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Gastroentrology > 1 (E): Acute Abdomen, GI Bleeding > Flashcards

1 (E): Acute Abdomen, GI Bleeding Flashcards

1
Q

Define acute abdomen

A

Surgical emergency characterised by acute-onset abdominal pain and tenderness

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2
Q

Describe visceral pain

A

Diffuse pain - hard to localise

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3
Q

Describe parietal pain

A

More intense pain

Easier to localise

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4
Q

What are 3 differentials for epigastric pain

A
  1. Peptic Ulcer
  2. ACS
    3.
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5
Q

What are 2 differentials for left hypogastric pain

A
  1. Splenic rupture

2. Pneumonia

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6
Q

What are 6 differentials for left hypogastric pain

A
  1. Biliary Colic
  2. Acute cholecystitis
  3. Ascending cholangitis
  4. Hepatitis
  5. Liver abscess
  6. Pneumonia
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7
Q

What are 2 differentials for right lumbar pain

A
  1. Renal Colic

2. Pyelonephritis

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8
Q

What are 2 differentials for left lumbar pain

A
  1. Renal Colic

2. Pyelonephritis

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9
Q

What are 2 gender-independent cause of right iliac fossa pain

A
  1. Appendicitis

2. Inguinal hernia strangulation

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10
Q

What are 3 causes of RIF pain in a female

A
  1. Ecoptic
  2. Ovarian torsion
  3. PID
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11
Q

What is a cause of RIF in a male

A

Testicular Torsion

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12
Q

What are 3 causes of umbilical pain

A
  1. Acute mesenteric ischaemia
  2. Ruptured AAA
  3. Intestina obstruction
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13
Q

What are 2 causes of supra-pubic pain

A
  1. UTI

2. Retention

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14
Q

What is a gender-independent differential for LIF pain

A

Diverticulitis

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15
Q

Give 3 causes of LIF pain in females

A
  1. Ecoptic
  2. Ovarian torsion
  3. PID
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16
Q

Give a differential for LIF pain in a male

A

Testicular torsion

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17
Q

What does initial assessment of acute abdomen involve

A

A-E approach

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18
Q

What is the most common cause of upper GI bleeding

A

Peptic ulcer (50-70%)

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19
Q

What are 5 causes of upper GI bleeding

A 
Oeseophagitis
Gastroduodenal erosion
Malignancy 
Mallory-Weiss tear 
Oesophageal Varices 
AV malformation
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20
Q

What is an AV malformation causing upper GI bleeding called

A

Dieulafoy lesion

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21
Q

What are 3 risk factors for upper GI bleeds

A

NSAID
Corticosteroids
H.pylori

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22
Q

How does GI bleeds present

A

Haematemesis
Melena
Iron-deficiency anaemia

Acute:

  • Tachycardia
  • Hypotension = dizziness, LOC
  • Cold peripheries
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23
Q

How does bleeding from peptic ulcer present

A
  • Small amounts of bleeding

- Usually presents as iron-deficiency anaemia

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24
Q

When may a peptic ulcer cause massive haemorrhage

A

Posterior duodenal ulcer extends into gasproduodenal.a - present as massive haemorrhage and haematemesis

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25
Q

How will diffuse erosive gastritis present

A

Haematemesis and epigastric discomfort

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26
Q

What is diffuse gastric erosions

A

ulcer that extends through stomach wall

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27
Q

How may oeseophagitis present

A

Small volumes fresh blood streaked in vomit. Background of GORD

28
Q

How do mallory-weiss tears present clinically

A

Fresh blood on repeated vomiting. Typical history starts as vomits with no blood and then contains blood

29
Q

How do oesophageal varices present clinically

A

Large volumes of blood (teaspoons) haematemesis. Meleana

Haemodynamically compromised

30
Q

How will upper GI malignancies present

A

haematemesis

31
Q

What score is used prior to endoscopy to predict patients risk of requiring intervention

A

Glasgow-Blatchford score

: pre-endoscopy score used to predict patient’s need of intervention

32
Q

If individual has a glasgow blatchford of 0 what does it mean

A

Consider early discharge

33
Q

what is rockall score and what does it predict

A

Based on pre and post-endoscopy findings. It is used to predict an individuals risk of re-bleeding and death

34
Q

How are individuals with GI-bleed categorised

A
  1. Acute severe
  2. High-risk stable
  3. Low risk
35
Q

What are the 4-features of acute severe GI bleed

A
  1. HR >100
  2. BP <100
  3. Haematemesis
  4. Co-morbidities
36
Q

What are three steps in management for acute-severe GI bleed

A
  1. Resuscitate
  2. Inform GI Team
  3. Immediate endoscopy
37
Q

What are the 3 features of high-risk stable GI bleed

A
  1. HR >100
  2. Postural Hypotension
  3. Co-morbidities
38
Q

How should a high risk stable GI bleed be managed

A
  1. Resuscitate
  2. Inform GI team
  3. Endoscopy in 12h
39
Q

What are the 3 features of a low risk GI bleed

A
  1. <60
  2. Coffee ground vomiting
  3. CVS stable
40
Q

What is the management of low risk GI bleed

A

Add to routine endoscopy

41
Q

How soon should endoscopy be requested in the following

a. Acute severe
b. High-risk
c. Low-risk

A

a. Immediate
b. 12h
c. Routinely

42
Q

How should low-risk GI bleeds be managed

A

Oral Fluids
Observe for evidence re-bleed
PPI
Routine endoscopy

43
Q

What is the initial management of someone with high-risk bleed

A
  • A-E
  • IV Access: G&S, Cross-match
  • Resuscitation fluids
  • Platelet transfusion if <50
  • FFP if fibrinogen <1 or PTT > 1.5
  • Immediate OGD
44
Q

What is a mallory weiss tear

A

tear in oesophageal mucosa - often causing shearing of submucosal blood vessels

45
Q

What causes a mallory weiss tear

A

increase in oeseophageal luminal pressure: vomiting caused by alcoholism or bulimia

46
Q

How will mallory weiss tear present clinically

A

repeated vomiting, followed by an episode of Haematemesis which is usually self-limiting

47
Q

How is a mallory weiss tear investigated

A

OGD

48
Q

How is a mallory weiss tear managed

A

Conservatively

49
Q

What are oesophageal varices

A

dilation of porto-systemic veins secondary to portal HTN

50
Q

What causes oesophageal varices

A

portal HTN- often secondary to liver cirrhosis form alcoholic liver disease

51
Q

How will variceal haemorrhage present

A

teaspoons of blood

52
Q

Explain emergency management of oesophageal varices

A
  1. A-E
  2. Insert two IV large-bore cannulas, G+S, Cross-match
  3. Fluid resuscitation
  4. Terlipressin
  5. Prophylactic antibiotics (in cirrhosis patients)
  6. OGD and immediate endoscopic variceal band ligation

If large haemorrhage and EVBL is not an option:

  • Sengstaken-Blakemore tube
  • If both fail, transjugular intrahepatic porto-systemic shunt (TIPSS)
53
Q

What tube is used for large haemorrhage in oesophageal varices

A

Sengstaken-Blakemore Tube

54
Q

What is used for prophylaxis of oesophageal varices

A

Propanolol

Endoscopic Variceal Band Ligtation

55
Q

What are are lower GI haemorrhages also referred to as

A

Rectal Bleeding

56
Q

What are 6 causes of rectal bleeding

A
  1. Colorectal Cancer
  2. IBD
  3. Haemorrhoids
  4. Fissure in-ano
  5. Gastroenteritis
  6. Diverituclosis
57
Q

What does haematochezia indicate

A

Rectum or Colon

58
Q

What does dark red blood indicate

A

Proximal source

59
Q

What does Melena indicate

A

Upper GI Bleed

60
Q

How may an anal fissure present

A
  • Small amounts of bright red blood following defecation

- Painful defecation

61
Q

How may haemorrhoids present

A
  • Bright red blood on wiping
  • History of straining
  • May be pain on wiping
62
Q

What exam may be performed for rectal bleeding

A

Rectal Exam

63
Q

What 5 blood tests are ordered for rectal bleeding

A
  1. FBC
  2. LFT
  3. Group and Save, Cross-Match
  4. U+E
  5. Coagulation studies
64
Q

What is important about U+Es

A

High urea (30:1) - indicate upper GI Bleed

65
Q

What imaging may be performed

A

Sigmoidoscopy - Colonoscopy

CT

66
Q

Explain management of person with rectal bleed

A
  1. A-E
  2. Two large-bore IV cannulas
  3. Fluid resuscitation
    Majority settle - then investigate outpatient

If patient unstable may need injection adrenaline.

Gastroentrology (18 decks)

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