After 9 days off it was back to work for me on Monday. I knew that colorectal was on-call at the weekend and therefore our UGI list wouldn’t be too bad.

Having said that the colorectal consultant on-call doesn’t do any UGI related problems and therefore when I arrived on Monday morning 9 referrals were waiting for me requesting to take over patients.

In addition to this I haven’t met the new F1’s yet and luckily I had two of the three working with me. Both seems very well organised. Our registrars were in theatres sorting out our elective patients and therefore the referrals had to wait until the afternoon to be seen by us. They get seen by the outgoing on-call team anyway so its not that they wouldn’t have a surgical review on that day.

I did add the elective patients to our list in the morning and after the ward round sorted out their medication and/or discharges.

The patient with the MND is still with us and nothing has really happened so far. On Monday the palliative consultant spoke to the patient and wanted to know the wishes going forward. However, the questions regarding the PEG couldn’t be answered as this wasn’t her area of expertise. She left the ball on the Nutrition team’s court to answer all of that.

We also did a Neurology referral to find out the prognosis and if the PEG is in the patient’s best interest.

It looks like the meeting is tomorrow and all “major players” (Nutrition team, Neurology, Palliative, patient and family) will be there to discuss the next steps. My gut instinct tells me we are going ahead with the liver cyst drain and then a PEG or RIG therefore I have arrange the relevant blood tests for tomorrow morning.

Let’s see and wait what the decision is.

We took over all the colorectal referrals and some of them are pretty bad pancreatitis. Two in particular needing NJT insertions and feeding regimes and referrals to Endocrinology due to their high Capillary Blood Glucose (CBG) readings and subsequent high ketones. Suddenly you are not “just” worrying about pancreatitis but also DKA – diabetic ketoacidosis – potentially fatal if not treated.

The endocrinology team review the patients and gave us some advice on how to treat them and we implemented their plans.

Our elective bariatric patients needed to be sorted with their regular medication and to start their post bariatric medication: Vitamins & Minerals, PPI, Enoxaparin (at least for 7 days) and Urso (it’s short for ursodeoxycholic acid as it’s bad enough to write is when you can read the drug) for 6 month.

We know that patients – who had bariatric surgery – suffer from potential formation of gallstones (if they not already have them). Urso is trying to prevent the formation of them therefore we have incorporated them in our bariatric protocol.

Post surgery they either look great and they are ready to go home the following day OR they look “like shit” and struggled over night with fluid intake, emesis and sometimes look pale. Luckily the latter are not that common.

A patient who needed a duodenal stent was admitted last week after an UGI MDT discussion. The patient has gastric outlet obstruction due to pancreatic cancer and to ensure the best quality of life a stent might be the best choice.

That happened earlier however the placement of the stent did not happen due to some unexpected findings during the gastroscopy and therefore we will have to have an intense discussion with the patient and the family tomorrow which won’t be easy.

Tough week so far: necrotising pancreatitis patient’s relatively poorly, a pancreatic cancer patient at the end of the road and a specialist Nurse who isn’t the easiest to deal with (more of that in the future)

So, awaiting tomorrow’s MND meeting outcome will be “exciting” as we can finally move forward with the patient as it’s not fair to them and the family.