Acute Upper and Lower Gastrointestinal Emergencies

Question 1

What is acute total dysphagia

Answer 1

Sudden complete dysphagia for solids and liquids

Question 2

What is the commonest cause of acute total dysphagia

Answer 2

Bolus food impaction on a pre-existing lesion

Question 3

What is the management for a patient with acute total dysphagia

Answer 3

Reassurance 
rehydration
endoscopic removal of obstruction
endoscopic dilatation of stricture if appropriate 
Treat aspiration pneumonia 
GIve advice about avoiding dysphagia 
Avoid fibrous foods 
Pentiful drinks 
PPI if stricture present

Question 4

What are the symptoms of an oesophageal rupture

Answer 4

Sudden severe chest pain after an obvious provoking cause

Question 5

What are the causes of an oesophageal rupture

Answer 5

Endoscopy or other instrumentation
Chest trauma
Forceful severe vomiting

Question 6

What are the investigations to confirm an oesophageal rupture

Answer 6

ECG and Cardiac enzymes 
Erect CXR 
CT scan chest and abdomen 
Serum amylase 
Gastrograffin swallow to confirm the location of the tear

Question 7

What is the management of an oesophageal rupture

Answer 7

Analgesia
IV fluids
NBM
Urgent surgical opinion

Question 8

If there is a large tear in the oeosophagus, what should be done

Answer 8

IV antibiotic - metronidazole
Early surgical repair
Enteral nutition - jejunal feeding tube

Question 9

If there is just a small tear in the oesophagus, what should be done

Answer 9

Conservative management

Question 10

What is the management of acute diarrhoea

Answer 10

Fluid replacement

Question 11

When are antibiotics indicated in acute diarrhoea

Answer 11

in certain patient groups and in epidemic diarrhoea to control the spread of the infection

Question 12

Why are antidiarrhoeal agents best avoided

Answer 12

They may prolong carriage of the organism

Question 13

What is the most likely diagnosis for a patient who has a past history of laparotomy and sudden onset of central abdominal pain and vomiting

Answer 13

Adhesional obstruction of the small bowel

Question 14

What is the pain like in a strangulated obstruction

Answer 14

Severe,
localised
unremitting pain

Question 15

Where does the pain tend to be from colonic obstruction

Answer 15

Peri-umbilically and in the hypogastrium

Question 16

If bowel sounds are absent, what does this suggest

Answer 16

Obstruction

Question 17

What is the most useful investigation to determine the site and cause of the obstruction

Answer 17

Abdominal CT scan

Question 18

In terms of ABGs, what does severe vomiting cause

Answer 18

Metabolic alkalosis

Question 19

What is the treatment for strangulation

Answer 19

Surgery

Question 20

How is an obstruction monitored

Answer 20

Nasogastric aspirate
urine output
electrolyte status
hydration status

Question 21

What is the management for a paralytic ileus

Answer 21

Stop provoking drugs and minimise opiate analgesia

Consider parenteral nutrition if prolonged

Question 22

What is the management for intusussception

Answer 22

Diagnosis is often established by US

Barium or gastrograffin meal may be therapeutic in reducing intussusception

Question 23

What is the management for Meckel’s diverticulum

Answer 23

Treat surgically

Question 24

What is the treatment for a volvulus

Answer 24

Sigmoid: deflate the gut is prefarable to surgery
Caecal: surgery as recurrence is common
Gastric: surgery to reduce the volvulus and repair diaphragmatic hatius that allows the gastric volvulus

Question 25

What is the priority in the case of a swallowed foreign body

Answer 25

Safeguard the airway

Question 26

If the foreign body gets passed the pylorus, how is the foreign body dealt with

Answer 26

it usually passes through the anus

Question 27

What is the management of foreign bodies

Answer 27

Reassure the patient

Perform CXR and AXR to confirm nature and quantity of ingested item