BUMC Basics.pdf - Anesthesia Home

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hepatitis, obesity), then they probably don’t have acute
liver failure; they have decompensated cirrhosis.
GENERAL GASTROENTEROLOGY
C. difficile
• Only one test is indicated: C diff toxin in stool
• The test may sometimes take > 24 hours to return, so
consider empiric treatment with oral Flagyl or Vancomycin
• If a patient is really sick, it is best to start directly with
Oral Vancomycin (pill or suspension): 125 mg po QID;
Otherwise, can use oral flagyl. DO NOT use IV
Vancomycin for C. difficile.
• Always consider C. difficile if unexplained leukocytosis
and diarrhea. Diarrhea is not always present, in fact in
severe C. difficile they may get a dilated colon with ileus,
so consider checking a KUB. If colon is dilated then make
sure GI is following and consider surgical consultation
(Colorectal or general)
Cholangitis
If you suspect a patient has cholangitis, then it is best to call a
gastroenterologist who does ERCP. Cholangitis is an indication
for urgent ERCP. Cholangitis should be suspected if a patient
has symptoms of Charcot’s triad:
1. Fever
2. RUQ pain
3. Jaundice
The patient may also have hypotension and altered mental
status which gives them all five of Reynold’s pentad. Patients
can sometimes just present with vague upper abdominal pain
and elevated transaminases. Always check a right upper
quadrant ultrasound.
Colonoscopy Prep
Nulytely 4 liters- 8 oz PO Q 10-15 minutes until gone. We
usually start this at about 5 p.m. on the day before a planned
colonoscopy. NPO except meds after midnight. Write generous
PRN orders for anti-emetics such as Zofran, Phenergan,