Category Archives: Gastroenterology

Investigation of persistent diarrhoea

Article from one of last year’s BJGPs, summarising the BSG guidance on investigation of persistent diarrhoea, as updated in April 2018: Definition Types 5 – 7 on Bristol stool chart, with increased frequency, for >4 weeks, different from normal. Investigation … Continue reading

Posted in Credits 2020, Gastroenterology | Leave a comment

PEG tubes

The BMJ had an article on PEG tubes, which was useful as I have two patients with these in situ. Short version: refer problems to a specialist. Potential problems requiring referral Clogging, if not responding to flushing with 40 – … Continue reading

Posted in Credits 2019, Gastroenterology | Leave a comment

Constipation in children

Red flags Constipation from birth or within first few weeks Failure to pass meconium in first 48 hours Ribbon stools (more likely in <1 yr) Undiagnosed or new weakness in legs Motor delay Abdominal distension with vomiting, or gross abdominal … Continue reading

Posted in Gastroenterology, Paediatrics | Leave a comment

IBS – NICE guidelines

There’s a summary of these in the latest BMJ, much of which I already know, but here are a few notes on the bits I need some aide-memoires for: Diagnostic criteria Abdominal pain or discomfort which is: Relieved by defaecation … Continue reading

Posted in Credits 2015, Gastroenterology | Leave a comment

Diverticular disease/diverticulosis/diverticulitis

I thought diverticular disease and diverticulosis were synonyms, but in fact diverticular disease refers to symptomatic diverticula. Diverticulitis, obviously, refers to inflammation/infection. Symptoms of diverticular disease can include: Lower abdominal pain Altered bowel habit Bloating PR bleeding Diverticulitis usually presents … Continue reading

Posted in Gastroenterology, Surgery | Leave a comment

Random prescribing points

Statins: Fluvastatin, simvastatin and atorvastatin are predominantly lipid-soluble, whereas pravastatin and rosuvastatin are predominantly water-soluble. Therefore, if a patient gets SEs on a lipid-soluble statin, it’s worth trying water-soluble.   Remember that the cut-offs for stopping are liver enzymes >3x … Continue reading

Posted in BMJ, Cardiovascular, Credits 2013, Gastroenterology, Medication, Prescriber, Psychiatry | Leave a comment

Investigation of raised ALP

Physiological causes Normal variation – statistically, 2.5% of the population will have levels above the ULN. Analytical variation – combined analytical & biochemical variation is approx 8%. Levels increase by approx 6% if sample stored for 96 hrs at room … Continue reading

Posted in BMJ, Clinical biochemistry, Credits 2013, Gastroenterology, Liver, Liver | Leave a comment