Session 9- Gastrointestinal Emergencies Flashcards
what is peritonitis
inflammation of the serosal membrane that lines the abdominal cavity
how can peritonitis occur
breakdown of the peritoneal membranes leading to foreign substances entering cavity
what is the posterior abdominal wall
posterior aspect of the peritoneal cavity
when is spontanous bacterial peritonitis most commonly seen
seen in patients eith end stage liver disease- patients with cirrhosis
what is SBP
spontaneous bacterial peritonitis is an infection of ascitic fluid that cannot be attributed to any intra-abdominal, ongoing inflammatory, or surgically correctable condition
what is ascites
pathological collection of fluid within the peritoneal cavity
how does ascites form in cirrhosis
portal hypertension
-causing increased hydrostatic pressure in the veins draining the gut
decreased liver function resulting in less albumin produced
-decreased oncotic pressure
NET MOVEMENT OF FLUID INTO PERITONEAL CAVITY
SECONDARY PERITONITIS
a result of an inflammatory process in the peritoneal cavity secondary to inflammation, perforation or gangrene of an intra-abdominal or retroperitoneal structure
common causes of secondary bacterial peritonitis
peptic ulcer disease
appendictis
divetivulitis
post surgery
non-bacterial causes of secondary peritonitis
tubal preganancy
ovarian cyst that burts
blood in peritoneal cavity
what is intussusception
when one part of the gut tube telescopes into an adjacent section
what causes small bowel obstrucions
intra-abdominal adhesions
hernia
IBD
causes from of large bowel obstruction
colon cancer
diverticular disease
volvulus
what is volvulus
part of the colon twists around its mesentery
most common in sigmoid colon and caecum
results in obstruction
when do you get vomiting in small vs large bowel obstrcutio
relatively early in small
relatively late in large
when do you gte constipation in small vs large bowel obstruction
relatively early in large
relatively late in small
what is acute mesenteric ischaemia
symtomatic reduction in blood supply to teh GI tract
what causes an acute occlusion
arterial embolism in SMA
what causes non-occlusive mesenteric ischaemia
low cardiac output
what causes mesenteric venous thrombosis
systemic coagulatopathy
malignancy
who is predisposed to an acute mesenteric ischaemia
females
people who have had a history of peripheral vascular disease
where do you have pain in acute mesenteric ischaemia
left sded because the blood supply to the splenic flexture is there and this is a vulnerable area- watershed area
what causes 20-50% of upper GI bleeding
peptic ulceration
portal drainage of oesophageal vein
left gastric vein then portal vein
systemic drainage of oesophagus
oesophageal veins drain into azygous vein, drains intO svc
what is the firs reposne to oesophagel varices
band ligation
what do you do if band ligation doesnt work
TIPS- transjugular intrahepatic portosystemic shunt
- an expandable metal is placed within the liver
- bridges the portal vein to an hepatic vein
- decompresses the portal vein pressure
- reduction in variceal pressure
- reduction in ascites
drug treatment of oesophageal varices
terlipressin- reduces portal venous pressure
what is an abdominal aortic aneurysn
permanent pathological dilation of the aorta with a diameter >1.5 times the expected AP diameter of that segment
pathoohysiogoly of AAA
degeneration of the media layer of arterial wall
where are most AAAS
infrarenal
what happens when an AAA ruptires
transient hypotension
-syncope, then blood fills up in the retroperitoneal space and can act as a tamponade and compress thw aorta
non surgical treatment of AAA
smoking cessation
hypertension control
