Disorders of Upper GI Flashcards
Causes of surgical upper abdominal pain
Peptic ulcer disease GORD Pancreatitis Biliary pathology Abdominal wall Vascular Large and small bowel
Causes of non surgical upper abdominal pain
Cardiac Gastroenterological Musculoskeletal Diabetes Dermatological
Investigation for upper abdominal pain
Chest and abdominal x ray
Rigler’s sign
Free intraperitoneal/subdiaphragmatic air
Perforation
Management for acute peritonitis
Pre-operative
- NG tube, nil by mouth and IV
- antibiotics
Operative
- identification of aetiology of peritonitis
- eradication of peritoneal source of contamination
- peritoneal lavage and drainage
Common sites of perforation
Anterior/superior surface of first part of duodenum or pylorus
-rarely on pre-pyloric antrum
Less frequently in stomach (lesser curvature, fundus)
Rarely found on posterior surface of first part of duodenum or stomach
Duodenal perforation 10x more frequent than gastric perforation
Acute ulcers in patients with no history in 25-30% cases
Perforation operation
Laparoscopic Omental patch
Acute pancreatitis severity assessment
Modified Glasgow criteria (alternative is Ranson’s criteria) P - PO2 < 8KPa A - age > 55 years N - WCC > 15 C - calcium < 2 mmol/L R - renal - urea > 16mmol/L E - enzymes - AST >200iu/L, LDH >600iu/L A - albumin <32g/L S - sugar >10mmol/L
Score of 3 or more within 48 hours onset suggest severe pancreatitis
CRP is independent predictor of severity
>200 suggest severe pancreatitis
Acute pancreatitis management
Fluid resuscitation (IV, urinary catheter)
Analgesia
Pancreatic rest (nutritional support if prolonged recovery)
Determination underlying cause
95% settle with conservative treatment
Surgery rarely required
Test to find gallstones
Ultrasound scan
Then MRCP
Then ERCP
CT bad at stones
Cholecystitis management
Conservative
IV antibiotics and fluid resuscitation
Pain relief
Until laparoscopic cholecystectomy
Structures needed to be identified and divided during a laparoscopic cholecystectomy
Cystic duct and cystic artery
