Acute Upper and Lower Gastrointestinal Emergencies Flashcards
What is acute total dysphagia
Sudden complete dysphagia for solids and liquids
What is the commonest cause of acute total dysphagia
Bolus food impaction on a pre-existing lesion
What is the management for a patient with acute total dysphagia
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
What are the symptoms of an oesophageal rupture
Sudden severe chest pain after an obvious provoking cause
What are the causes of an oesophageal rupture
Endoscopy or other instrumentation
Chest trauma
Forceful severe vomiting
What are the investigations to confirm an oesophageal rupture
ECG and Cardiac enzymes Erect CXR CT scan chest and abdomen Serum amylase Gastrograffin swallow to confirm the location of the tear
What is the management of an oesophageal rupture
Analgesia
IV fluids
NBM
Urgent surgical opinion
If there is a large tear in the oeosophagus, what should be done
IV antibiotic - metronidazole
Early surgical repair
Enteral nutition - jejunal feeding tube
If there is just a small tear in the oesophagus, what should be done
Conservative management
What is the management of acute diarrhoea
Fluid replacement
When are antibiotics indicated in acute diarrhoea
in certain patient groups and in epidemic diarrhoea to control the spread of the infection
Why are antidiarrhoeal agents best avoided
They may prolong carriage of the organism
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
Adhesional obstruction of the small bowel
What is the pain like in a strangulated obstruction
Severe,
localised
unremitting pain
Where does the pain tend to be from colonic obstruction
Peri-umbilically and in the hypogastrium
If bowel sounds are absent, what does this suggest
Obstruction
What is the most useful investigation to determine the site and cause of the obstruction
Abdominal CT scan
In terms of ABGs, what does severe vomiting cause
Metabolic alkalosis
What is the treatment for strangulation
Surgery
How is an obstruction monitored
Nasogastric aspirate
urine output
electrolyte status
hydration status
What is the management for a paralytic ileus
Stop provoking drugs and minimise opiate analgesia
Consider parenteral nutrition if prolonged
What is the management for intusussception
Diagnosis is often established by US
Barium or gastrograffin meal may be therapeutic in reducing intussusception
What is the management for Meckel’s diverticulum
Treat surgically
What is the treatment for a volvulus
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
What is the priority in the case of a swallowed foreign body
Safeguard the airway
If the foreign body gets passed the pylorus, how is the foreign body dealt with
it usually passes through the anus
What is the management of foreign bodies
Reassure the patient
Perform CXR and AXR to confirm nature and quantity of ingested item
