Upper GI Disorders Flashcards
How
1 year history of upper abdominal pain Always worse when hungover A&E with worsening abdo pain for 3 hours 1 vomit Slightly raised WBC
What are causes of upper abdo pain? (surgical)
PUD/GORD Pancreatitis Biliary pathology Abdominal wall Vascular Small bowel Large bowel
What are causes of upper abdo pain? (non-surgical)
Cardica Gastroenterological MSK Diabete Derm
What is the first investigation after bloods for abdo pain?
CXR and AXR
Look for air under the diaphragm - perforation
How does the patient represent?
Been taking double dose ibuprofen a
Worsening epigastric pain
Vomiting
Sinus tachycardia
What does the patient have?
Perforated viscus
What is the sign of perforated vicus on CXR?
Rigler’s sign
Free intraperitoneal air
Free subdiaphragmatic air
What is the most-likely perforated organ?
Duodenum
What is the primary management for perforation?
NGT
NBM
IV fluids
ABx
What is the aim of surgical treatment of perforation?
- Identification of aetiology
- Eradication of peritoneal source of contamination
- Peritoneal lavage and drainage
What is the range of treatment for peritonitis?
Conservative treatment (Taylor’s approach) - not free drainage of gasrtic contents, perforation has sealed itself off
Racial surgery (vagotomy, gasterctomy)
Where are perforations found?
Anterior/superior surface of the first part of the duodenum
Rarely pre=pyloric antrum
Less frequently stomach
Rarely posterior surface
What is the safest surgery for perforation?
Laparoscopic omental patch
Stitch one side of the defect, take a bit of omentum to cover the hole
What happened to the patient post-op?
SOB
O2 drops to 87% on 2L nasal specs
Temp - 38.5
100 bpm
What is the most likely cause of his deterioration?
Pneumonia
How does pneumonia develop?
Pain relief inadequate Do not take deep breaths Air does not fill lung Lungs fill with fluid Infection
How does the second patient present?
Intermittent abdo pain for 1 yr Now severe with vomiting Pyrexial WCC up LFTs slightly abnormal Amylase 2150 100bpm
What is the most likely diagnosis for the patient?
Gallstone pancreatitis
What are the 4 principles of management of gallstone pancreatitis?
Fluid resuscitation
Analgesia
Pancreatic rest (nutritional support if prolonged recovery)
Determine underlying cause
What is a HIDA scan?
Nuclear medicine
labels bile
What is the next investigation after bloods for gallstone pancreatitis?
USS abdo
What would your next investigation be?
MRCP
LFTs are still deranged
What would the third investigation be?
ERCP
After establishing she has stones in common bile duct
What happens of Day 7 of inpatient admission?
In pain
Tachycardia
What investigation would you do?
CT abdo/pelvis
A week later now - complications form pancreatitis now present
What is cholecystitis?
Inflamed galbladder
When do you do acute laparoscopic cholecystectomy?
Within 48 hours
What do you do if is noticed later than 48 hours?
Treat conservatively
Then book in for day case surgery
What two structures need to be identifies and divided during a laparoscopic cholecystectomy?
Cystic duct and cystic artery
What can be seen in surgery?
Biliary anomalies
Vascular anomalies
