GI Bleeding, Pancreatitis, C Diff Flashcards
INR goals in massive GIB?
<1.5
3 scoring systems for GIB. What are they and the difference?
- Rockall: needs endoscopic data.
- Glasgow-Blatchford: no endo
- AIM65: Alb, INR, AMS, SBP, Age.
What are the components of the AIM65 scoring system for GIB?
Alb, INR, AMS, SBP, Age.
Role for pro-kinetics prior to endoscopy for GIB? (e.g., erythromycin)
Shortens procedure time, decreased need for second look. Used for patients you need to “clean out” prior to endoscopy.
Definitions of “urgent”, “very early”, and “early” endoscopy for GIB?
- Urgent < 6 hours
- Very early < 12 hours
- Early < 24 hours (only one to show benefit)
Indications for antibiotics in UGIB?
Concurrent cirrhosis. Benefits mortality, infection, rebleeding, LoS.
Contraindications to TIPS?
- HF
- Severe pulmonary hypertension
- Severe TR
- Sepsis, systemic infection
- Hepatic Encephalopathy
Screening test for C Diff?
Enzyme Immunoassay for Glutamine Dehydrogenase Antigen - detects toxinogenic & non-toxinogenic organisms
Test for C Diff toxin?
Enzyme immunoassay for toxins A & B. High FN rate.
Problem with NAAT testing for C Diff?
Tests for genes specific to toxin. Does not test for active toxin production. I.e., detects carriers.
Criteria for severe C Diff?
WBC > 15 or Cr>=1.5
Criteria for fulminant C Diff?
Hypotension, ileus or megacolon
Treatment for initial, non-severe C Diff?
PO vanco 125 QID -or- fidaxomycin. Alternative is Flagyl.
Treatment for initial, severe C Diff
PO vanco 125 QID -or- fidoxamycin. Flagyl is not an option.
Treatment for initial, fulminant C Diff?
IV Flagyl + PO Vanco 500 TID. If ileus, consider PR vanco too.
