Lecture 16 - GI emergencies Flashcards
Ascites due to cirrhosis
- Portal hypertension - increased hydrostatic pressure in veins draining the gut
- Decreased liver function - less albumin produced decreasing oncotic pressure
- Net movement of fluid into the peritoneal cavity
Symptoms of ascites
Abdominal pain
Fever
Vomiting
Mild symptoms
Diagnosed by aspiration of ascitic fluid
Secondary peritonitis
Result of inflammatory process in the peritoneal cavity secondary to inflammation, perforation or gangrene of an intraperitonel or retroperitoneal structure.
Common causes of secondary bacterial peritonitis
Perforated:
- peptic ulcer
- diverticulum
- appendix
Post surgery
Non bacterial causes of secondary peritonitis
Tubal pregnancy that bleeds
Ovarian cyst
How to treat peritonitis
Control infectious source - surgery
Eliminate bacteria and toxins - antibiotics
Maintain organ system function - ICU
Common causes of bowel obstruction in children
Intussusception
Intestinal atresia - failure for recanalisation
Common causes of bowel obstruction in adults
Strictures
Incarcerated hernias
Consequences of intussusception
Venous and lymph node drainage is impaired - Oedema
Occlude arterial blood supply - ischaemia and necrosis
Presentation of intussesception
Vomiting
Haematochezia
Abdo pain
Treatments of intussesception
Air enema
Surgery
Primary peritonitis
Most commonly seen in patients with liver cirrhosis
Spontaneous bacterial peritonitis - infection of ascitic fluid
Small bowel obstruction effects
Abdominal distension Abdominal constipation (late)
Causes of small bowel obstruction
Intra-abdominal adhesions
Hernias
Inflammatory bowel disease (crohn’s)
Diagnosis no small bowel obstruction
Hx - Abdominal cramps and intermittent
Ex - abdominal distension, absent bowel sounds +/- presence of hernia
CT - abdominal distension
