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Gastrointestinal > GI MEDICAL EMERGENCIES > Flashcards

GI MEDICAL EMERGENCIES Flashcards

1
Q

what causes acute upper GI haemorrhage?

A

ulcers, gastric erosion, varices, mallory-weis tear, oesophagitis, erosive duodenitis, neoplasm

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2
Q

ix for acute upper GI haemorrhage?

A

endoscopy is gold standard but you must use a type of score to assess risk of using endoscopy

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3
Q

what is the scoring system for endoscopy usage in acute upper GI bleed?

A

Rockball Risk Scoring System

  • sys BP <100
  • HR >100
  • Hb <100
  • age >60
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4
Q

Mx for acute upper GI bleed?

A

ABCDE, exclude upper source e.g. vascular or ulceration

- O2, IV access (transfusion and bloods), stop anticoags & NSAIDs

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5
Q

prognosis for an acute upper GI haemorrhage?

A

30-40% mortality

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6
Q

true/false…

young people have worse prognosis for upper GI haemorrhage

A

true…

young people compensate so crash harder

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7
Q

what are types of upper GI bleeds?

A

bleeding peptic ulcer, acute visceral bleeding

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8
Q

site of bleeding peptic ulcer?

A

duodenal ulcers or gastric ulcers

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9
Q

stigmata of ulcer?

A

BCV!

active bleeding, overlying clot, visible vessel

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10
Q

tx for bleeding peptic ulcer?

A

endoscopy for haemostasis, acid suppressions (PPIs), H.pylori eradication, surgery as last resort

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11
Q

what therapeutic techniques can be carried out using endoscopy for peptic ulcer bleed?

A

injections, heater probe coagulant, clips, haemo-spray

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12
Q

how common is it for cirrhotic patients with varices to present with acute visceral bleeding?

A

20-40% of pts

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13
Q

aetiology of an acute visceral bleed?

A

varices due to cirrhosis

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14
Q

s/s of acute visceral bleed?

A

palmar erythema, leukonychia, encephalopathy, ascites, jaundice

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15
Q

initial tx for visceral bleed?

A

coagulotherapy (terlipressin), monitor, antibiotics, ABCDE

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16
Q

haemostasis tx for visceral bleed?

A

endoscopic variceal ligation, SB balloon > TIPSS > transplant?

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17
Q

how long does acute abdomen pain last?

A

<10 days but progressively worsens

18
Q

aetiology of acute abdomen?

A

appendicits, obstruction, renal calculi, gallstones, diverticulitis, perforated duodenum, pancreatitis, AAA, infection

19
Q

s/s of acute abdomen?

A

abdominal pain, nausea, vomiting, burping, heartburn, change in bowel habits, PR blood

20
Q

exam findings for acute abdomen?

A

localised peritonism, guarding, tenderness, Rosvig’s sign, cullen’s/ grey-tuner sign, tinkling bowel sounds

21
Q

ix for acute abdomen?

A

bloods- amylase to rule out pancreatitis, CT, USS, ACX*

22
Q

Mx for acute abdomen?

A

ABCDE, urinalysis, IV access etc

23
Q

specific mx for acute abdomen caused by volvulus?

A

decompress using sigmoidoscopy

24
Q

what is a volvulus?

A

loop of intestine loops around itself resulting in bowel obstruction

25
Q

specific mx for acute abdomen caused by malignant obstruction?

A

stent/ operate

26
Q

specific mx for acute abdomen caused by perforation?

A

remove colon

27
Q

specific mx for acute abdomen caused by diverticulitis

A

antibiotics and surgery if perforated

28
Q

what is acute liver disease?

A

rapid development of hepatic dysfunction with no previous liver disease

29
Q

what is the difference between acute liver disease and chronic liver disease?

A

acute liver disease is <6months duration

30
Q

aetiology of acute liver disease?

A

viruses, drugs, shock, cholangitis, alcohol, malignancy

rarely: Budd Chiari

31
Q

what drugs may cause acute liver disease?

A

co-amoxiclav, flucloxacillan, NSAIDs

32
Q

s/s of acute liver disease?

A

none, jaundice, lethargy, nausea, anorexia, pain, itch, arthralgia

33
Q

ix for acute liver disease?

A

LFTs (albumin & bilirubin*), prothrombin time, virology, USS

34
Q

Mx for acute liver disease?

A

supportive- rest, fluids, inc calories, observe for FHF

35
Q

what is fulminant hepatic failure (FHF)?

A

acute episode of severe liver dysfunction

36
Q

s/s of FHF?

A

jaundice, encephalopathy in pts with no previous liver disease

37
Q

causes of FHF?

A

paracetamol, HBV

38
Q

what are the 4 factors that cause liver damage…

A
  1. Nutrition (NASH, AFLP- acute fatty liver of pregnancy)
  2. Toxicity (drugs, alcohol)
  3. Genetic (Wilsons, Haemochromatosis, Budd Chiari)
  4. Immunological (PBC, AIH)
39
Q

assessment of FHF?

A
  • endoscopy to exclude cirrhosis, alcohol liver injury or malignancy
  • bloods
40
Q

tx for FHF?

A

supportive- inotropes and fluids, transplant

Gastrointestinal (24 decks)

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