GI CASES & PANCREATITIS

As you can see, there is a lot of overlap with common surgical GI problems. Gastro-oesophageal reflux disease is very common too. Crohn's and UC also crop up very frequently. Pancreatitis is a very commonly tested topic along with its Glasgow Scoring system and mnemonic PANCREAS:



Mnemonic --> CriteriaPositive when: 
​ P - PaO2 <60 mmHg 
 A Age >55 years 
 N Neutrophils (white blood cell count) >15x109/l 
 C Calcium <2 mmol/l 
 R Raised urea >16 mmol/l 
 E Enzyme (lactate dehydrogenase (LDH)) >600 units/l 
 A Albumin <32 g/l 
 S Sugar (glucose) >10 mmol/l 

The use of drugs like PPI's, lactulose, rifaximin, octreotide, cyclosporin, alverine, hysocine butylbromide, magnesium, albumin and tranexamic acid/octoplex/vitamin K are common. Why?


Case:
You get called to attend to a patient on the GI ward who has become very unwell. MEWS score >7. HR 115, BP 88/30, RR28, Sats 93% on NRM15L, alert and tired, but orientated. They have bruising around their flank areas bilaterally and they look unwell. She has yellow sclera. She has a swollen abdomen and is also pyrexic at 38.5c. She is tender on examination globally in the abdomen but particularly in the epigastric region. You note a 100ml bag of saline which is tinted clear yellow with a medication being administered IV.


1. What are the signs in the abdomen and what do they mean?
2. What is the likely diagnosis in this patient? You can also name some differentials if you like.
3.  What medication is being given IV?
4. What is the likely cause of the tachycardia and low BP?
5. What are your initial actions/investigations?
6. Why is calcium low in this condition?
7. What would escalation in care of this patient involve?