20220902 nupbridg gastro abdo

Case 1 ascites
Fluid thrill - flick with finger
Mention bag and fluid.
Liver case check flap cos if Asterixis refer a&e need icu
After abdo, sit up check lymph nodes listen to lungs
Alcohol
Tattoos hep c. Malignancy . Rule out rrt.
 
If cirrhosis can give spironilactone25 to 50mg (block aldosterone). Frusemide is to balance out
hyperkalaemia 20mg. Low salt diet. No fluid restriction unless hyponatremia Below 125.
 
mild ascites not symptomatic no need A&E. Can start diuretics recheck renal function 1week.
 
Fibroscan - indeterminate or F2 refer gastro
 
 
Raised GGT. Check alp. scan liver for gallstones, fatty liver. Alcohol. Trend once more explain
nonspecific then give red flag liver advice.
 
Alp can be vit d and CKD related.
 
anaemia - can scope for atrophic gastritis, gastric cancer. If intestinal metaplasia repeat scope 2 to 3
years.
 
Omeprazole
Ppi in elderly can keep.
Dyspepsia give tapering. BD for 2week, om 4 to 6 weeks.