GI Emergencies

Question 1

Define peritonitis and why it’s more common in women. (2)

Describe treatments for it. (3)

Answer 1

Inflammation of the peritoneum.
Because women have two holes in it for ovaries.
Control infection source (surgery), abx, maintain other organs.

Question 2

Describe primary peritonitis. (2)
Symptoms (2)
Diagnosis (1)

Answer 2

Sometimes called dpontaneous bacterial peritonitis.
Often seen in those with cirrhosis as an infection of ascitic fluid.
Abdominal pain, fever, vomiting.
Diagnosed with an ascitic fluid neutrophil count over 250.

Question 3

Describe secondary peritonitis. (6)

Answer 3

Inflammation of the peritoneal cavity secondary to perforation.
Can be bacterial: peptic ulcers, appendicitis, post surgery
Or abacterial: ruptured ectopic, ovarian cysts.

Question 4

Define bowel obstruction (2)

Answer 4

Mechanical or functional problem inhibiting normal movement of gut contents in the large or small bowel.

Question 5

Define intussusception. (3)
Symptoms (2)
Treatment (2;

Answer 5

When one part of the bowel telescopes into another part. Can impede blood supply with oedema from venous blockage.
Abdominal pain, vomiting, haematochezia
Treat with high pressure air enema (but can just happen again) or surgery.

Question 6

Describe small bowel obstruction
Causes (3)
Symptoms (3)

Answer 6

Adhesions, hernias, IBD (Crohn’s)
Colicky pain (3-4 mins), nausea, bilious vomiting,  distension, absent bowel sounds.

Question 7

Describe large bowel obstruction.
Causes (3)
Symptoms (3)

Answer 7

Often in the older generation, caused by colon cancer, dilverticular disease, volvulus.
Presents with constipation, distension, colicky abdominal pain (10-15 mins), late nausea/vomiting

Question 8

Describe the differences between large bowel and small bowel obstruction on an x Ray. (3)

Answer 8

Small: complete plicae circularis, smaller lumen, central
Large: incomplete haustra, larger, peripheral.

Question 9

Describe acute mesenteric ischaemia and it’s three subtypes (6)
Presentation (3)
Investigations (2)
Treatments. (2)

Answer 9

Symptomatic reduction in blood supply to the GI tract, more common in women and with a history of peripheral vascular disease.
Acute occlusion - emboli in the SMA
Non-occlusive ischaemia - low CO
Venous thrombosis - coagulopathy, malignancy.
Older patients, pain is disproportionate for limited findings, nausea and vomiting.
Blood tests (metabolic acidosis), CXR (perforation).
Surgery and thrombolytics.

Question 10

Describe two causes for major upper GI bleeding. (2)

Answer 10

Peptic ulceration.

Oesophageal varices.

Question 11

Describe treatments for oesophageal varices. (3)

Answer 11

Endoscopic band ligation
Shunt portal blood into systemic
Drug treatment to reduce portal pressure

Question 12

Describe an AAA (2)
Pathophysiology (1)
Risk factors (4)
Symptoms (5)
Treatments (4)

Answer 12

Permanent pathological dilation of the aorta, often infrarenal.
Due to the degredation of media layer of the arterial wall.
Risk factors: male, genetics, old, smoking.
Normally asymptomatic until rupture.
Can cause compression of nearby structures or have a palpable pulsitile mass.
On rupture presents with transient hypotension (retroperitoneum can tamponage temporarily) then drastic CVS collapse.
Non-surgical: smoking cessation, hypertension control.
Surveillance
Endovascular repair: stunting
Open surgical repair: cut open aorta and sew it back up.