upper gi disorders Flashcards
What is a cause of sub-diaphragmatic air (air under the diaphragm)?
Hollow viscous perforation
What is rigler’s sign? What can it imply?
Free intraperitoneal air (free air within peritoneal cavity. Hollow viscous perforation
What is the most commonly perforated organ?
Duodenum
Risk factors for perforation?
Drinker, smoker, NSAIDs
What can perforation cause?
acute peritonitis
How do you manage acute peritonitis?
- Pre-operatively NGT to empty gastric contents, NBM & IV fluids for rescucitation + antibiotics.
- Operatively identify aeitology of peritonitis (leakage of enteric contents into cavity) and eradication of peritoneal source of contamination & peritoneal lavage & drainage.
Difference between anterior and posterior ulcers?
Anterior ulcer perforate & posterior ulcers bleed
When are laparoscopic omental patches done and what are they?
For duodenal ulcers, take bit of omentum and tie stitches - must wash away contamination
Why chest infections after upper abdomen operations?
Pain from operation means they take deep breaths, lungs fill with fluid/phlegm.
What are intra-abdominal collections? how to prevent?
Pockets of pus - extensive lavage to prevent.
What does high bilirubin, high alk phosp, WBC high and high amylase point to?
gallstone pancreatitis
How do you assess severity of acute pancreatitis?
Modified glasglow criteria (severe if score 3 or more). Or CRP >200 on its own.
How to manage acute pancreatitis?
Fluid resucitation (IV fluids), analgesia, pancreatic rest (NJ feeding or PN). Mostly conservative management. Antibitoics only if necrotic/infected.
Order of investgations for pancreatitis?
USS abdomen, MRCP, ERCP, CT abdo/pelvis
Why can pancreatitis cause ischaemic bowel?
Portal vein behind pancreas so pancreatitis can eat mesentery and cause ischaemia
