Gastro

Question 1

management of variceal bleeding?

• ABCDE
• Fluid resuscitate
• IV ____ (2mg bolus, 1mg qds maintenance)
• Oral ____
• If PT prolonged give IV _____
• If PT> 20 seconds (or INR >2.0) – give _____
• If platelets <50 – give IV ____
• Transfuse blood if Hb
• Early endoscopy after resuscitation (within 12 hours)

Answer 1

• terlipressin
• tazocin
• vitamin K
• FFP (2-4 units)
• platelets
• 70

Question 2

management of encephalopathy

Answer 2

• Look for precipitant (GI bleed, constipation, dehydration, sepsis, medications etc.)
• lactulose or phosphate enema (aiming for 2 soft stools/day)
• If in clinical doubt in a confused patient request CT head to exclude subdural haematoma

Question 3

what is decompensated cirrhosis and how can it present?

Answer 3

defined as a patient with cirrhosis who presents with an acute deterioration in liver function that can manifest with:

• Jaundice
• Increasing ascites
• Hepatic encephalopathy
• Renal impairment
• GI bleeding
• Signs of sepsis/hypovolaemia

Question 4

Frequently there is a precipitant that leads to the decompensation of cirrhosis, such as?

Answer 4

• GI bleeding (variceal and non-variceal)
• Infection/sepsis
• Alcoholic hepatitis
• Acute portal vein thrombosis
• Development of hepatocellular carcinoma
• Drugs (Alcohol, opiates, NSAIDs etc)
• Ischaemic liver injury (sepsis or hypotension)
• Dehydration
• Constipation