Gastroenterological emergencies

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1. Adult patients (aged 16 years or over)
1. Abdominal pain (adult)
2. Cirrhosis (suspected or known) (adult)
3. Concern for colorectal cancer (rectal bleeding or positive Faecal Occult Blood Test) (adult)
4. Gastrostomy feeding tube problems with blocked or displaced gastrostomy in patients with nil oral route for nutrition or hydration
5. Hepatocellular cancer (suspected or known) or liver lesion (adult)
6. Inflammatory bowel disease or irritable bowel syndrome (suspected or known)
7. Iron deficiency
8. Liver dysfunction
9. Upper gastrointestinal dysfunction
2. Paediatric patients (aged 0 to 15 years)
1. Abdominal pain (paediatric)
2. Altered bowel habit (paediatric)
3. Coeliac disease (paediatric)
4. Fever in post-liver transplant or other immune suppressed patients
5. Gastrointestinal bleeding (paediatric)
6. Inflammatory bowel disease (suspected or known) (paediatric)
7. Liver dysfunction (paediatric)
8. Nutritional and weight concerns (paediatric)
9. Upper gastrointestinal dysfunction (paediatric)

Adult patients (aged 16 years or over)

Abdominal pain (adult)

• Acute severe colitis (for example, Crohn’s disease, ulcerative colitis or infectious) > 6 bloody bowel stools per 24 hours with any of the following:
• temperature > 37.8°C
• pulse rate > 90 bpm
• haemoglobin < 105 g/L
• severe abdominal pain
• suspected abscess, perforation or megacolon
• Acute surgical syndrome suspected by symptoms of shock, sepsis or severe abdominal pain with signs suggestive of acute abdomen or jaundice.

Cirrhosis (suspected or known) (adult)

• Cholangitis (pain, fever and jaundice).
• Cirrhosis with acute clinical decompensation event (for example, encephalopathy, gastrointestinal bleeding or new onset ascites, especially if with pain, fever or other systemic symptoms).
• Liver failure (bilirubin > 100, INR > 2.0) with clinical signs of decompensation.

Concern for colorectal cancer (rectal bleeding or positive Faecal Occult Blood Test) (adult)

Melaena or haematochezia, haematemesis or vomiting in large volume or with haemodynamic compromise.

Gastrostomy feeding tube problems with blocked or displaced gastrostomy in patients with nil oral route for nutrition or hydration

Gastrostomy feeding tube problems with blocked or displaced gastrostomy in patients with nil oral route for nutrition or hydration.

Hepatocellular cancer (suspected or known) or liver lesion (adult)

Nil emergency criteria.

Inflammatory bowel disease or irritable bowel syndrome (suspected or known)

• Suspected or known inflammatory bowel disease with concern for severe or complicated colitis (perforation, toxic mega colon, abscess, bowel obstruction) indicated by:
• fever
• tachycardia
• hypotension
• significant abdominal pain or peritonism
• abscess (abdominal or perianal)
• acute severe colitis: > 6 bloody bowel motions per 24 hours with at least one of the following:
• temperature > 37.8°C
• pulse rate > 90 bpm
• haemoglobin < 105 gm/L
• raised inflammatory markers (erythrocyte sedimentation rate (ESR) > 30 mm/hr or C-reactive protein (CRP) > 30 mg/L)
• Suspected or known inflammatory bowel disease with symptoms suggestive of severe flare of known inflammatory bowel disease accompanied by fever, haemodynamic compromise, significant abdominal pain, suspected megacolon, perforation, bowel obstruction and/or abscess and unable to be controlled in the community.

Iron deficiency

Melaena or haematochezia, haematemesis or vomiting in large volume or with haemodynamic compromise.

Liver dysfunction

Liver failure (bilirubin > 100, INR > 2.0) with clinical signs of decompensation.

Upper gastrointestinal dysfunction

Dysphagia with inability to tolerate oral intake.

Paediatric patients (aged 0 to 15 years)

Abdominal pain (paediatric)

• Acute, severe abdominal pain for surgical review:
• peritonitis, infarction or obstruction (for example, rigid abdomen, guarding, pain out of proportion to clinical signs)
• suspected bowel obstruction – bilious vomiting, significant distention, lack of passage of flatus
• suspected ectopic pregnancy, ovarian torsion, or testicular torsion
• suspected appendicitis
• acute inflammatory condition with systemic signs of sepsis requiring intravenous antibiotics, urosepsis, gynaecological sepsis, cholecystitis
• abdominal pain associated with acutely irreducible hernia
• Shock or sepsis.

Altered bowel habit (paediatric)

• Acute severe colitis (> 6 bloody bowel motions per 24 hours).
• Dehydration unable to be managed at home.
• Suspected bowel obstruction – bilious vomiting, significant distention, lack of passage of flatus, obstipation.

Coeliac disease (paediatric)

Nil emergency criteria.

Fever in post-liver transplant or other immune suppressed patients

Fever in post-liver transplant or other immune suppressed patients (for example, inflammatory bowel disease on biologics, immunomodulators, steroids, anti-rejection medications).

Gastrointestinal bleeding (paediatric)

• Acute haematemesis or melaena.
• Acute lower gastrointestinal bleeding in large volume or with haemodynamic compromise.

Inflammatory bowel disease (suspected or known) (paediatric)

• Suspected or known inflammatory bowel disease with severe abdominal pain and/or bloody diarrhoea, and any of the following features:
• fever
• haemodynamic compromise
• suspected megacolon
• suspected bowel perforation
• bowel obstruction
• abscess (abdominal or perianal)
• haemoglobin < 90 g/L.

Liver dysfunction (paediatric)

• Acute liver failure (for example, INR > 1.5 and encephalopathy or INR > 2, in the absence of pre-existing liver disease).
• Acute paracetamol toxicity: referral to paediatrician is indicated if no liver synthetic dysfunction..
• Chronic liver failure with fever or sepsis.
• Jaundice with confusion.
• Newborn with persistent (> 6 weeks), severe, recurrent unconjugated hyperbilirubinemia (despite phototherapy): phone on-call gastroenterologist for advice..
• Post-transplant jaundice with fever or sepsis.
• Sudden onset, obstructive jaundice.

Nutritional and weight concerns (paediatric)

Acute onset vomiting and/or diarrhoea in the context of dehydration unable to be managed hydration at home and/or electrolyte disturbances.

Upper gastrointestinal dysfunction (paediatric)

• Caustic ingestion.
• Dysphagia with obstruction from food.
• Suspected or known oesophageal foreign body (especially button battery or > 1 magnet).