GI Emergencies Flashcards
What is peritonitis?
Inflammation of the peritoneum, typically caused by bacterial infection either via the blood or after rupture of an abdominal organ.
It can occur spontaneously. (Primary)
Occurs via breakdown of the peritoneal membrane leading to foreign substances entering cavity (secondary)
What is the connection between greater and lesser sac?
The foramen of winslow /The epiploic foramen
What is primary peritonitis?
Most commonly seen in patients with end stage liver disease (patients with cirrhosis)
It is an infection of ascetic fluid that cannot be attributed to any ongoing intra-abdominal inflammatory or surgically correctable condition.
Symptoms: abdominal pain, fever, vomiting -usually mild.
Diagnosed by aspirating ascitic fluid (high neutrophil count).
What is ascites?
Fluid in peritoneal cavity
How is ascites caused by cirrhosis?
A combination of:
- Portal hypertension (increased hydrostatic pressure in the veins draining the gut)
- Decreased liver function resulting in less albumin production (decreased intravascular oncotic pressure)
- The result is the next movement of fluid into the peritoneal cavity
What is secondary peritonitis?
Secondary (surgical) peritonitis is a result of an inflammatory process in the peritoneal cavity secondary to inflammation, perforation, or gangrene of an intra-abdominal or retroperitoneal structure.
What are some common causes of secondary peritonitis?
Bacterial peritonitis: Peptic ulcer disease (perforated) Appendicitis (Perforated) Diverticulitis (perforated) Post Surgery
Non bacterial:
Tubal (ectopic) pregnancy that bleeds (peritoneal cavity is not enclosed in females)
Ovarian cyst
Blood is highly irritant to the peritoneal cavity.
Describe the clinical presentation of peritonitis
Abdominal pain -
Patients lie very still movement make it worse. Often have knees flexed and are breathing shallowly.
May come on gradually or acutely.
Diffuse abdominal pain is common in perforated viscera.
How do you treat peritonitis?
Control of infectous source -surgery
Eliminate bacteria and toxins - antibacterial therapy
Maintain organ system function - ITU
What is intussuseption?
Intussuseption is when one part of the gut give telescopes into an adjacent section.
Cause not well know:
- Motility issues
- ‘lead point’ (mass that precipitates telescoping action) -Meckel’s diverticulum, enlarged lymph nodes
Can extend quite far or even prolapse out of rectum.
When lymphatic and venous drainage impaired -oedema. If enough, can impede arterial supply (infarction).
Symptoms: abdominal pain, vomiting, haematochezia.
How do you treat intussuseption?
Air enema - fancy bicycle pump -pumps air into bowel.
Surgery
What are common causes of small bowel obstruction?
Intra-abdominal adhesions
- Arise after 50% of abode surgeries
- Damage to mesothelium
- Also cause abdominal pain and infertility
Hernia’s
IBD
What are some common symptoms of small bowel obstruction?
Nausea and vomiting (bilious) are most common early symptoms.
Cramping every 3-5 minutes
How do you diagnose small bowel obstruction?
History - crampy, intermittent abdominal pain
Physical exam -abdo distention, increased / absent bowel sounds, hernia’s
Imaging
What are some common causes of large bowel obstruction?
Colon cancer
Diverticular disease
Volvulus - sigmoid, caecal
What are the symptoms of large bowel obstruction?
Change in bowel habits
Abdominal distention
Cramping abdominal pain
Nausea and vomitting
What is a volvulus?
From Latin ‘to twist’
When part of the colon twists around its mesentry
Most common in sigmoid colon (60%) and caecum but can occur anywhere.
It results in obstruction.
Where is a volvulus most common?
Sigmoid colon (60%) and caecum
What can cause a volvulus?
Overload of the sigmoid colon (constipation)
Extra mass predisposes elongates the sigmoid (relatively smaller mesenteric attachment)
High fibre diet can also lead to sigmoid overload and twisting.
What age groups get small vs large bowel obstruction?
Small bowel - younger
Large bowel - older
explained by causes as large bowel obstructions tend to develop over time.
What is the difference in symptoms between small and large bowel obstruction?
Small bowel - colicky abdominal pain every 3-4 mins, vomiting relatively early and constipation late.
Large bowel - colicky abdominal pain every 10-15 mins, vomiting relatively late and constipation early.
What is acute mesenteric ischaemia?
Sypmtomatic reduction in blood supply to the GI tract.
Most common in females (75%) and if you have a history of peripheral vascular disease.
Symptoms: Nausea, vomiting, abdominal pain - left sided as blood supply to splenic flexure is most fragile.
What are the different types of acute mesenteric ischaemia?
Acute occlusion - 70% of cases, causes by an arterial embolism in SMA (50%)
Non-occlusive mesenteric ischaemia - (20%) - low cardiac output
Mesenteric venous thrombosis (5-10%) - systemic coagulopathy, malignancy
Who is acute mesenteric ischaemia common in?
Older people with CVS risk factors.
More common in females.
If pain comes on about 30mins after eating, lasts 4 hours and is disproportionate to finding - consider this.
