Review of Gastroenterology liver disease .pdf
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Title: Review of Gastroenterology& liver disease
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Review of Gastroenterology
& liver disease
Prof A K M Musa
Symptoms Of GI System
• Nausea & vomiting
• Hematemesis & melaena
Upper GI endoscopy
• Common Causes
• Take a brief history and examine to assess severity.
• Ask about past GI bleeds;
• 1) dyspepsia/known ulcers;
• 2) known liver disease or oesophageal varices
• 3 ) dysphagia; vomiting; weight loss. –Carcinoma
• 4 ) History of drugs and alcohol use
• 5) . Is there serious comorbidity (bad prognosis), eg cardiovascular
disease, respiratory disease, hepatic or renal impairment, or
• Look for signs of chronic liver disease and do a PR to check for
melaena. Is the patient shocked? “Do you feel faint when you sit up?”
Also Peripherally shut down/cool and clammy; capillary refilling
(CR) time >2s—urine output < 1 . mL/kg/h.
• •GCS (tricky to assess in decompensated liver disease or signs of
• • Poor urine output, eg <25mL/h or <1 .mL/kg/h.
• • Tachycardic (pulse >100bpm, and JVP not raised).
• • Systolic BP <100mmHg; postural drop >20mmHg.
Management of Upper GI Bleeding
• Gain IV access with large-bore cannula × 2
• Check full blood count, routine biochemistry and coagulation screen; cross-match blood
• Perform hourly measurements of blood pressure, pulse and urine output; consider
central venous pressure monitoring in the high-dependency unit for severe bleeding
• Give IV crystalloids in patients with hypotension and tachycardia
• Transfuse with blood if blood pressure remains low and
patient is actively bleeding
• Organise endoscopy for diagnosis and treatment once patient is resuscitated
• Give 72-hr proton pump inhibitor IV infusion for bleeding peptic ulcer
• Consider surgery or interventional radiological intervention
(e.g. arterial embolisation) if bleeding recurs.