upper GIT disorders tutorial Flashcards
POSSIBLE non surgical causes of upper gastro pain
cardiac
gastroenterological
muscleoskeletal
diabetes
dermatological
possible surgical causes of upper gastro pain
PUD (peptic ulcer disease) / GORD
pancreatitis
billiary pahtology
abdo pain
vascular
small bowel/ LB
WHAT is the first investigation to do in upper abdo pain presentation?
CXR and AXR (chest and abdo)
pain improves with fluids and paracetamol and is discharged. then he represents 2 days later, fevers and infection signs, vomiting, pain now constant rather than itnemrmittent. what are you suspecting?
perforated viscus
most likely site of perforated viscus?
duodenum
sign expected in CXR AND AXR in perforated viscus?
Rigler’s sign: free intraperitoneal air (in AXR - some clack in there)
and free subdiaphragmatic air (black inder diaphragm- normally no black just liver- white) in CXR
abdo CT sign in perforated intestine
you see black in intestine, normal but also black OUTSIDE intestine between intestine and belly
pre-operative management of acute peritonitis
NGT (nasal gut tube)
NBM (nil by mouth)
and IV fluids
ABx
operative management of acute peritonitis
identification of aetiology of peritonits
eradication of the source ofperitoneal contamination
lavage and drainage of peritoneum
possible treatments for perforated ulcers - conservative and radical
conservatives treatment- taylors approach
surgery: laparoscopic omental patch ( patch over ulcer with the peritoneum )
radical surgery- vagotomy anf gastrectomy
where are perforations specifically more and less likely?
more on anterior/ superior surface of duodenum
less on posterior surface of duodenum, pre- pyloric antrum, stomach .
how many times mor eliely is duodenal perforation compared to gastric?
10x
how often do acute ulcers show up in patients with nO history of ulceraiton
25-30%
post op the patient is fine initially but 3rd day after he has SOB, O2 sats drop, HIGH TEMP, SINUS TACHY, BIBASAL CREPS ON AUSCULTATION R>L low pO2. what is it prob?
pneumonia
then hes fine but returns 2 days after with abdo pain and vomit
low bp hr 110 febrile 38
abdomen soft but tender and guarding epigastrium
high wcc
ecg sinus tachy and cxr axr unremarkkable
likely diagnosis
intra abdo collection
what to do for intra abdo collection
drainage and IV antibiotics
how do we asses severity for acute pancreatitis
modified glasgow criteria
what are the glasgow criteria for acute pancr
ACRONYM: P A N C R E A S
PO2
AGE OVER 75
N- WCC >15
C CALCIUM<2
RENAL : UREA > 26 MMOL/L
E: ENZYMES
A: ALBUMIN
S: SUGAR
hoe much do you need to score for acute pancr on glasgow criteria
score of 3> within 48h of onset suggetss evere
CRP what des it tell us for acute pancreatitis diagnosis
its and independent predictor of severity >200 suggests severe
what is the first step to acute pancreatitis management?
ABC if needed
4 principles of acute pancreatitis
1) fluid resuscitation (IV Fluids, Urinary catheter, strict fluid balance monitoring)
2) analgesia
3) pancreatic rest (+/- nutritional support if prolonged recovery)
4) determine underlying cause
what percentage of people with pancreatitis settle with conservative treatment? what are approaches for more severe cases?
95% settle
HDU (high dependancy unit) if severe pancreatitis score
surgery very rare
when do we give antibiotics for severe pancreatitis?
NOT ROUTINE (THOUGH its a common mistake) bc its inflammation and nOT infection. only give if necrotic pancreatitis or infective necrosis.
