GI Emergencies Flashcards
What is peritonitis and how does it occur
Peritonitis - inflammation of the serosal membrane lining the abdominal cavity
Can occur spontaneously (primary) or due to breakdown of the peritoneal membranes leading to foreign substances entering the cavity (secondary)
Name a primary peritonitits, how it occurs and what its symptoms are
Spontaneous bacterial peritonitis - infection of the ascitic fluid that cannot be attributed to intra-abdominal, ongoing or surgically correctable condition
Symptoms: abdo pain, fever, vomiting
How does secondary peritonitis occur and name some causes
Secondary peritonitis is the result of an inflammatory process in peritoneal cavity secondary to inflammatoin, perforation or gangrene
Common bacterial causes: perforated peptic ulcer, appendicitis or diverticulosis. Bacterial peritonitis can be occur post surgery
Non-bacterial causes: tubal pregnancy that bleeds (blood is an irritant), ovarian cyst
What are the symptoms of peritonitis
Abdominal pain that may come on graudally or acutely
Patients often lie still
Nausea, fever, bloating, loss of appetite, thirst, diarrhoea
What are the common causes of bowel obstruction in children and adults
Children - intussusception and intestinal atresia
Adults - adhesions and incarcerated hernias
What is intussusception, what are the symptoms and what is the treatment
Intussusception is where one part of the gut tube telescopes into an adjacent section
Get oedema as soon as lymphatic and venous drainage of the section impaired - can then impede arterial supply
Symptoms: abdo pain, vomiting, haematochezia
Treatment: air enema, surgery
What are the symptoms of small bowel obstruction and what is found on examination
Nausea
Bilious vomiting
Abdominal distension
Late absolute constipation
Examination - abdominal distension, increased or absent bowel sounds, presence of hernia
What are some causes of small bowel obstruction
Intra-abdominal adhesions - abnormal fibrous bands between organs, tissues or both in abdo cavity. Damage the mesothelium causing capillary bleeding leading to exudation of fibrinogen. Causes abdo pain and secondary infertility
Hernias - can narrow lumen enough to cause obstruction. Most common is incarcerated groin hernia
IBD - Crohn’s disease
What are the symptoms of a large bowel obstruction
Change in bowel habit - cancer
Abdominal distension
Crampy abdominal pain
Nausea and vomiting - late
Constipation
Name some causes of large bowel obstruction
Colon cancer
Diverticular disease
Volvulus
What is volvulus, where is it most common and what factors predispose a patient to volvulus
Volvulus - where part of the colon twists around its own mesentery resulting in obstruction
Most common in sigmoid and caecum
Predisposing factors: overloaded/extra mass in sigmoid colon, high fibre diet
What is acute mesenteric ischaemia, what causes it and what symptoms occur
Symptomatic reduction in blood supply to the GI tract
Common in: females, history of peripheral vascular disease
Causes: acute occlusion (arterial embolism in SMA), non-occlusive mesenteric ischaemia (low CO), mesenteric venous thromboss
Symptoms: abdominal pain (classicaly 30mins after eating), nausea and vomiting, pain often left sided (blood supply to splenic fixture most fragile)
What are two common causes of a major upper GI bleed and briefly describe them
Peptic ulceration - peptic ulcers caused by disruption in gastric/duodenal muscoa which goes through submucosa. Can erode into gastroduodenal or splenic artery
Oesophageal varices - varices easily bleed due to rupture. Control using band ligatoin or trans-jugular intrahepatic portosystemic shunt
What is an abdominal aortic aneurysm and what is it usually caused by
AAA is permanent pathological dilatation of the aorta with a diameter >1.5x the expected anteroposterior diameter of that segment
Usualyl due to degradation of tunica media of artery wall causing the lumen to gradually widen
Name some risk factors for AAA
Male
Inherited risk
Increasing age
Smoking
