Gastroenterology indications CC

Question 1

Albumin indications

Answer 1

• HRS - 1 g /kg daily
• SBP - 1.5 g/kg 1st day and 1 g/kg on 3rd day
• More than 5 liters of paracentesis - 8 g for each 1 liter

Question 2

When to give albumin in SBP?

Answer 2

• Creatinine is > 1 mg/dL (88 micromol/L)
• The blood urea nitrogen is > 30 mg/dL (10.7 mmol/L)
• The total bilirubin is > 4 mg/dL (68 micromol/L)

Question 3

King’s College Hospital criteria for liver transplantation (paracetamol liver failure)

Answer 3

• Arterial pH < 7.3, 24 hours after ingestion or
• all of the following:
  
  • prothrombin time > 100 seconds,
  • creatinine > 300 µmol/l,
  • grade III or IV encephalopathy

MCQs

Question 4

King’s College Hospital criteria for liver transplantation (non-paracetamol induced ALF)

Answer 4

• INR > 6.5 (PT>100 seconds) or
• any three of the following:
  
  • Age <11 or >40 years,
  • Etiology non-A, non-B hepatitis, or idiosyncratic drug reaction (i.e. not hyperacute),
  • Time from onset of jaundice to encephalopathy >7 days,
  • INR >3.5 (PT >50 seconds),
  • Serum bilirubin >300 μmol/l

Question 5

Indications of stress ulcer prophylaxis

Answer 5

• Coagulopathy, defined as a platelet count < 50,000 per m3, an International Normalized Ratio (INR) > 1.5, or a partial thromboplastin time (PTT) > 2 times the control value
• Mechanical ventilation for > 48 hours
• History of GI ulceration or bleeding within the past year
• Traumatic brain injury, traumatic spinal cord injury, or burn injury
• On non-steroidal anti-inflammatory or anti-platelet agents
• Two or more of the following:
  
  • sepsis,
  • an ICU stay > 1 week,
  • occult GI bleeding ≥ 6 days, or
  • glucocorticoid therapy (more than 250 mg hydrocortisone or the equivalent)

Question 6

Potential indications for whole-bowel irrigation

Answer 6

• Iron poisoning
• Lithium poisoning
• Sustained-release or enteric-coated medication toxicity
• Retained illicit drug packets (i.e., from body packing)

Question 7

Contraindications for whole-bowel irrigation

Answer 7

• Unprotected airway (relative)
• Bowel obstruction
• Ileus
• Bowel perforation
• Uncontrolled vomiting
• Hemodynamic instability
• Toxic colitis

Question 8

Indications for operative intervention in severe UC

Answer 8

• Toxic megacolon
• severe hemorrhage,
• perforation,
• peritonitis, and
• failure of rescue therapy with infliximab or cyclosporine.

Multiple scoring systems have been developed to assist providers in decision making regarding the appropriate timing of colectomy. One of the simplest is the Oxford index, in which a stool frequency of more than 8 bowel movements per day on day 3 of intravenous steroids, along with a CRP greater than 45 mg/L is predictive of requiring a colectomy during admission in 85% of cases.

Question 9

UGIB: Indications for very early
(< 12 hours) upper gastrointestinal endoscopy

Answer 9

• patients with high-risk clinical features, such as
  hemodynamic instability, eg, hypotension and tachycardia that
  persist despite ongoing attempts of volume resuscitation,
• in-hospital bloody emesis nasogastric aspirate, or
• contraindication for interruption of anticoagulation.