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Gastrointestinal > Gastrointestinal Emergencies > Flashcards

Gastrointestinal Emergencies Flashcards

1
Q

What is peritonitis?

A

Inflammation of the serosal membrane that lines the abdominal cavity

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2
Q

Types of peritonitis

A
  • Primary: spontaneous + not as a result of pathology in another organ
  • Secondary: breakdown of the peritoneal membranes leading to foreign substances entering cavity
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3
Q

What is the peritoneal cavity?

A

Space between the visceral + parietal layers of peritoneum

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4
Q

What are the subdivisions of the peritoneal cavity?

A

Greater sac
Lesser sac

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5
Q

What is spontaneous bacterial peritonitis?

A
  • Primary peritonitis
  • Infection of asitic fluid that cannot be attributed to any intra-abdominal, ongoing inflammatory or surgically correctable condition
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6
Q

Presentation of spontaneous bacterial peritonitis

A

Variable
Abdominal pain
Fever
Vomiting

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7
Q

Investigation of spontaneous bacterial peritonitis

A

Aspirating ascitic fluid
Neutrophil count >250 cells/mm3

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8
Q

Bacterial causes of secondary peritonitis

A
  • perforated peptic ulcer disease
  • perforated appendicitis
  • perforated diverticulitis
  • post surgery
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9
Q

Non bacterial causes of secondary peritonitis

A
  • tubal pregnancy that bleeds (ruptured ectopic pregnancy)
  • ovarian cyst
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10
Q

Clinical presentation of secondary peritonitis

A
  • abdominal pain
  • lie very still as movement makes pain worse
  • rebound tenderness
  • guarding (abdominal wall muscles tense when going to exam)
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11
Q

Treatment of secondary peritonitis

A
  • surgery: control infectious source
  • antibacterial therapy: eliminate bacteria
  • intensive care: maintain organ system function
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12
Q

What is a bowel obstruction?

A

Mechanical or functional problem that inhibits the normal movement of gut contents

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13
Q

Common causes of bowel obstructions in children vs adults

A

children:
- intussusception
- intestinal atresia

adults:
- adhesions
- incarcerated hernias

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14
Q

What is intussusception?

A

When one part of the gut tube telescopes into an adjacent section

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15
Q

Clinical presentation of intussusception

A

Adnominal pain
Vomiting
Haematochezia (fresh red rectal bleeding)

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16
Q

Treatment of intussusception

A

Air enema (reverses telescoping)
Surgery

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17
Q

What is haematochezia?

A

Fresh red rectal bleeding

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18
Q

Causes of small bowel obstruction

A
  • intra abdominal adhesions
  • hernias
  • Crohn’s disease
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19
Q

What are intra-abdominal adhesions?

A

Abnormal fibrous bands between organs, tissues or both in abdominal cavity that are normally separate

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20
Q

Clinical presentation of small bowel obstruction

A
  • nausea + vomiting (bilious) (early on)
  • abdominal colicky pain + distension
  • absolute constipation (later on)
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21
Q

What is colicky pain?

A

Comes + goes in waves
**»

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22
Q

Diagnosis of small bowel obstructions

A
  • History
  • Physical exam: abdominal distension, presence of hernias, high pitched tinkling bowel sounds
  • Imaging
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23
Q

Who does large bowel obstruction more commonly occur in?

A

Older patients

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24
Q

Causes of large bowel obstructions

A

Colon cancer (most common)
Diverticular disease
Volvulus - sigmoid, caecal

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25
Q

What is a closed loop obstruction?

A

There is a complete obstruction distally and proximally in the given segment of the intestine

26
Q

Presentation of large bowel obstruction

A
  • symptoms appear gradually if cancer + abruptly with volvulus
  • change in bowel habit (constipation) (early)
  • abdominal distension
  • cramps abdominal pain
  • nausea + vomiting (late)
27
Q

Diagnosis of large bowel obstruction

A

History
Physical exam
Imaging

28
Q

what is a volvulus?

A

Part of the colon twists around its mesentery

29
Q

Where are volvulus most likely to occur?

A

Sigmoid colon
Then caecum

30
Q

What is a risk factor for volvulus?

A

High fibre diets

31
Q

Compare the symptoms of small and large bowel obstruction

A

Small:
- colicky pain more frequently
- vomiting occurs early
- constipation occurs later

Large:
- vomiting occurs later
- constipation occurs earlier

32
Q

What imaging is used to determine the cause of an obstruction?

A

CT

33
Q

What is acute mesenteric ischaemia?

A

Symptomatic reduction in blood supply to GI tract

34
Q

Who is acute mesenteric ischaemia more common in?

A

Females
History of peripheral vascular disease

35
Q

Types of acute mesenteric ischaemia

A

Arterial compromise:
- acute occlusion: arterial embolism in SMA or vasculitis
- non occlusive mesenteric ischaemia: low cardiac output

Venous compromise:
- mesenteric venous thrombosis

36
Q

Clinical presentation of acute mesenteric ischaemia

A
  • mainly in elderly patients with CV risk factors
  • abdominal pain (30mins after eating)
  • nausea + vomiting
  • pain often on left side
37
Q

Where is pain often located in acute mesenteric ischaemia?
Why?

A

Left sided
Blood supply to splenic flexure is most fragile
(Watershed area)

38
Q

Investigations of acute mesenteric ischaemia

A
  • blood tests: metabolic acidosis + increased lactate levels
  • erect chest X ray (check for perforation)
  • CT angiography
39
Q

Treatment of acute mesenteric ischaemia

A
  • resection of ischaemic bowel
  • thrombolysis/angioplasty
40
Q

Where are peptic ulcers most common?

A

D1

41
Q

Common site of gastric ulcers

A

Lesser curve
Antrum

42
Q

What could cause a major upper GI bleed?

A

Peptic ulceration
Varices

43
Q

What vessel is at risk of damage if a duodenal ulcers perforates?

A

Gastroduodenal artery

44
Q

Why do oesophageal varices form?

A

Portal hypertension

45
Q

What is the normal pressure in the portal vein?

A

5-10 mmHg

46
Q

Venous drainage of the oesophagus

A

Upper 2/3: oesophageal veins > azygous vein > SVC
Lower 1/3: left gastric vein > portal vein

47
Q

Treatment of oesophageal varices

A
  • Endoscopy + band ligation
  • Blood transfusion if bleeding
  • terlipressin: reduces portal venous pressure
48
Q

What is abdominal aortic aneurysm?

A

Permanent pathological dilation of the aorta with diameter >1/5 x the expected diameter

49
Q

What drug is used to treat variceal bleeds?

A

Terlipressin
Reduces portal venous pressure

50
Q

Location of most AAA

A

Below renal arteries

51
Q

How does AAA occur?

A
  • Degradation of the elastin + collagen in media layer of arterial wall
  • lumen gradually dilates
52
Q

risk factors of AAA

A

Male
Family history
Increase age
Smoking

53
Q

Clinical presentation of ruptured AAA

A
  • asymptomatic until rupture
  • abdominal pain radiating to back
  • pulsation abdominal mass
  • transient hypotension > syncope
54
Q

Diagnosis + investigation of AAA

A
  • physical exam: presence of pulsation abdominal mass
  • ultrasonography
  • CT
  • X- ray if calcified
55
Q

Treatment of AAA

A
  • smoking cessation
  • hypertension control
  • surveillance of AAA (>5.5cm refer to vascular surgeons)
  • endovascular repair
  • open surgical repair
56
Q

What are the surgical treatment of AAA?

A

Endovascular repair
Open surgical repair

57
Q

Outline endovascular repair of AAA

A

Relining the aorta using an endograft inserted through the femoral artery

58
Q

Outline open surgical repair of AAA

A
  • Clamp aorta
  • Open aneurysm (remove thrombus + debris)
  • Suture in synthetic graft to replace diseased segment
59
Q

Who is spontaneous bacterial peritonitis most commonly seen in?

A

Patients with end stage liver disease

60
Q

Causes of small bowel obstruction in children vs adults

A

children:
- intussuscpetion
- malrotation
- hernias
.
adults:
- adhesions
- hernias
- crohn’s strictures

61
Q

Causes of large bowel obstructions in children vs adults

A

children:
- Hirschsprung’s disease
.
adults:
- colon cancer
- diverticulitis
- volvulus

62
Q

What is Hirschprung’s disease

A
  • congential disorder of colon where there is a lack of myenteric + submucosal plexuses
  • parasympathetic neuroblasts fail to migrate from neural crest to distal colon > developmental failure of meissner + Auerbach plexuses
  • causing hypomobility + constipation

Gastrointestinal (28 decks)

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