Gastrointestinal Emergencies

Question 1

What is the peritoneal cavity?

Answer 1

The space between the visceral and parietal layers of the peritoneum

Question 2

What is found in the peritoneal cavity?

Answer 2

A small amount of fluid

Question 3

What is primary peritonitis?

Answer 3

An infection of ascitic fluid

Question 4

How would primary peritonitis be diagnosed?

Answer 4

Aspiration of ascitic fluid with high neutrophil count

Question 5

What is secondary peritonitis?

Answer 5

Inflammation in the peritoneal cavity secondary to infection, inflammation or perforation of abdominal structure

Question 6

What are some causes of secondary peritonitis from ruptured viscera?

Answer 6

Appendicitis (perforated), peptic ulcer disease (perforation), diverticulitis (perforation)

Question 7

What are some none bacterial causes of secondary peritonitis?

Answer 7

Ectopic pregnancy rupture, ovarian cyst rupture

Question 8

What is the clinical presentation of secondary peritonitis?

Answer 8

Severe abdominal pain with gradual or acute onset, patient may stay very still to avoid pain

Question 9

What are two common causes of bowel obstruction in children?

Answer 9

Intussusception, intestinal atresia

Question 10

What are two common causes of small bowel obstruction in adults?

Answer 10

Adhesions, incarcerated hernias

Question 11

What is intussusception?

Answer 11

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

Question 12

What treatment is used for intussusception?

Answer 12

Air enema, sometimes surgery

Question 13

What are the most common symptoms of small bowel obstruction?

Answer 13

Nausea, vomiting and abdominal distension

Question 14

What are inta-abdominal adhesions?

Answer 14

Abnormal fibrous bands between organs/tissue in abdomen which are usually separated

Question 15

What is the biggest cause of intra-abdominal adhesions?

Answer 15

Abdominal surgeries

Question 16

What are some common causes of large bowel obstruction?

Answer 16

Colon cancer, diverticula disease, volvulus

Question 17

How will onset of symptoms differ between large bowel obstruction caused by colon cancer compared to a volvulus?

Answer 17

Symptoms with cancer often appear gradually and volvulus more abrupt

Question 18

What are some symptoms of large bowel obstruction?

Answer 18

Abdominal distension, cramps abdominal pain, change in bowel habit (cancer). Later on there may be nausea/vomiting

Question 19

What is a volvulus?

Answer 19

Where a part of the colon twists on its mesentery

Question 20

Which two places are volvulus most common?

Answer 20

Sigmoid colon and caecum

Question 21

What sign shows on abdominal X-ray with sigmoid colon volvulus?

Answer 21

Coffee bean sign

Question 22

What are some key differences in presentation between small and large bowel obstruction?

Answer 22

Small: colicky every few minutes, vomiting first
Large: colicky every 10-15 minutes, constipation first

Question 23

What is acute mesenteric ischaemia?

Answer 23

A symptomatic reduction in blood supply to the GI tract

Question 24

What are some risk factors of acute mesenteric ischaemia?

Answer 24

Elderly, peripheral vascular disease, CVD risk factors, more common in females

Question 25

Why is pain often left died in acute mesenteric ischaemia?

Answer 25

Splenic flexure is area most likely affected as blood supply most fragile

Question 26

How is acute mesenteric ischaemia treatment?

Answer 26

Surgical resection of ischaemic bowel

Question 27

Which part of the duodenum is most susceptible to peptic ulcers?

Answer 27

The first part of the duodenum

Question 28

Which artery lies behind the first part of the duodenum?

Answer 28

Gastro-duodenal artery

Question 29

Where in the stomach are peptic ulcers most likely to form in the stomach?

Answer 29

Lesser curve and antrum

Question 30

If a peptic ulcer forms in the body of the stomach, which artery could it possibly erode into?

Answer 30

Splenic artery

Question 31

What is the first line treatment of a bleeding oesophageal varice?

Answer 31

Endoscopic band ligation

Question 32

What is a transjugular intrahepatic portosystemic shunt (TIPS), how does this help oesophageal varices?

Answer 32

Expandable stent placed in liver helps blood flow from portal vein to hepatic veins and so reduces portal vein and varicella pressure

Question 33

What is an abdominal aortic aneurysm?

Answer 33

A permanent pathological dilation of the aorta

Question 34

What are some risk factors of an AAA?

Answer 34

Male, smoking, increasing age, family history

Question 35

In relation to the renal arteries, where do most aortic aneurysms occur?

Answer 35

Below the renal arteries (infrarenal)

Question 36

What are symptoms of an unruptured AAA?

Answer 36

Usually asymptomatic, can have pulsating mass or effects from compression of nearby organs (nausea, frequency, back pain)

Question 37

What is the usual presentation of AAA rupture?

Answer 37

Persistent abdominal and back pain, syncope, sudden cardiovascular collapse