFTs of unknown origin
Assessment of fibrosis in chronic liver disease
Suspected cirrhosis
Suspected hepatic lesions/cancer

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53
Q

Pre-op for liver biopsy

A

Nil by mouth for 8 hr
INR < 1.5
Platelets > 50x10^9/L

54
Q

Liver biopsy procedure

A

Sedation and analgesia may be given
Do under US/CT guidance
Liver borders percussed
Lidocaine 2% infiltrated down to the liver capsule
Breathing rehearsed and needle biopsy taken with breath held in expiration
Lie on right hand side for 2hr
Stay in bed for 4 hr
Check BP and pulse every 15 mins for 1 hr then 30 mins for 2 hrs then hourly
Discharge 4 hr post op

55
Q

Complications of liver biopsy

A

Local pain
Pneumothorax
Bleeding
Death

56
Q

Define dysphagia

A

Difficulty swallowing

57
Q

Key questions to ask with dysphagia

A 
Difficulty swallowing solids and liquids from the start
- y - motility disorder
- n - stricture - benign or malignant
Difficult to initiate swallowing
- y - bulbar palsy
Swallowing painful
- y - ulceration - malignancy, oesophagitis, viral infection, Candida 
Dysphagia intermittent
- intermittent - oesophageal spasm
- constant and worsening - malignant stricutre
Neck buldge or gurgle
- y - pharyngeal pouch
58
Q

Signs associated with dysphagia

A 
Cachectic
Anaemic
Examine mouth
Feel for supra-clavicular nodes
Systemic disease - sclerosis, CNS
59
Q

Investigations for dysphagia

A 
FBC - anaemia
U&amp;Es - dehydration
Upper GI endoscopy +- biopsy 
Contrast swallow - pharyngeal pouch
Video fluroscopy - neurogenic causes
Oesophageal manometry - dysmotility
60
Q

Findings in vomit

A

Coffee grounds - upper GI bleed
Recognisable food - gastric stasis
Feculent - small bowel obstruction

61
Q

Timing of vomit

A

Morning - pregnancy or raised ICP
1hr post food - gastric stasis/gastroparesis
Relieves pain - peptic ulcer
Preceded by loud gurgling - GI obstruction

62
Q

Investigations for vomiting

A

Bloods - FBC, U&Es, LFTs, Ca2+, glucose, amylase
ABG - metabolic alkalosis from loss of gastric contents indicates severe vomiting - pH > 7.45, increased HCO3-
Plain AXR - if suspected bowel obstruction
Upper GI endoscopy - bleed or persistent vomitting¬

63
Q

Treatment for N+V

A

Identify and treat underlying causes
Symptomatic relief - oral route first anti-emetic, IV fluids with K+ replacement
Monitor fluid and electrolyte balance

64
Q

H1 receptor antagonists antiemetics

A

Cyclizine - 50mg/8h PO/IV/IM - GI causes

Cinnarizine - 30mg/8hr PO - vestibular disorders

65
Q

D2 receptor antagonists antiemetics

A

Metoclopramide - 10mg/8h PO/IV/IM - GI causes + prokinetic
Domperidone - 60mg/12h PR, 20mg/6hr PO - prokinetic
Prochlorperazine - 12.5 mg IM, 5mg/8h PO - vestibular + GI causes
Haloperidol - 1.5mg/12h PO - chemical causes (opioids)

66
Q

5HT3 receptor antagonist antiemetics

A

Ondansetron - 4-8mg/8hr IV slowly - doses can be higher for chemo

67
Q

Other antiemetics

A

Hyoscine hydrobromide - 200-600mcg SC/IM - antimuscarinic, antispasmodic and antisecretory - don’t prescribe with prokinetic
Dexamethasone - 6-10mg/d PO/SC - unknown MOA, adjuvant
Midazolam - 2-4mg/d SC (syringe driver) - unknown MOA, anti-emetic effect outlasts sedative effect

68
Q

Mechanical causes of dysphagia

A 
Malignant stricture
- pharyngeal cancer
- oesophageal cancer
- gastric cancer
Benign strictures
- oesophageal web or ring
- peptic stricture
Extrinsic pressure
- lung cancer
- mediastinal lymph nodes
- retrosternal goitre
- AAA
- left atrial enlargement
Pharyngeal pouch
69
Q

Motility disorders causing dysphagia

A 
Achalasia
Diffue oesophageal spasm
Systemic sclerosis
Neurological bulbar palsy
- pseudobulbar palsy
- Wilson's or Parkinson's disease
- syringobulbia
- bulbar poliomyelitis
- Chagas's disease
- Myasthenia gravis
70
Q

Other causes of dysphagia

A

Oesophagitis

Globus

71
Q

Symptoms of dyspepsia

A

Epigastric pain often related to hunger, specific foods or time of day
Fullness after meals
Heartburn (retrosternal pain)
Tender epigastrium

72
Q

Red flags of dyspepsia

A 
Anaemia - iron deficiency
Loss of weight
Anorexia
Recent onset/progressive
Melaena/haematemsis
Swallowing difficulty
73
Q

Treatment for H.pylori

A

PPI + 2 antibiotics for 1 week

  • Lansoprazole 30mg/12hr PO
  • Clarithromycin 250mg/12hr PO
  • Amoxicillin 1g/12hr PO
74
Q

Risk factors for a peptic ulcer

A 
H.pylori
Drugs - NSAIDs, steriods, SSRI
Increased gastric acid secretion
Increased gastric emptying - lowers duodenal pH
Blood group O
Smoking
Stress
75
Q

Symptoms and signs of a peptic ulcer

A

Asymptomatic or epigastric pain
+- weight loss
Epigastric tenderness

76
Q

Risk factors for gastritis

A 
Alcohol
NSAIDs
H.pylori
Reflux/hiatus hernia
Atrophic gastritis
Granulomas - Crohn's, sarcoidosis
CMV
Zollinger-Ellison syndrome
77
Q

Symptoms of gastritis

A

Epigastric pain

Vomiting

78
Q

Complications of peptic ulcer disease

A

Bleeding
Perforation
Malignancy
Reduced gastric outflow

79
Q

Treatment of functional dyspepsia

A

H.pylori eradication
PPIs and psychotherapy
Low-dose amitriptyline - 10-20mg each night PO

80
Q

H.pylori tests

A 
CLO test
Histology
Culture
13C breath test - most accurate non-invasive
Stool antigen
Serology
81
Q

Differential diagnosis of dyspepsia

A 
Non-ulcer dyspepsia
Duodenal/gastric ulcer
Duodenitis
Oesophagitis/GORD
Gastric malignancy
Gastritis
82
Q

Causes of GORD

A 
Lower oesophageal spinchter hypotension
Hiatus hernia
Oesophageal dysmotility
Obesity
Gastric acid hypersecretion
Delayed gastric emptying
Smoking
Alcohol
Pregnancy
Drugs - tricyclics, anticholinergics, nitrates
83
Q

Symptoms of GORD

A 
Oesophageal
- heartburn
- belching
- acid brash
- waterbrash
- odynophagia
Extra-oesophageal
- nocturnal asthma
- chronic cough
- laryngitis
- sinusitis
84
Q

Complications of GORD

A 
Oesophagitis
Ulcers
Benign strictures
Iron-deficiency
Barrett's oesphagus
85
Q

Treatment of GORD

A 
Lifestyle
- weight loss
- smoking cessation
- small regular meals
- reduce hot drinks, alcohol, citrus fruits, onions, fizzy drinks, spicy foods, caffeine, chocolate
- avoid eating 3 hrs before bed
Drugs
- antacids relieve symptoms
- PPI
Surgery
86
Q

Describe a sliding hiatus hernia

A

Gastro-oesophageal junction slides up into the chest

Acid reflux occurs as LOS becomes less competent

87
Q

Describe a paraoesophageal hernia

A

Gastro-oesophageal junction remains in abdomne but buldge of stomach herniates up into chest alongside oesophagus

88
Q

Clinical features of hiatus hernia

A

Common - 30% > 50yrs, esp obese women

Large hernias -> GORD

89
Q

Imaging of hiatus hernia

A

Upper GI endoscopy visualises mucosa but cannot exclude hitatus hernia

90
Q

Treatment of hiatus hernia

A

Weight loss
Treat GORD
Surgery

91
Q

Surgical indications for hiatus hernia

A

Intractable symptoms despite aggressive medical therapy

Complications

92
Q

Define haematemesis

A

Vomiting of blood

  • may be bright red or like coffee grounds
  • indicates upper GI bleed
93
Q

Define malaena

A

Black stools due to altered blood

- indicates upper GI bleed

94
Q

Stages of a GI bleed history

A 
Past GI bleeds
Dyspepsia/known ulcers
Known liver or oesophageal varices
Dysphagia
Vomiting
Weight loss
Drugs - antiplatelets, anticoagulants, NSAIDs
Alcohol use
Co-morbidities - liver disease
95
Q

Signs of a GI bleed

A 
Peripherally cool/clammy
Capillary refil >2s
Urine output <0.5mL/kg/h
Reduced GCS
Tachycardic - pulse > 100bpm
Systolic BP <100mmHg
96
Q

Investigations for upper GI bleed

A

FBC - anaemia and platelet count
- thrombocytopenia suggestive of chronic liver disease
U&Es - raised urea
Clotting
Group and save - may need blood transfusion
LFTs
Venous blood gas - quick haemoglobin result

97
Q

Acute management of upper GI bleeed

A

2 large-bore (14-16g) IV cannulae
- give IV fluids if haemodynamically compromised
- give O Rh- blood
Correct clotting - FFP, vitamin K, platelets
If suspicion of varices - IV Terlipressin and IV antibiotics
Arrange urgent upper GI endoscopy
Monitor hourly

98
Q

Rockall risk-scoring for upper GI bleeds

A

Age - <60, 60-79, >80
Cormorbidity - No, Heart failure or IHD, Renal or liver failure, Metastases
Shock - No shock, Tachycardia, Hypotension
Source of bleeding - M-W tear, all other diagnosis, malignancy
Stigmata of recent bleeding - None, blood in upper GI tract visible of spurting vessel

99
Q

Blatchford score

A

Admission risk markers

  • blood urea
  • haemoglobin
  • systolic BP
  • others
100
Q

Features of Crohn’s disease

A 
Mouth to anus
Skip lesions
Transmural inflammation
Fissuring ulcers
Lymphoid and neutrophil aggregates
Non-caseating granulomas
Increased incidence in smokers
101
Q

Features of UC

A 
Rectum then proximally
Continuous
Mucosal and submucosa inflammation
Crypt abscesses
Decreased incidence in smokers
102
Q

IBD investigations

A 
Blood tests
- FBC - anaemia or raised platelets
- U&amp;Es - deranged electrolytes of AKI 
- CRP - inflammatory marker
Stool tests 
- cultures - exclude infection colitis
- Faecal calprotectin - raised in active disease
Imaging
- AXR - proximal constipation
- CT - acute complications
- MRI enterography - small bowel Crohn's
- MRI rectum - perianal Crohn's
Endoscopy
- flexible sigmoidoscopy - safest in bloody diarrhoea
- colonoscopy - proximal disease
- capsule endoscopy - small bowel mucosa
103
Q

What are patients admitted to hospital with acute IBD at high risk of?

A

VTE - need prophylactic heparin

104
Q

IBD steriod treatment

A

Acute flare ups

  • topically - suppositories, enemas
  • orally - prednisolone or budesonide in small bowel disease
  • IV - hydrocortisone (100mg qds for 3-5 days)
105
Q

UC treatment

A 
Maintain remision
- Mesalazine
Rescue therapy
- ciclosporin
- biologics
- surgery
106
Q

Crohn’s treatment

A 
Maintain remission
- azathioprine
- biologics - perianal or fistulating
Rescue therapy
- biologics
- surgery
107
Q

Presentation of coeliac disease

A 
Loose stools
Bloating
Wind
Abdo cramps
Weight loss
Dermatitis herpetiformis
108
Q

Complications of untreated coeliac disease

A

Small bowel lymphoma
Small bowel cancer
Osteoporosis
Gluten ataxia and neuropathy

109
Q

How to diagnose coeliac disease

A

Continue normal diet
Tissue transglutaminae - raised
OGD and duodenal biopsies - villous atrophy and intra-epithelial lymphocytosis

110
Q

Treatment of coeliac disease

A

Gluten free diet

  • barley
  • wheat
  • oats
  • rye
111
Q

Functions of the liver

A 
Nutrition
- stores glycogen
- releases glucose
- absorbs fats, fat soluble vitamins and iron 
- manufactures cholesterol
Bile salts dissolve dietary fats
Breakdown of haemoglobin to haemoglobin
Manufactures clotting factors
Detoxification
- drug excretion
- alcohol breakdown
Kupfer cells engulf antigens
Manufactures proteins
- albumin
- binding proteins
112
Q

Risk factors of liver disease

A 
Blood transfusion prior to 1999 in UK
IVDU
Operations/vaccinations with dubious sterile procedures
Sexual exposure
Medications
FH of liver disease, diabetes, IBD
Obesity
Alcohol 
Foreign travel
113
Q

Features of acute liver disease

A 
No pre-existing liver disease
Resolves in 6 months
Causes
- viral - Hep A, Hep E, CMV, EBV
- drug-induced liver injury (DILI)
114
Q

Features of chronic liver disease

A 
Starts with acute liver disease
On-going effects beyond 6 months
May lead to cirrhosis and its complications
Causes
- alcohol
- Hep C
- Non-alcoholic steatohepatitis
- autoimmune (PBC, PSC, AIH)
115
Q

Grading of hepatic encephalopathy

A 
Grade 1
- psychomotor slowing
- constructional apraxia
- poor memory
- reversed sleep pattern
Grade 2
- lethargy
- disorientation
- agitation/irritability
- asterixis
Grade 3
- drowsy
Grade 4
- coma
116
Q

Investigations for liver disease

A 
Thrombocytopenia - liver fibrosis
LFTs 
- ALT - hepatocytes
- ALP - ducts
Bilirubin, Albumin and Prothrombin time - synthetic function
USS - cirrhosis
117
Q

Hepatic causes of deranged LFTs

A 
ALT > 500
- viral
- ischaemia
- toxic - paracetamol
- autoimmune
ALT 100-200
- non-alcoholic steatohepatitis
- autoimmune hepatitis
- chronic viral hepatitis
- drug induced  liver injury
118
Q

Cholestatic causes of deranged LFTs

A 
Dilated ducts
- gallstones
- malignancy
Non-dilated ducts
- alcoholic hepatitis
- cirrhosis - PBC, PSC, alcohol
- drug-induced liver injury - antibiotics
119
Q

Components of the liver screen

A 
Hepatitis B&amp;C serology
Iron studies - ferritin and atransferrin saturation
Autoantibodies and immunoglobulins
Caeuruloplasmin - under 30 yrs
Alpha-a-antitrypsin
Coeliac serolgy
TFTs, lipids and glucose
120
Q

Commonest causes of chronic liver disease

A

Alcoholic liver disease
Non-alcoholic steatohepatitis
Viral hepatitis - B+C

121
Q

Less common causes of chronic liver disease

A 
Women
- autoimmune hepatitis
- PBC
Men
- PSC - associated with IBD
- haemachromatosis
Adolescents
- Wilsons disease
- anti LKM autoimmune hepatitis
122
Q

Treatment of chronic liver disease

A

Removing underlying aetiology to prevent further damage and progression to cirrhosis

  • stop drinking
  • weight loss
  • antivirals
  • venesection
123
Q

Diagnosis of cirrhosis

A

Chronic liver disease pts with thrombocytopenia or clinical stigmata of chronic liver diease
Imaging - splenomegaly, coarse texture and nodularity
Fibroscan - quicker

124
Q

Management of cirrhosis

A

Screen for varices
Spironolactone - ascites
DEXA scan for osteoporosis
Alpha-fetoprotein and USS every 6 months - hepatocellular carcinoma

125
Q

What should be performed on all patients admitted with ascites?

A

Diagnositc ascitic tap - cell count and MC&S

- look for spontaneous bacterial peritonitis

126
Q

Components of nutritional assessment

A 
Appetite
Diet history
Changes in oral intake
Changes in weight
Malnutrition Universal Screening Tool (MUST)
127
Q

Steps of nutritional support

A 
Food and encouragement
- protected mealtimes
- high calorie options encouraged
- food fortification
Nutritional supplements - large calories but small volumes
NG tube
PEG
Parenteral
128
Q

NG tube

A

Short term
Supplementary feeding or solo
Get in way and attached to drip
Do on eliminated aspiration - pts aspirate on saliva

129
Q

PEG

A 
Longer term access to 
- Stomach - PEG
- Small bowel - PEG-J
Placed endoscopically (PEG) or Radiologically - (RIG)
Indicated
- feeding difficulty
- need to provide supplementary feeding
Do on eliminated aspiration - pts aspirate on saliva
130
Q

Parenteral nutrition

A

Nutrition and fluid directly into patients veins
Indicated when
- GI tract not accessible - blocked
- GI tract not working - short, leaking, diseased
Mix of fluid, marco and micronutrients
Given via dedicated central line
Risks of line sepsis and liver dysfunction

Yr3 - General Medicine (9 decks)

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