Acute GI Flashcards
what are the differentials for diverticulitis
mesenteric ischaemia, diverticulosis, IBS, ovarian cyst/rupture/torsion
what Ix do you want to perform in diverticulitis?
- BEdside - Obs, urine dip and pregnancy test
- Bloods -FBC, UE, LFT, CRP, amylase, INR, clotting screen, G&S + blood culture if pyrexic, urine dip and culture, bHCG.
- CT abdo pelvis - is the imaging of choice
I would also consider doing a PR exam to check for maligancy
what is the management of diverticulitis
- IV fluids, consider catheter and ?NG tube
- Analgesia and antiemetic (NSAIDs and opiates avoided due to risk of perforation)
- sepsis 6 if required
- VTE prophylaxis
- Clear fluids only initially, gradually build up over 2-3 days
- ABx
- Surgical management may be required in severe pts who fail to respond conservatively
WHat investigations should you perform in SBO/LBO?
-Bedside - Obs, fluid balance, PR, pregnancy test
- Bloods -FBC, UE, LFT, CRP, amylase, INR, G&S + blood culture if pyrexic, urine dip and culture, bHCG.
VBG/ABG (lactate is a key marker), bone profile
- erect CXR, then CT abdo pelvis, gastrogafin study may be indicated in SBO
what is the management of SBO
Conservative - Drip and suck - using a wide bore NG tube
Fluid resus
analgesia
VTE prophylaxis
urethral catheter and fluid balance monitoring
- anti emetic
- abx as required
- cardiac monitoring
- correction of electrolytes
Surgical - if obstructing lesions or complications such as evidence of ischaemia or perforation surgery such as resection and primary anastomosis via laparoscopy or laparotomy.
what is the long term management of diverticulitis?
Outpatient colorectal follow-up and colonoscopy
advice high fibre diet - to avoid constipation
elective surgical intervention if recurrent attacks
what is the management of LBO?
if malignant obstruction = surgical options include defuncitoning stoma and resecion with primary anastomosis or stenting
If volvulus = flatus tube decompression
what investigations should you perform in a suspected ectopic
- Bloods -FBC, UE, LFT, CRP, amylase, INR, G&S + blood culture if pyrexic, urine dip and culture, bHCG.
- Serum bHCG + trend, transvaginal USS
what is the management of an ecopic pregnancy
- IV fluids, consider catheter and ?NG tube
- Analgesia and antiemetic
- VTE prophylaxis
- If surgery think NBM, check INR and G&S, stop anticoags/antiplatelets/diabetic medication
- 2 wide - IV bore cannulas
- laproscopic salpingostomy/salpingectomy
- Anti-D prophylaxis
what are the differentials for gastric/peptic ulcer?
- differentials - pancreatitis, cholescystitis
what investigations should you perfrom in gastric/peptic ulcer disease
- Bloods -FBC, UE, LFT, CRP, amylase, INR, G&S + blood culture if pyrexic, urine dip and culture, bHCG.
ECG to rule out cardiac pathology - OGD +- biopsy
what is the initial management of gastric/peptic ulcer disease
- IV fluids, consider catheter and ?NG tube
- Analgesia and antiemetic
- VTE prophylaxis
- If surgery think NBM, check INR and G&S, stop anticoags/antiplatelets/diabetic medication
- PPI
- H.pylori eradication
what are some differentials for renal colic
pyelonephritis, biliary colic
what investigations should you perfrom in renal colic?
- Bloods -FBC, UE, LFT, CRP, amylase, INR, G&S + blood culture if pyrexic, urine dip and culture, bHCG.
- X-ray KUB, CT KUB
what is the management of renal colic
- IV fluids, consider catheter and ?NG tube
- Analgesia and antiemetic
- VTE prophylaxis
- If surgery think NBM, check INR and G&S, stop anticoags/antiplatelets/diabetic medication
- Diclofenac analgesia
- antibiotics if infection
- removal <1 cm - smooth muscle relaxants = tamulosin
- > 1cm uteroscopy or ESWL
- > 2cm - in renal pelvis = percutaneous nephrolithotomy QA
- ureteric stent or nephrostomy if obstruction