What do GI attendings get called in for during call emergencies?

[LFSdriver]

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I am curious what a GI attending would be called into the ER for when they are on call? (aka what are the major GI emergencies)

I had a relative with a one time GI bleed present to the ER, and the GI attending on call was called at home. He said he'd see him in the morning after the bleed settled. He was transfused a unit as well as some fluids. The bleeding had stopped by the time he got the ER. The following day he had a formal GI consult and a scope was arranged a couple of days later. Red cell tagged scan showed nothing which was ordered for very early the next morning.

And as I understand major GI bleeds would require a surgical consult instead of GI?

 

[drfunktacular]

The joke about GI is that if the patient is unstable they're too unstable to scope tonight, and if they're stable then they're stable enough to wait until tomorrow for scope.

If it's a cirrhotic with an upper GI bleed due to varices though, it really is an emergency that has to be addressed now, not later. Other things like bleeding from PUD or lower GI bleeding might be surgical issues depending on the underlying disease and patient status. Usually a GI will be involved in one way or another though.

Food bolus impaction is another one that may require the GI doc to come in at night.

 

[LFSdriver]

The joke about GI is that if the patient is unstable they're too unstable to scope tonight, and if they're stable then they're stable enough to wait until tomorrow for scope.

If it's a cirrhotic with an upper GI bleed due to varices though, it really is an emergency that has to be addressed now, not later. Other things like bleeding from PUD or lower GI bleeding might be surgical issues depending on the underlying disease and patient status. Usually a GI will be involved in one way or another though.

Food bolus impaction is another one that may require the GI doc to come in at night.

Cool thanks for the response!

What is the treatment for a food bolus impacted? Endoscopy to push it down?

 

[VCMM414]

Cool thanks for the response!

What is the treatment for a food bolus impacted? Endoscopy to push it down?

If small enough. Larger, more solid boluses may need to be cut and brought out piecemeal.

 

[Entgegen]

I am curious what a GI attending would be called into the ER for when they are on call? (aka what are the major GI emergencies)

Blown O-ring. Not pretty.

 

[aashiq]

I am curious what a GI attending would be called into the ER for when they are on call? (aka what are the major GI emergencies)

I had a relative with a one time GI bleed present to the ER, and the GI attending on call was called at home. He said he'd see him in the morning after the bleed settled. He was transfused a unit as well as some fluids. The bleeding had stopped by the time he got the ER. The following day he had a formal GI consult and a scope was arranged a couple of days later. Red cell tagged scan showed nothing which was ordered for very early the next morning.

And as I understand major GI bleeds would require a surgical consult instead of GI?

Bleeding and foreign bodies is thats about it. Not every major GI bleed would go to the surgeons

 

[Rendar5]

And as I understand major GI bleeds would require a surgical consult instead of GI?

In the GI bleeder who's exsanguinating in front of your eyes: From the ED perspective, you'd actually need both consultants, with surgery being the back-up in case GI can't provide a solution. Some institutions you'd also wake up the interventional radiologist. A lot is institution dependent.

 

[Meat Cookie]

Though uncommon, a disc battery in the esophagus will get you out of bed at night...leads rapidly to liquefactive necrosis.

 

[jabreal00]

As a practicing Gastroenterologist the times I've had to come in at night were for food bolus impactions. We often pull those out with Roth's nets. Sometimes they can be pushed down but that's after we've evaluated the esophagus distal to the impaction, otherwise pushing without knowing what's ahead can result in perforation. After 12 hours of meat impaction, the risk for perforation increases significantly. It's a GI emergency. Variceal bleeds will make me come in. For the advanced guys, ascending cholangitis from common bile duct obstruction.

If the ER calls with either of those three (food bolus impaction, variceal hemorrhage (active UGI bleed from PUD also) and cholangitis), there is no getting out of coming in.