What you need to know
For new patients admitted with suspected IBD (Crohns or UC)
GI Bleeds
Blood Tests: Daily FBC, U+E every other day for 5 days or until no bleeding.
Monitoring: Stool charts for all patients.
Acute Colitis
Stool Tests: Send for cultures, C. difficile toxin, and maintain stool charts.
Bloods: FBC, U+E, LFTs, CRP daily. Include Mg, Ca, and PO4 if major nutritional issues. For new patients pre biologic screen including TPMT.
Imaging: Erect CXR and AXR as needed to exclude toxic dilatation (consult SpR for frequency).
Refeeding Syndrome
Monitoring: Daily U+E, Ca, PO4, and Mg until stable.
Parenteral Nutrition: Daily monitoring (FBC, U+E, Mg, Ca, PO4, LFTs, CRP) if unstable, twice weekly once stable.
Commonly used drugs in gastroenterology reference guide (not for clinical use, please cross reference.)- by Dr Ben McCleod.
Post-ERCP
Monitoring: If pain-free and NEWS normal, no bloods required. If in pain, perform FBC, U+E, LFT, CRP, and amylase. Consider urgent CT (perforation) and surgical review.
Post-EUS/Other Therapies
If pain-free and mobilizing, no bloods required. If in pain or NEWS abnormal, manage like post-ERCP (omit amylase).
Gastroscopy/OGD
Fasting: Minimum 4 hours, ideally nil by mouth from midnight for morning lists or light breakfast for afternoon lists.
Urgency: Urgent requests should be delivered directly to the endoscopy unit and discussed with the endoscopy sister/nurse in charge.
Consent: Completed by the scoping clinician in the endoscopy department.
Colonoscopy
Bowel Prep: Moviprep (specific timing depending on morning/afternoon list). Stop ferrous sulfate 1-2 weeks before.
Antiplatelets/Anticoagulants: Check with seniors about stopping these drugs before the procedure if therapeutic interventions (e.g., polypectomy) are planned.
ERCP/EUS
Fasting: As per OGD guidelines.
Bloods: FBC, U+E, LFTs, clotting, and Group and Save.
Consent: Taken by SpR or consultant.
Antiplatelets/Anticoagulants: Stop 7 days before (except aspirin).
Intestinal Failure Patients
Key Notes: Do not handle central lines; only trained staff manage them to avoid infections.
Bloods on Admission: FBC, U+E, LFT, clotting, CRP, Mg, bone profile, B12, folate, and Vitamin D.
Monitoring: Fluid balance, electrolyte levels, and nutritional status. Address high stoma outputs with TPN adjustments, fluid restriction, and medications (e.g., loperamide, codeine, PPIs).
Liver Procedures
Bloods: FBC, U+E, LFTs, clotting, Group and Save.
Consent: Registrar or consultant only.
Pre-Procedure Management: Confirm antiplatelets/anticoagulants are stopped. Vitamin K, platelets, or FFP may be needed for coagulation support.
Specific Procedures:
Liver Biopsy: Consider plugged or transjugular biopsy if clotting is abnormal.
TACE/TIPSS: Requires antibiotics pre- and post-procedure, adequate hydration, and coagulation correction if needed.
UK Acute Upper GI Bleeding bundle https://www.bsg.org.uk/wp-content/uploads/2019/12/Fig-1-Summary-AUGIB-care-bundle.pdf
BSG Decompensated Cirrhosis Care Bundle video https://www.bsg.org.uk/clinical-resource/bsg-decompensated-cirrhosis-care-bundle/
Gastroenterology/Nutrition
BSG Investigation of Chronic Diarrhoea in adults:
https://www.bsg.org.uk/clinical-resource/guidelines-for-the-investigation-of-chronic-diarrhoea-in-adults-bsg-3rd-edition/
NICE guidance on Ulcerative Colitis https://www.nice.org.uk/guidance/ng130
A practical approach to the management of high-output stoma https://fg.bmj.com/content/5/3/203