Gastroenterology Flashcards
Describe investigations to do for suspected inflammatory bowel disease
Blood tests – FBC, U&Es & CRP
Stool tests – stool cultures, faecal calprotectin
Simple imaging – AXR
Endoscopy – flexible sigmoidoscopy, colonoscopy, capsule endoscopy
Cross sectional imaging – CT abdomen, MRI enterography, MRI rectum
Describe the treatment for inflammatory bowel disease
Steroids – can be delivered topically, orally or IV
UC – rescue therapy is ciclosporin, biologics or surgery & mesalazine is used to maintain remission in UC
Crohn’s – rescue therapy is biologics or surgery & azathioprine, and biologics are used in maintenance treatment
Biologics – first choice medication in perianal or fistulating Crohn’s
List the two assessment scores for GI bleeding
ROCKALL score – simple score based on bedside parameters that predicts the risk of death and rebleeding from an upper GI bleed
-score split into pre-endoscopy & post-endoscopy score that can only be completed with endoscopy findings
Blatchford score – predicts the need for intervention (blood transfusion or therapeutic endoscopy) and requires the results of some blood tests in addition
-most useful in deciding if a patient needs admitting to hospital or not
Describe the investigations done for suspected an upper GI bleed
A-E approach
FBC – Hb and platelets
U&E – raised urea supports diagnosis of upper GI bleeding
Clotting
Group and save – may need to give blood transfusion
LFTs
Venous blood gas
Describe the management for upper GI bleeding
1) Variceal bleeding – emergency, most often presents with fresh haematemesis +/- melaena
- Gain IV access, IV terlipressin & IV abx, refer urgently to GI team for upper GI endoscopy -> endoscopic banding (but if this doesn’t control bleeding, a Linton or Sengstaken may be required temporarily, or a TIPSS procedure)
2) Non-variceal bleeding – these conditions are more likely to stop bleeding on their own than variceal bleeds
- Gain IV access, PPI may be indicated post-endoscopy, definitive treatment: discussed with gastroenterology team & dependent on pathology found -> if bleeding cannot be stopped by endoscopy, radiological embolization or surgery may be possible
Describe a nutritional assessment
History – appetite, diet, history, changes in oral intake and changes in weight
Malnutrition universal screening tool (MUST) – simple validated bedside tool
Describe the management for malnutrition
First step is using food and encouragement
Mealtime interruptions should be kept to a minimum & high calorie options encouraged
Assistance with eating
Food fortification – provide additional calories without increasing the volume that needs to be consumed
Describe the dietician’s role in management of malnutrition
Make use of nutritional supplements as these provide large amounts of calories in small volumes
-some of these are nutritionally complete
Supplement drinks should only be continued after discharge from hospital if advised by the dietician
Describe options available for patients who are still unable to meet their nutritional requirements after first-line management
NG tube: short term access and may provide all of the nutritional and fluid requirements/be used for supplementary feeding on top of patient’s usual oral intake
-need to check pH prior to each use -> ensure tip is in the stomach and not the lungs
PEG/RIG/PEGJ/RIGJ: all provide longer-term enteral access than an NG tube
-tube may feed into the stomach (PEG or RIG) or into small bowel (PEG-J and RIG-J) & be placed endoscopically (PEG and PEG-J) or radiologically (RIG and RIG-J)
-all methods require puncture of the stomach with a trocar
-indicated when the feeding difficulty, or need to provide supplementary feeding, is likely to be medium or long term
Parenteral nutrition: provides nutrition and fluid directly into a patient’s veins
-only indicated when the GI tract is either no accessible or not working
-needs to be given via a dedicated central line (PICC or hickman line)
-risks of line sepsis and liver dysfunction
