GI emergencies W8

Question 1

acute UGI bleed - main causes?

Answer 1

peptic ulcer disease
varices

Question 2

variceal bleed incidence/prognosis?

Answer 2

occurs in 30-35% of cirrhotic patients
1/3 episodes are fatal
1/3 survivals will rebleed within 6 months
1/3 will survive >1y

Question 3

variceal bleeds and transfusion?

Answer 3

restrictive transfusion important to avoid rapid expansion of volume, which may lead to further bleed.

Question 4

variceal bleed management?

Answer 4

endoscopy early on (6-12h)
oesophageal = banding
gastric/ectopic = histoacryl or thrombin (larger veins will leave a hole if banding)

IV antibiotics, iv terlipressin (reduce portal pressure)

Question 5

peptic ulcer disease (PUD)?

Answer 5

ulcer in oesophagus, stomach, duodenum due to acid

Question 6

how is an ulcer different to an erosion?

Answer 6

penetrates muscularis mucosae. can be acute or chronic

Question 7

peptic ulcer causes?

Answer 7

H. Pylori (>90% DUs, >70% GU’s)
NSAIDs (deplete mucosal defence)

Question 8

perforated ulcer presentation? mortality, treatment?

Answer 8

sudden severe abdominal pain spreading to shoulder tip.
peritonitis, shock
air under diaphragm (bilateral)

mortality 10%
emergency surgery

Question 9

bleeding ulcer presentation? morality?

Answer 9

haematemesis (vomiting blood)
melaena (black stool)

mortality 10%

Question 10

management of UGIB? (upper GI bleeding)

Answer 10

assess need for blood transfusion
timely endoscopy

Question 11

rescue therapies?

Answer 11

angiography/embolism

when endoscopy fails -> failed primary haemostasis

patient unfit for laparotomy

site would render surgery extensive

Question 12

HP eradication/NSAIDs

Answer 12

important not to forget to look for HP
eradicate, check complete 6-12 weeks later with stool antigen test.
stop NSAIDs

Question 13

surgical intervention?

Answer 13

<5% of patients need surgery
usually if all else fails
worse prognosis for deep ulcers in posterior duodenum (erosion of gastroduodenal artery)

Question 14

acute pancreatitis commonest causes?

Answer 14

gallstones
alcohol

Question 15

presentation of acute pancreatitis?

Answer 15

acute epigastric pain
colicy or continuous pain
nauesa, vomiting
collapse or hypotension
fever, tachycardia
obstructive jaundice

Question 16

complications of acute pancreatitis?

Answer 16

hypocalcaemia, hypoxia
paralytic ileus
hypovolaemia
renal failure, disseminate intravascular coagulation, effusions
recurrent attacks
death (6-28%)

Question 17

acute pancreatitis management?

Answer 17

imaging (ultrasound, CT scan), assess pancreas (oedema, irregularity, biliary tree, pseudocysts)
assess severity

Question 18

where is there tenderness in appendicitis?

Answer 18

McBurney’s point, 2/3 from umbilicus to ASIS

Question 19

treatment for acute appendicitis

Answer 19

IV fluids
broad spectrum antibiotics
emergency appendectomy
IV analgesics after surgery

Question 20

generalised peritonitis?

Answer 20

perforated ulcer
colonic perforation
perforated appendicitis

amylase?

Question 21

localised peritonitis?

Answer 21

acute appendicitis
acute diverticulitis
acute cholecystitis
ruptured ovarian cyst-ovarian torsion

Question 22

abdominal pain and shock?

Answer 22

acute mesenteric ischaemia
severe acute pancreatitis
intestinal obstruction
ruptured AAA
ruptured ectopic pregnancy

Question 23

cardiovascular causes of acute abdomen?

Answer 23

inferior myocardial infarction
pericarditis

Question 24

respiratory causes of acute abdomen?

Answer 24

lower lobe pneumonia
pulmonary emolism

Question 25

genitourinary causes of acute abdomen?

Answer 25

pyelonephritis

Question 26

endocrine causes of acute abdomen?

Answer 26

diabetic ketoacidosis