GI Emergencies Flashcards
most common GI emergency
acute upper GI bleed
most common causes of upper GI bleed
peptic ulcer disease
varices
how are variceal bleeds treated in terms of blood transfusion
with restrictive transfusion
don’t want to overload body and cause another bleed
investigation of variceal bleed
endoscopy
oesophageal varices treatment
banding ligation
gastric varices treatment
histoacryl or thrombin injection
where can peptic ulcers be found
oesophagus
stomach
duodenum
how are ulcers different to erosions
erosions are more superficial
what layer of the wall do ulcers penetrate to
muscularis mucosae
are peptic ulcers acute or chornic
can be either
what is perforation
when the ulcer is very deep and erodes through the submucosa and makes a hole through to peritoneum
main causes of peptic ulcer disease
h.pylori
NSAIDs
who’s more at risk of h.pylori infection
low SES
older
Eastern europe and asia
why should h.pylori be eridicated if found
it can cause cancer
how do NSAIDs cause peptic ulcers
impair prostaglandin synthesis in mucosa which results in mucosal injury
symptoms of perforation of peptic ulcer
peritonitis
shock
sudden severe pain
shoulder tip pain
air under diaphragm
signs of bleeding from peptic ulcer
haematemesis
melaena
what vessels are commonly eroded due to peptic ulcers
supraduodenal
gastroduodenal
what score is used to assess severity of bleeding
rockall score
how is the need for blood transfusion in upper GI bleed determined
depends on underlying condition
haemodynamic status
markers of tissue hypoxia
when and where should endoscopy be performed for UGIB
within 6-24h when patient is stable
in critical care environment with anaesthetic support
why are PPIs given in UGIB
need a pH > 6 to stabilise clots in the stomach so given a large dose of PPI to neutralise acid
what should be checked for in UGIB and what should be done about it
h.pylori
eradication
what drug should be stopped after UGIB
NSAIDs
indication for surgery after GI bleed
failure to control bleeding
describe pain of acute pancreatitis
acute epigastric pain
colicy or continuous pain
symptoms of acute pancreatitis in addition ot pain
nausea
vomiting
collapse
hypotension
fever
tachycardia
obstructive jaundice
common causes of acute pancreatitis
alcohol
gallstones
post ERCP (after trying to remove gallstones)
what blood tests detect acute pancreatitis
> 3x normal amylase or lipase
(made by pancreas and spilled into blood)
differential diagnosis of acute pancreatitis
perforated ulcer
ischaemic bowel
abdominal aortic dissection
biliary colic
initial management of pancreatitis
high flow oxygen
painkillers
nil by mouth
IV fluids
complications of pancreatitis
hypocalcaemia
hypoxia
paralytic ileus
hypovolaemia
renal failure
