Abdominal Emergencies

Question 1

Common laboratory tests ordered for abdo pain

Answer 1

FBE, WCC
CRP
Amylase
Lipase
Liver function tests

Question 2

Bio maker for acute pancreatitis

Answer 2

Lipase - rises to a greater extent and remains elevated for longer thank amylase. Both enzymes are elevated to at least 3 times their normal value
Both amylase and lipase are produced by acinar cells of the pancreas
An elevated crp is suggestive of severe disease

Question 3

Suspected GI bleeding

Answer 3

NBM
NG tube - this will rest the gut, reduce additional pressure in the stomach, and reduce the likelihood of vomiting
IVT
Strict fluid balance

Question 4

Pancreatitis

Answer 4

Characterised by acinar cell damage that leads to necrosis, oedema and inflammation

Question 5

Risk factors for pancreatitis

Answer 5

Gallstones (obstructive biliary tract disease- cholelithiasis)
ETOH
Trauma
Drugs
Hypercalemia and hyperlipidemia

Question 6

Manifestations of acute pancreatitis

Answer 6

Epigastric to mid abdominal discomfort to severe, incapacitating pain.
Pain may radiate to back
Nausea and vomiting
Fever
Jaundice can occur

Question 7

Goal of treatment in pancreatitis

Answer 7

Stop the process of autodigestion and prevent systemic complications.
Narcotics, NSAIDs and acetaminophen are used to relieve pain
Haemodynamic monitoring and parenteral fluids are essential to restore blood volume and prevent hypotension and shock.
NG suction maybe necessary to relieve pain and prevent paralytic ilieus for pts with nausea and vomiting. Feeding usually commences in 24-48hrs if ilieus not present

Question 8

Pancreatitis

Answer 8

Regardless of mechanism pancreatitis is characterised by acinar cell damage that leads to necrosis, oedema and inflammation.

Question 9

Liver cirrhosis diagnosis

Answer 9

Liver biopsy (gold standard)
Bloods - serum bilirubin
AST, ALT, ALP, GGT
Platelet count

Question 10

Treatment of liver cirrhosis

Answer 10

Prevent further damage by treating the underlying cause.
Stop ETOH
Anti virals for hepatitis
Liver transplant

Question 11

Causes of liver cirrhosis

Answer 11

Excessive ETOH
Prolonged viral attack - hep B,C

Question 12

Symptoms of cirrhosis

Answer 12

Jaundice
Ascites
Easy bruising
Hepatic encephalopathy
Dry skin/pruritus

Question 13

Investigations for Liver disease

Answer 13

Serology- hep a,b,c
Clotting: INR
LFT’s
Bilirubin
U&E’s, glucose, ABG, FBE, cultures
CXR, ECG, CT

Question 14

Complications of cirrhosis

Answer 14

Portal HTN
Variceal bleeding
Ascites
Spontaneous bacterial peritonitis
Hepatorenal syndrome
Hepatic encephalopathy

Question 15

Aetiology of pancreatitis

Answer 15

Gallstones and alcohol together make up 80% of all causes of pancreatitis

Question 16

Management of acute pancreatitis

Answer 16

Mild: early aggressive IV fluid isotonic crystalloid solution with in the first 12-24hrs
NBM until abdo pain and N & V stopped
Oral feeds once pain resolved and no N & V
Cholecystectomy in mild biliary pancreatitis
Severe: early aggressive IV fluid isotonic crystalloid 12-24 hrs
Persistent organ failure - management in ICU
Enteral feeding commenced early for nutritional support
ABs if indications of infection

Question 17

Assessment of aetiology of pancreatitis

Answer 17

Important for guiding management
Hx of ETOH, medications, hyperlipidaemia, trauma, recent ercp, and family Hx of pancreatitis
Abdo ultrasound to evaluate for cholelithiasis
Lab tests: liver enzymes, serum triglycerides and calcium levels

Question 18

Fluid resuscitation in pancreatitis

Answer 18

Hartmann - early aggressive fluid resuscitation reduces the risk and extent of pancreatic necrosis

Question 19

Lower GI bleed.

Answer 19

Occurs between upper oesophagus to the duodenum at the ligament of treitz
Bleeding is either visceral or non viceral

Question 20

Jaundice- in cirrhosis

Answer 20

Increase in bilirubin in the blood

Question 21

Ascites

Answer 21

Accumulation of fluid in the peritoneal cavity. Higher portal vein pressures pushes fluids into tissues like the peritoneal cavity