Gastrointestinal, Hepatic and Renal Emergencies
Core concepts
Cover the assessment and resuscitation of upper GI bleeding (two large-bore cannulas, crossmatch, restrictive transfusion strategy, early endoscopy, terlipressin and antibiotics in variceal bleeding). Understand acute pancreatitis diagnosis and severity scoring. Know the approach to the acute abdomen and the red flags of mesenteric ischaemia. For hepatic emergencies, recognise encephalopathy, spontaneous bacterial peritonitis, and paracetamol hepatotoxicity. For renal emergencies, distinguish pre-renal, renal, and post-renal acute kidney injury, and manage hyperkalaemia with the ECG-guided emergency sequence (calcium, insulin-dextrose, salbutamol, removal).
Traps
Examiners test over-transfusion in variceal bleeding (raises portal pressure and rebleeding). In hyperkalaemia, calcium stabilises the myocardium but does not lower potassium - a classic distractor. In pancreatitis, amylase level does not correlate with severity. Beware attributing abdominal pain in the elderly to benign causes when mesenteric ischaemia (pain out of proportion) is possible.
Rule of thumb
For hyperkalaemia with ECG changes, give IV calcium first, then shift potassium intracellularly, then remove it from the body. For suspected variceal bleed, give antibiotics and a vasoactive agent before endoscopy.
Worked example
A 45-year-old with known cirrhosis presents with haematemesis and BP 90/60: resuscitate with blood products, start terlipressin and prophylactic antibiotics, and arrange urgent endoscopy - avoid aggressive crystalloid that worsens variceal bleeding.