9. GI Emergencies Flashcards
What is peritonitis?
Inflammation of the serosal membrane that lines the abdominal cavity
How does peritonitis occur?
Peritoneal cavity usually sterile
Can happen spontaneously (primary) or by breakdown of peritoneal membranes leading to foreign substances entering cavity (secondary)
What is primary peritonitis?
Spontaneous bacterial peritonitis is an infection of ascitic fluid that cannot be attributed to any intra-abdominal, ongoing inflammatory, or surgically correctable condition
Most commonly seen in patients with end stage liver disease
What are the symptoms of primary peritonitis?
Abdominal pain, fever, vomiting
How is primary peritonitis diagnosed?
By aspirating ascitic fluid - neutrophil count >250 cells/mm^3
What is secondary peritonitis?
As a result of an inflammatory process in the peritoneal cavity secondary to inflammation, perforation or gangrene of an intra-abdominal or retroperitoneal structure
What are common causes of secondary bacterial peritonitis?
Peptic ulcer disease (perforated)
Appendicitis (perforated)
Diverticulitis (perforated)
Post surgery
What are some non bacterial causes of secondary peritonitis?
Tubal pregnancy that bleeds Ovarian cyst (ruptured)
What is the clinical presentation of peritonitis?
Abdominal pain
May come on gradually or acutely
Diffuse abdominal pain is common in perforated viscera
Patients often lie very still
What are the treatment approaches for peritonitis?
Control the infectious source - surgery
Eliminate bacteria and toxins - antibacterial therapy
Maintain organ system function - intensive care
What is a bowel obstruction?
Is a mechanical or functional problem that inhibits the normal movement of gut contents
Can affect large and small intestine
What are the common causes of bowel obstruction in children?
Intussusception
Intestinal atresia
What are some common causes of bowel obstruction in adults?
Adhesions
Incarcerated hernias
What is intussusception?
When one part of the gut tube telescopes into an adjacent section
Can extend quite far
When lymphatic and venous drainage is impaired, you get oedema which can lead to infarction
What are possible lead points in intussusception?
Meckel’s diverticulum
Enlarged lymph node
What is the classical presentation of intussusception?
Abdominal pain
Vomiting
Haematochezia
What is the treatment for intussusception?
Air enema
Surgery
What can cause small bowel obstruction?
Intra-abdominal adhesions
Hernias - incarcerated groin hernias most common
Crohn’s - repeated episodes of inflammation/healing causes narrowing
What are the symptoms of small bowel obstruction?
Nausea and vomiting (bilious) - early
Abdominal distension, absolute constipation - late
What are adhesions?
Abnormal fibrous bands between organs or tissues or both in the abdominal cavity that are normal separated
Greater omentum involved in 80%, bowel in 50%
How is small bowel obstruction diagnosed?
History - intermittent abdominal pain (3-5mins), cramps
Physical examination - abdominal distension, increased/absent bowel sounds, presence of hernia
Imaging - central position of bowel, bowel distension >3cm
What are the common causes of large bowel obstruction?
Colon cancer
Diverticular disease
Volvulus - sigmoid, Caesar
What are the symptoms of large bowel obstruction?
Often appear gradually if caused by cancer but abrupt with volvulus Change in bowel habit (cancer) Abdominal distension Cramps abdominal pain Nausea/vomiting
What is a volvulus?
Part of colon twists around its mesentery
Most common in sigmoid colon and cecum
Results in obstruction
Can result from overloaded sigmoid colon (constipation)
Caecal volvulus results in small and large bowel obstruction
