Critical Care Scenarios Lightning rounds 53: GI Q&A with Elliot Tapper
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Jun 11, 2025 Elliot Tapper, a leading gastroenterologist and director of the cirrhosis program at the University of Michigan, dives deep into critical GI issues. He tackles constipation, framing it as 'gut failure' and offers effective laxative strategies. Elliot also sheds light on antiemetic alternatives to ondansetron and explains the nuances between MRCP and ERCP for cholangitis. Other highlights include his insights on managing ileus in the ICU and the importance of careful reassessment when using rectal tubes. A treasure trove of clinical pearls!
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Treat Constipation By Mechanism
- Assess constipation like heart failure: determine outlet obstruction, low preload, or low contractility to target therapy.
- Use glycerol suppositories or disimpaction for outlet issues, PEG (Miralax) for preload, and senna/bisacodyl for contractility.
Be Proactive With Opioid-Related Constipation
- Track bowel output and be proactive when starting constipating meds like opioids.
- Start scheduled senna or Miralax when initiating opioids rather than waiting for severe constipation.
Simple, Practical Antiemetic Ladder
- For general nausea start ondansetron and escalate to compazine, olanzapine, or metoclopramide if needed.
- Try sniffing isopropyl alcohol swabs as a rapid short-lived antiemetic alternative in acute settings.