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Gastrointestinal > GI Emergencies > Flashcards

GI Emergencies Flashcards

1
Q

What is Peritonitis?

A

Inflammation of the serosal membrane that lines the abdominal cavity. There are 2 types, primary (spontaneous) and secondary.

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2
Q

What is Primary Peritonitis?

A

Usually a spontaneous bacterial peritonitis, most commonly seen in patients with end stage liver disease (cirrhosis).
It is an infection of ascitic fluid that cannot be explained to any intra-abdominal ongoing inflammatory, or surgically correctable condition.

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3
Q

What is ascites?

A

Pathological collection of fluid within the peritoneal cavity.

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4
Q

What causes ascites in cirrhosis?

A
  1. Portal hypetension: causing increased hydrostatic pressure in the veins draining the gut.
  2. Decreased liver function resulting in less albumin production: decreasing intravascular oncotic pressure.
  3. The result is the net movement of fluid into the peritoneal cavity.
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5
Q

What are the symptoms of Spontaneous Bacterial Peritonitis?

A
  1. Abdominal pain.
  2. Fever.
  3. Vomiting.
    Symptoms are usually mild.
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6
Q

How do you diagnose Spontaneous Bacterial Peritonitis?

A

Aspirating ascitic fluid, looking for a neutrophil count of more than 250cells/mm^3.

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7
Q

What is Secondary Peritonitis?

A

Breakdown of the peritoneal membrane leading to foreign substances entering the cavity.
Secondary peritonitis is a result of an inflammatory process in the peritoneal cavity secondary to inflammatory, perforation or gangrene of an intra-abdominal or retroperitoneal structure.
If a viscera perforates then the content will enter the peritoneal cavity.

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8
Q

What are the common bacterial causes of secondary peritonitis?

A
  1. Peptic Culver disease (perforated).
  2. Appendicitis (perforated).
  3. Diverticulitis (perforated).
  4. Post surgery.
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9
Q

What are the common non-bacterial causes of secondary peritonitis?

A
  1. Ectopic pregnancy that bleeds.
  2. Ovarian cysts.
    Blood is irritant to the peritoneal. cavity.
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10
Q

What is a Bowel Obstruction?

A

A mechanical/functional problem that inhibits the normal movement of the gut contents. Can affect the large and small intestine, at any age.

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11
Q

What are the commonest causes of children bowel obstruction?

A
  1. Intussusception.

2. Intestinal atresia.

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12
Q

What are the commonest cause of adult bowel obstruction?

A
  1. Adhesions.

2. Incarcerated hernias.

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13
Q

What is Intussusception?

A

When one part of the gut tube telescope into an adjacent section. Can extend quite far.

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14
Q

What is the cause of Intussusception?

A

Potentially due to motility issues with a lead point (mass that precipitates the telescoping action) like Meckel’s diverticulum or an enlarged lymph nodes. As soon as lymphatic and venous drainage is impaired you get oedema, enough oedema can impede the arterial supply.

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15
Q

What are the symptoms of Intussusception?

A
  1. Abdominal pain.
  2. Vomiting.
  3. Haematochezia.
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16
Q

How do you treat Intussusception?

A
  1. Air enema: mainly effective for treating children.

2. Surgery.

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17
Q

What are the symptoms of Small Bowel Obstruction?

A
  1. Nausea (early).
  2. Vomiting (early).
  3. Abdominal distension.
  4. Absolute constipation (late).
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18
Q

What is Small Bowel Obstruction caused by?

A
  1. Intra-abdominal adhesions: abnormal fibrous bands between organs or tissues or both in the abdominal cavity. Usually the greater omentum or the bowel, damage to the mesothelium. This causes abdominal pain and potential secondary infertility.
  2. Hernias: can narrow the lumen enough to cause obstruction: incarcerated groin hernias.
  3. Inflammatory bowel disease: Crohn’s: repeated episodes of inflammation/healing causes narrowing.
19
Q

How do you diagnose Small Bowel Obstruction?

A
  1. History: abdominal pain is crampy, intermittent.
  2. Physical examination: abdominal distension, increasing/absent bowel sounds, presence of hernias.
  3. Imaging.
20
Q

Who does the Large Bowel Obstruction commonly affect?

A

Affects the older generation.

21
Q

What are the common cause of Large Bowel Obstruction?

A
  1. Colon cancer.
  2. Diverticula disease.
  3. Volvulus- Sigmoid, Caecal
22
Q

What are the symptoms of Large Bowel Obstruction?

A
  1. Change in bowel habit (cancer).
  2. Abdominal distension.
  3. Crampy abdominal pian.
  4. Nausea/vomiting (later).
23
Q

What is a Volvulus?

A

A part of the colon twists around its mesentery. Commonest in the sigmoid colon, causing obstruction.

24
Q

What causes Volvulus?

A

Can result from overloading sigmoid colon in constipation. The extra mass predisposes it to elongate the sigmoid as it has a small mesenteric attachment. Higher fibre diets can also lead to sigmoid overload and twisting.
Caecal volvulus results in small and large bowel obstruction.

25
Q

Compare a Small and Large Bowel Obstruction?

A
  1. Small is more common is younger people and large in older people.
  2. Depends on the competence of the ileo-caecal valve: if it is competent the colon cannot decompress. proximally. Closed loop obstruction causes ischaemia and perforation.
  3. Abdominal pain is colicky 3-4 minutes in small bowel obstruction and 10-15 minutes in large bowel.
  4. Vomiting is early in SI and late in LI.
  5. Constipation is late in SI and early in LI.
26
Q

How can we identify a large or small intestine problem on CT?

A

The small intestine has central lines, a smaller lumen and is more in the middle.
The large intestine is peripheral, has haustra and a larger lumen.

27
Q

What is Acute Mesenteric Ischaemia?

A

A symptomatic reduction in blood supply to the GI tract.

28
Q

Who are commonly affected by Acute Mesenteric Ischaemia?

A

Females with a history of peripheral vascular disease.

Elderly patients with cardiovascular risk factors.

29
Q

What are the causes of Acute Mesenteric Ischaemia?

A
  1. Acute occlusion: due to arterial embolism in SMA.
  2. Non-occlusive mesenteric ischaemia: low cardiac output.
  3. Mesenteric venous thrombosis: systemic coagulopathy and malignancy.
30
Q

What are the symptoms of Acute Mesenteric Ischaemia?

A

Non-specific so hard to diagnose.

  1. Abdominal pain is disproportionate to the clinical findings: classically pain comes on 30 minutes after eating and lasts 4hours.
  2. Nausea and vomiting.
  3. Pain is often left sided because the blood supply to the splenic flexure is most fragile.
31
Q

How do you investigate Acute Mesenteric Ischaemia?

A
  1. Blood tests: metabolic acidosis/increased lactate levels.
  2. Erect chest X-ray: check for perforation.
  3. CT angiography: intravenous contrast.
32
Q

How do you treat Acute Mesenteric Ischaemia?

A
  1. Surgery: resection of ischaemic bowel: bypass graft.

2. Thrombolysis/angioplasty.

33
Q

What are the causes of major upper GU bleeding?

A
  1. Peptic Ulcers.

2. Oesophageal Varices.

34
Q

What is a Peptic Ulcer?

A

Disruption in the gastric/duodenal mucosa usually greater than. 5mm in diameter, going through to the submucosa through the muscuarlis mucosa.
Commonly in the duodenum, can dig into the gastro-dudodenal artery lies behind the first part of the duodenum.
Gastric ulcers commonly effect the lesser serve and antrum of the stomach.

35
Q

What are oesophageal varices?

A

A pathology due to portal hypertension in an area with porto-systemic anastamosise.
The oesophagus drains into the left gastric vein and then into t he portal vein as well as draining into the azygous drain and to the superior vena cava.

36
Q

What are the causes of portal hypertension?

A
  1. Pre-hepatic: portal-vein thrombosis.
  2. Hepatic: Cirrhosis, schistosomaiasis.
  3. Post-hepatic: hepatic vein thrombosis and RHF.
37
Q

How do you treat Oesophageal Varices?

A
  1. Band Ligation.
    If bleeding not controlled:
  2. Transjugular- Intrahepatic Portosystemic Shunt: an expandable metal placed in the liver to bridge the portal vein to the hepatic vein To decompress the pressure and reduce the variceal pressure and the ascites.
  3. Drug: Terlipressin: reduces portal venous pressure.
38
Q

What is a Abdominal Aortic Aneurysm?

A

A permanent pathological dilation of the aorta with a diameter of more than 1.5 times the expected anteroposterior diameter of the segment for a given sex and body size. 3cm or more.

39
Q

What is the Pathophysiology of AAA?

A

Commonly affected the renal arteries-> infrarenal.
Usually due to the degeneration of the media layer of the arterial wall due to elastin and collagen degeneration. The lumen gradually starts to dilate.

40
Q

What are the risk factors of AAA?

A
  1. Male,
  2. Inherited risk.
  3. Increasing age,
  4. Smoking.
41
Q

What is the presentation of someone with AAA?

A
  1. Abdominal pain.
  2. Back pain.
  3. Pulsatile abdominal mass.
  4. Transient hypotension causing syncope. The retroperitoneum can temporarily temponade and stabilise the bleed.
  5. Sudden cardiovascular collapse.
    Can cause symptoms in other systems due to compression.
42
Q

How do you diagnose AAA?

A
  1. Physical examination: presence of a pulsatile abdominal mass, sometimes.
  2. Ultrasonography: non-invasive, can detect free peritoneal blood.
  3. Computed Tonography: can detect a lot of anatomy and be used for planning for elective surgery.
  4. Plain x-rays: if the aneurysm has calcified.
43
Q

How do we treat AAA?

A
  1. Smoking cessation.
  2. Hypertension control.
  3. Surveillance: if greater than 5.5cm refer to surgeon.
  4. Endovascular repair: endograft stent, inserted. through the femoral artery below the renal artery and above the common iliac.
  5. Open s surgical repair: clamp the aorta and suture in a synthetic graft to replace the diseased segment.

Gastrointestinal (10 decks)

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