Upper Gastrointestinal Bleed

In this episode the always excellent Dr Charlotte Peal guided us through the often dramatic world of Upper GI bleeds.

NICE guidelines? Yes, here they are.

Pre-Endoscopy risk assessment is with the Glasgow Blatchford Score.

Post is based on what you find on endoscopy and is through the Rockall Score (mortality and re-bleeding risk).

And here is the Take Visually for this episode:

Acute Abdomen

Mr Riad Hosein came down to discuss the Acute Abdomen and how to approach a patient with abdominal pain.  Red flags are discussed as well as how to differentiate the patient with a life threatening acute abdomen.

Some key points from the podcast:

  • 40% will have a final diagnosis of non-specific abdominal pain
  • 20% appendicitis
  • 20% gallstone disease
  • 20% other causes

(Patterson-Brown, S., The acute abdomen, in Principles and Practice of Surgery, e.a. OJ Garden, Editor. 2007, Churchill Livingstone: Edinburgh. p. 332-340, King KE, W.J., Abdominal Pain, in Rosens Emergency Medicine: Concepts and Clinical Practice, H.R. Marx JA, Walls RM, Editor. 2006, Mosby: Alibani. p. 1343-54).

Cochrane review stated that there is no evidence that opiates mask the signs of peritonism or lead to a delay in diagnosis (Lameris, W., et al., Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: diagnostic accuracy study. BMJ, 2009. 338(jun26_2): p. b2431-).

Here's the RCEM page on Abdominal Pain without shock