GI MEDICAL EMERGENCIES Flashcards
what causes acute upper GI haemorrhage?
ulcers, gastric erosion, varices, mallory-weis tear, oesophagitis, erosive duodenitis, neoplasm
ix for acute upper GI haemorrhage?
endoscopy is gold standard but you must use a type of score to assess risk of using endoscopy
what is the scoring system for endoscopy usage in acute upper GI bleed?
Rockball Risk Scoring System
- sys BP <100
- HR >100
- Hb <100
- age >60
Mx for acute upper GI bleed?
ABCDE, exclude upper source e.g. vascular or ulceration
- O2, IV access (transfusion and bloods), stop anticoags & NSAIDs
prognosis for an acute upper GI haemorrhage?
30-40% mortality
true/false…
young people have worse prognosis for upper GI haemorrhage
true…
young people compensate so crash harder
what are types of upper GI bleeds?
bleeding peptic ulcer, acute visceral bleeding
site of bleeding peptic ulcer?
duodenal ulcers or gastric ulcers
stigmata of ulcer?
BCV!
active bleeding, overlying clot, visible vessel
tx for bleeding peptic ulcer?
endoscopy for haemostasis, acid suppressions (PPIs), H.pylori eradication, surgery as last resort
what therapeutic techniques can be carried out using endoscopy for peptic ulcer bleed?
injections, heater probe coagulant, clips, haemo-spray
how common is it for cirrhotic patients with varices to present with acute visceral bleeding?
20-40% of pts
aetiology of an acute visceral bleed?
varices due to cirrhosis
s/s of acute visceral bleed?
palmar erythema, leukonychia, encephalopathy, ascites, jaundice
initial tx for visceral bleed?
coagulotherapy (terlipressin), monitor, antibiotics, ABCDE
haemostasis tx for visceral bleed?
endoscopic variceal ligation, SB balloon > TIPSS > transplant?
how long does acute abdomen pain last?
<10 days but progressively worsens
aetiology of acute abdomen?
appendicits, obstruction, renal calculi, gallstones, diverticulitis, perforated duodenum, pancreatitis, AAA, infection
s/s of acute abdomen?
abdominal pain, nausea, vomiting, burping, heartburn, change in bowel habits, PR blood
exam findings for acute abdomen?
localised peritonism, guarding, tenderness, Rosvig’s sign, cullen’s/ grey-tuner sign, tinkling bowel sounds
ix for acute abdomen?
bloods- amylase to rule out pancreatitis, CT, USS, ACX*
Mx for acute abdomen?
ABCDE, urinalysis, IV access etc
specific mx for acute abdomen caused by volvulus?
decompress using sigmoidoscopy
what is a volvulus?
loop of intestine loops around itself resulting in bowel obstruction
specific mx for acute abdomen caused by malignant obstruction?
stent/ operate
specific mx for acute abdomen caused by perforation?
remove colon
specific mx for acute abdomen caused by diverticulitis
antibiotics and surgery if perforated
what is acute liver disease?
rapid development of hepatic dysfunction with no previous liver disease
what is the difference between acute liver disease and chronic liver disease?
acute liver disease is <6months duration
aetiology of acute liver disease?
viruses, drugs, shock, cholangitis, alcohol, malignancy
rarely: Budd Chiari
what drugs may cause acute liver disease?
co-amoxiclav, flucloxacillan, NSAIDs
s/s of acute liver disease?
none, jaundice, lethargy, nausea, anorexia, pain, itch, arthralgia
ix for acute liver disease?
LFTs (albumin & bilirubin*), prothrombin time, virology, USS
Mx for acute liver disease?
supportive- rest, fluids, inc calories, observe for FHF
what is fulminant hepatic failure (FHF)?
acute episode of severe liver dysfunction
s/s of FHF?
jaundice, encephalopathy in pts with no previous liver disease
causes of FHF?
paracetamol, HBV
what are the 4 factors that cause liver damage…
- Nutrition (NASH, AFLP- acute fatty liver of pregnancy)
- Toxicity (drugs, alcohol)
- Genetic (Wilsons, Haemochromatosis, Budd Chiari)
- Immunological (PBC, AIH)
assessment of FHF?
- endoscopy to exclude cirrhosis, alcohol liver injury or malignancy
- bloods
tx for FHF?
supportive- inotropes and fluids, transplant
