Gastrointestinal IM Flashcards
Melena can sometimes be mistaken for what other stools? How to differentiate?
Iron stools. Melena is alot blacker than iron stools. Can be due to charcoal tablets, iron tablets, bismuth.
Iron stools give greenish smear on tissue
Purpose of Glasgow-Blatchford score for UGI bleeding?
Risk stratification tool
Predict risk for needing endoscopic intervention.
1 or above is high risk of re-bleeding and needs urgent intervention.
4 criteria = Blood urea nitrogen, Hb, Systolic BP and “other additional criteria”
Total is 0-23
Principles for endoscopy planning for UBGIT patients?
- Early endoscopy <24 hrs recommended for all pts who aren’t at low risk of re-bleeding.
- Very early <12 hrs UGI endoscopy can be considered for pts with high risk features e.g. GBS >7, Hematemesis, comorbids like cirrhosis.
- Routine very early <12hrs UGI endoscopy does not improve clinical outcomes and may cause ADR e.g. due to inadequate resuscitation
Whats the half-life of antiplatelets? Is there a need to stop them before endoscope?
Antiplatelets usu have T-half of 5-7 days. No point stopping before scope.
Principles of stopping oral anticoagulants before endoscopy?
For drugs with short T-half of <12-15 hrs, just stop them.
If got renal impairment, may take longer to clear.
When to re-start anticoagulation after scopy for UGBIT pts?
Ideally within 4-7 days. BUT up to clinical judgement of doctor - just restart when hemostasis has been achieved.
What basic drug to give right after seeing UBGIT?
PPI
Possible causes of GI malabsorption?
Pancreatic insufficiency
Short gut syndrome
Celiac disease
IBD
Bile acid deficiency
Infections e.g. bacterial, fungal
Gut flora produces which vitamin
Vitamin K
What is Secondary bacterial peritonitis?
inflammation of the peritoneum caused by bacterial infection from a surgically treatable intraabdominal source
What is spontaneous bacterial peritonitis
infection of the ascitic fluid in the absence of any focal intraabdominal, surgically treatable source of infection
What is Zollinger-Ellison syndrome?
Gastrin-secreting neuroendocrine tumour often localized to DDM and pancreas.
Typically presents with recurrent persistent PUD and diarrhoea
May be due to MEN syndrome. Malignant in most patients
What is Curling ulcer?
Stress-induced ulcer of stomach or DDM related to physical stress, e.g. BURNS
Extensive burn causes more stress on whole body than any other injury
How does hirschsprung disease present?
First sign usu when newborn fails to pass meconium within 48 hrs after birth with symptoms of IO
Commonest site of Hirschsprung’s disease?
Rectosigmoid junction
