Discover and read the best of Twitter Threads about #gastrotwearls

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A 4๏ธโƒฃ tweet guide on investigating and managing:

๐Ÿฉธ๐—œ๐—ฟ๐—ผ๐—ป ๐—ฑ๐—ฒ๐—ณ๐—ถ๐—ฐ๐—ถ๐—ฒ๐—ป๐—ฐ๐˜† ๐—ฎ๐—ป๐—ฎ๐—ฒ๐—บ๐—ถ๐—ฎ (IDA)

for GPs & non-Gastroenterology colleagues.

Defined as:

โฌ‡๏ธ๐ŸฉธHaemoglobin levels
(based on your local laboratory reference range)
cฬ… โฌ‡๏ธ MCV / MCH

#GastroTwearls 1/
Check:
๐Ÿ’‰Haematinics
โ—๏ธCoeliac Ab (3-5% of IDA)
๐Ÿ”treat โฌ‡๏ธ B12/ folate
โŒ no need for FIT

โœ… Confirm IDA
โฌ‡๏ธ ferritin or
โฌ‡๏ธ transferrin sats or
โฌ†๏ธ TIBC ๐˜ข๐˜ฏ๐˜ฅ โฌ‡๏ธ iron or
โฌ‡๏ธ CHr or
โ‰ฅ 10 g/L โฌ†๏ธ Hb cฬ… 2/52 iron

โŒ โฌ‡๏ธ iron ๐˜ข๐˜ญ๐˜ฐ๐˜ฏ๐˜ฆ (?anaemia of chronic disease)

#GastroTwearls 2/
โ˜‘๏ธ Confirmed IDA

โš’Start ๐—ข๐—ก๐—˜ iron tablet daily

๐ŸฉธAsk if bleeding from:

๐Ÿ‘ƒ๐ŸฝNose, refer ๐Ÿ”œ ENT
๐Ÿ—ฃHaemoptysis ๐Ÿ”œ Resp
๐Ÿ’งHaematuria (+ve dip) ๐Ÿ”œ Urology

๐ŸฉฒHeavy PV bleeding (ask if clots/ flooding) in menstruating ๐Ÿ‘ฉ๐Ÿป
or
๐ŸฉฒPV bleeding in menopausal ๐Ÿ‘ฉ๐Ÿผโ€๐Ÿฆฐ
๐Ÿ”œ Gynae

#GastroTwearls 3/
Read 6 tweets
I have vetted ~3๏ธโƒฃ0๏ธโƒฃ0๏ธโƒฃ referrals from primary care to Gastroenterology in last 2/52.

Pathways vary around the country - nevertheless I have observations / advice about managing common GI problems in primary care & when to refer in 7๏ธโƒฃ tweets

#GastroTwearls 1/7
Simple GORD does not need an OGD. This is as per national guidance as OGDs arenโ€™t pleasant & rarely changes management.

See #GastroTwearl๐Ÿ‘‡๐Ÿผ

When giving a PPI, Omeprazole is better than Lansoprazole (fewer SEs) - give a decent dose of 40 mg / day

2/7
Constipation is really common & poorly recognised. Often a symptom of IBS.

Opioids are a major culprit and cause much misery - give concomitant laxatives.

See #GastroTwearl below for a 4๏ธโƒฃ tweet guide.

3/7
Read 8 tweets
A 4๏ธโƒฃ tweet guide on investigating and managing:

๐Ÿฉธ๐—œ๐—ฟ๐—ผ๐—ป ๐—ฑ๐—ฒ๐—ณ๐—ถ๐—ฐ๐—ถ๐—ฒ๐—ป๐—ฐ๐˜† ๐—ฎ๐—ป๐—ฎ๐—ฒ๐—บ๐—ถ๐—ฎ (IDA)

for GPs and non-Gastroenterology colleagues.

Defined as:

๐ŸฉธHaemoglobin levels
๐Ÿ™Ž๐Ÿปโ€โ™‚๏ธ< 110 g/L
๐Ÿ™๐Ÿผโ€โ™€๏ธ< 100 g/L
with โฌ‡๏ธ MCV / MCH

#GastroTwearls 1/
New anaemia case:

๐Ÿ’‰Check haematinics
โ—๏ธDonโ€™t forget coeliac screen

Confirm IDA:
โœ… โฌ‡๏ธ ferritin or
โœ… โฌ‡๏ธ transferrin sats or
โœ… โฌ†๏ธ TIBC & โฌ‡๏ธ iron ๐˜ต๐˜ฐ๐˜จ๐˜ฆ๐˜ต๐˜ฉ๐˜ฆ๐˜ณ

โŒ ๐˜ฏ๐˜ฐ๐˜ต โฌ‡๏ธ serum iron alone (can be anaemia of chronic disease)

๐Ÿ”Correct โฌ‡๏ธ B12 / folate

#GastroTwearls 2/
โ˜‘๏ธ When confirmed IDA

โš’Start ๐—ข๐—ก๐—˜ iron tablet daily

๐ŸฉธAsk if bleeding from:

๐Ÿ‘ƒ๐ŸฝNose, refer ๐Ÿ”œ ENT
๐Ÿ—ฃHaemoptysis, ๐Ÿ”œ Resp
๐Ÿ’งHaematuria, ๐Ÿ”œ Urology

๐ŸฉฒHeavy PV bleeding in menstruating ๐Ÿ‘ฉ๐Ÿป(ask about clots / flooding) or
๐ŸฉฒPV bleeding in menopausal ๐Ÿ‘ฉ๐Ÿผโ€๐Ÿฆฐ
๐Ÿ”œ Gynae

#GastroTwearls 3/
Read 4 tweets

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