session 9- GI emergencies Flashcards
what is peritonitis
inflammation of the serosal membrane lining the abdominal cavity
what is primary peritonitis
spontaneous bacterial peritonitis. infection of gastric fluid that cannot be attributed to a specific cause.
how does liver cirrhosis cause primary peritonitis
portal hypertension causes increased hydrostatic pressure in veins. decreased albumin due to decreased liver function causes increased intravascular oncotic pressure. this causes net movement of fluid into peritoneal cavity.
symptoms of primary peritonitis
diffuse abdominal pain, fever, vomiting. white cell count above 250, lie very stilll
what causes secondary peritonitis bacterial
peptic ulcer disease, appendicitis, diverticulitis, post surgery
what causes secondary peritonitis non bacterial
tubal pregnancy that bleeds, ovarian cyst
treatment peritonitis
control infectious source w surgery, eliminate bacteria and toxins, maintain organ system function
what is a bowel obstruction
mechanical or functional problem that inhibits normal movements of gut content.
causes of bowel obstruction
intussception and intestinal atresia in children. adhesions and incarcerated hernias in adults
what is intussusception
when one part of gut tube telescopes into adjacent section. can cause prolapse out of rectum. causes impaired lymphatic and venous drainage and therefore oedema.
treatment intussusception
air enema, surgery
symptoms intussusception
abdo pain, vomiting, haematochezia
symptoms small bowel obstruction
nausea, vomiting, abdo distension, absolute constipation
cause of small bowel obstruction
intraabdominal adhesions, damage to mesothelium, incarcerated groin hernias, IBS eg chrons
symptoms small bowel obstruction
crampy intermittent abdo pain, abdo distension, absent bowel sounds, hernia presence
large bowel obstruction casues
colon cancer, diverticular disease, sigmoid volvulus.
symptoms large bowel obstruction
cancer- gradual. volvulus- sudden
abdo distension, crampe pain, nausea
what is a volvulus
part of the colon twisting around mesentery. causes obstruction
compare small vs large obstruction
small has vomiting then constipaiton, large is constipation then vomiting.
what is acute mesenteric ischaemia
symtomatic reduction in blood supply to GI tract.
cause of acute mesenteric ischaemia
acute occlusion caused by SMA embolism. non occulsive caused by low cardiac output or mesenteric venous thrombosis.
symptoms acute mesenteric ischaemia
abdo pain disproportionate to findings, nausea and vomiting, left sided pain
investigations acute mesenteric ischaemia
blood tests for metabolic acidosis/increased lactate. erect chest x ray, CT angiography
treatment acute mesenteric ischaemia
surgery to resect ischameic bowel, thrombolysis/angioplasty
what is peptic ulcer
disruption in gastric/duodenal mucosa that extends through muscularis mucosa
what is the most common peptic ulcer and what blood vessel does it affect
duodenal, gastroduodenal artery
where in stomach to gastric ulcers occur
lesser curve
what is the portal and systemic drainage of an oesophogeal varicies
portal- left gastric>portal vein
systemic- azygous> SVC
how to treat oesophageal varices
TIPS inserted. expandable metal in liver that bridges portal vein to hepatic vein to decompress the portal vein pressure and reduce variceal pressure and therefore ascites. or terlipressin
what is an AAA
permanent pathological dilation of aorta with diameter greater than 3 cm.
cause of AAA
degeneration of media layer of arterial wall caused by degeneration of elastin and collagen. lumen dilates
risk factors AAA
male. age, smoking
symptoms expanding AAA
nausea, urinary frequency, back pain
symptoms AAA rupture
abdo pain, back pain, pulsatile abdo mass, transient hypotension, sudden CVS collapse
diagnosis AAA
physical exam shows pulsatile abdo mass, ultrasonopgraphy detects free peritoneal blood, CT scan, plain x rays
treatment AAA
smoking cessation, hypertension control, endovascular repair, open surgical repair
