Gastroenterology S
Res
WARD
TPN CHARTING
1. When On-call during hours and afterhours:
• As above, however no afterhours or weekend responsibilities
• Handover with fellow each weekday (morning and afternoon)
3. Outpatient
‘SCH gastro’ calendar (Gupta)
IBD Pharmacopeia (SCH IBD Clinic):
Prednisone 1 mg/kg/day (max 40-50 mg /day) mane (for initial period, then wean) (?prophylaxis PPI / Vitamin D)
Budesonide 6-9 mg/day (3 mg tabs)
IV Steriods Hydrocortisone 2-4 mg/kg/day (q6h)
Sulphasalazine 50-75 mg/kg/day (up to 3-4 grams daily) (500 mg tab)
Mesasal 30-50 mg/kg/day (250 mg tab)
Salofalk granules (as for Mesasal) (500 mg and 1 g packs)
Olsalazine 30-50 mg/kg/day (250 mg cap/500 mg tab)
Metronidazole 10 mg/kg/dose, given bd, (max 1 gm daily)
Ciprofloxacin 20 mg/kg/day BD
Azathioprine Start 1 – 1.5 mg/kg/day - Increase to between 2 – 3 mg/kg/day (depending upon levels)
6-MP Start 1 – 1.5 mg/kg/day - Increase to around 2 mg/kg/day (depending upon levels)
Methotrexate 15 mg / m2 (max 25 mg) weekly sc
Tacrolimus 0.2 mg/kg/day in 2 divided doses p.o. (ongoing dose dependant on levels)
Cyclosporin 3-8 mg/kg/dose Q12H
Mycophenolate (MMF) 15 mg/kg/day
Consent:
Endoscopy:
- 1/10,000 risk of serious bleeding
- 1/10,000 risk of perforation
- Common: Sore throat, bloating, abdominal pain/ache
- Rare: Sepsis, acute pancreatitis
Colonoscopy:
- 1/2,000 risk of serious bleeding
- 1/2,000 risk of perforation
- Common: Abdominal bloating, abdominal pain, failure to complete the procedure (5%)
- Rare: Sepsis
Liver Biopsy (consent taken by radiologist)
Infliximab (for MDU purposes):
- “The known short term and long term risks of Infliximab have been discussed with me by a Paediatric Gastroenterologist’
To learn
WARD
- 8am: Update handover on P-drive and morning handover in L4
- WR: Med charts, chart IV fluids, Bloods/imaging
- TPN Rd: Bloods/charting
- MDU admissions
- DC summaries/referrals (outpatient registrar to hold resident pager for 1-2 hours/week)
- IBD clinic
TPN CHARTING
- Mon/Thur TPN round with consultant and sterile pharmacist
- Check bloods, then chart TPN (all patients except oncology & ICU)
- Bloods: FBC, EUC, LFT, CMP, Triglycerides, cholesterol, BSL
- daily bloods for first couple of days and then twice weekly
1. When On-call during hours and afterhours:
- WR
- CWR (notify relevant team members)
- IBD patients: Rachel
- home PN/ TOF: Cathy
- Dietitian (Kylie or Kate)
- UK/KO daily, AL/NG couple per week
- First on-call: consults, admissions, out of hospital calls (not outpatient), and ward issues during hours and afterhours
- IBD clinic +/- others
- Saturday WR
• As above, however no afterhours or weekend responsibilities
• Handover with fellow each weekday (morning and afternoon)
3. Outpatient
- clinics
- Take files to clinic (except IBD)
- Letters as per template
- Print and sign for Avi, email to rest
- phone and email enquiries
- d/w consultant via email
- print note/email > telephone queries folder + patient file
- cc Rachel Messenger (IBD), Cathy Clarkson (Home PN)
- Results folder (scan and email abnormal results to bosses)
- Hold resident pager for 1-2 hours/week for DC summaries
‘SCH gastro’ calendar (Gupta)
- Use ‘Internet explorer’> ‘webmail’ > ‘public folders’ icon (bottom left of screen) > Expand the ‘SESIAHS’ folder > ‘Sydney Children’s Hospital’ >‘SCH Gastroenterology’ > “SCH Gastro’ calendar
- add your approved leave
- ROSTER CHANGES ARE TO BE SENT TO BOTH THE HEAD OF DEPT AND DEPT SECRETARY
IBD Pharmacopeia (SCH IBD Clinic):
Prednisone 1 mg/kg/day (max 40-50 mg /day) mane (for initial period, then wean) (?prophylaxis PPI / Vitamin D)
Budesonide 6-9 mg/day (3 mg tabs)
IV Steriods Hydrocortisone 2-4 mg/kg/day (q6h)
Sulphasalazine 50-75 mg/kg/day (up to 3-4 grams daily) (500 mg tab)
Mesasal 30-50 mg/kg/day (250 mg tab)
Salofalk granules (as for Mesasal) (500 mg and 1 g packs)
Olsalazine 30-50 mg/kg/day (250 mg cap/500 mg tab)
Metronidazole 10 mg/kg/dose, given bd, (max 1 gm daily)
Ciprofloxacin 20 mg/kg/day BD
Azathioprine Start 1 – 1.5 mg/kg/day - Increase to between 2 – 3 mg/kg/day (depending upon levels)
6-MP Start 1 – 1.5 mg/kg/day - Increase to around 2 mg/kg/day (depending upon levels)
Methotrexate 15 mg / m2 (max 25 mg) weekly sc
Tacrolimus 0.2 mg/kg/day in 2 divided doses p.o. (ongoing dose dependant on levels)
Cyclosporin 3-8 mg/kg/dose Q12H
Mycophenolate (MMF) 15 mg/kg/day
Consent:
Endoscopy:
- 1/10,000 risk of serious bleeding
- 1/10,000 risk of perforation
- Common: Sore throat, bloating, abdominal pain/ache
- Rare: Sepsis, acute pancreatitis
Colonoscopy:
- 1/2,000 risk of serious bleeding
- 1/2,000 risk of perforation
- Common: Abdominal bloating, abdominal pain, failure to complete the procedure (5%)
- Rare: Sepsis
Liver Biopsy (consent taken by radiologist)
Infliximab (for MDU purposes):
- “The known short term and long term risks of Infliximab have been discussed with me by a Paediatric Gastroenterologist’
To learn
- IBD: Crohn's UC
- Motility
- GOR
- high res oesophageal (+antroduodenal/colonic/anorectal) manometry, ph monitoring, impedance
- TOF
- CF
- Nutrition
- Scope: indications, consent