acute gastrointestinal-emergencies-1232208980905009-3
TRANSCRIPT
Acute Gastrointestinal EmergenciesAcute Gastrointestinal Emergencies
• F C Campbell
• Dept of Surgery
Acute GI Emergencies - ObjectivesAcute GI Emergencies - Objectives
• Know conditions which commonly present as GI emergency, according to GI site
• Know typical clinical presentation• Know underlying pathology• Know treatment strategy
Acute GI Emergencies - 1Acute GI Emergencies - 1
Classify by siteOesophagus – Acute
dysphagia
Perfusion
Bleeding
Stomach/duodenum –
Perfusion
Bleeding
Acute GI Emergencies - 2Acute GI Emergencies - 2
Gallbladder/Biliary TractCholecystitisCholangitisObstructive jaundice
Pancreas
Acute pancreatitis
Acute GI Emergencies - 3Acute GI Emergencies - 3
Small intestineIntestinal obstructionMesenteric Infarct(Infectious diarrhoea)Crohn’s DiseaseMeckel’s Diverticulum
Acute GI Emergencies - 4Acute GI Emergencies - 4
Large Bowel (+ App)Acute AppendicitisAcute DiverticulitisLower GI bleedingPerforationIntestinal obstructionUncontrolled ulcerative colitis
Acute GI Emergencies - 5Acute GI Emergencies - 5
Perintoneal cavityPeritonitis
Intra-abdominal abscess
Oesophagus - BleedingOesophagus - Bleeding
Oesophagitis, Mallroy Weiss, Varices
Variceal bleeding – can be catastrophic
Treatment - varicesSengstaken tubeSomatostatin injection
Oesophagus – Acute DysphagiaOesophagus – Acute Dysphagia
Presentation – cannot swallow
May have benign stricture or cancer Triggered by food bolus or tabletTreatment -
remove bolusdeal with underlying
oesophageal disease
Oesophagus – PerforationOesophagus – Perforation
High mortality
May follow endoscopy Presentation – acute chest/abdominal painAir in mediastinum and soft tissuesTreatment -
surgery - benignintubation - malignant
Stomach/duodenum – Perforation
Presentation – abdominal painrigidityperitonism, shock Air under diaphragm on X-rayTreatment
antibiotics, resuscitaterepair
Stomach/duodenum – BleedingStomach/duodenum – Bleeding
Presentation – Haematemesis +/-MelaenaSeverity
Increased PR>90Fall BP<100
Causes DU, erosions, GU
Treatment – transfusioninject DU
Gall bladder/Biliary TractGall bladder/Biliary Tract
Obstructive Jaundice Yellow skin, scleraePale stools, dark urine+/- Pain+/- Courvoisier’s signCT – dilated bile ducts
Establish diagnosisGallstonesCa Head of Pancreas
Appropriate treatment
Gall bladder/Biliary TractGall bladder/Biliary Tract
Acute Cholecystitis Presentation
Acute RUQ pain+/- Pyrexia+/- RigorsDiagnosis – FBC, WBCC, USSTreatment – Antibiotics,
analgesicsEarly surgery
PancreasPancreas
Acute pancreatitis Constant pain, vomiting,
shock
CausesGallstones, orAlcohol
DiagnosisSerum amylaseelevation, USScomplications
pseudocyst, phlegmonabcess
Small IntestineSmall Intestine
Meckel’s Diverticulum rarediverticulum of terminal ileumcan be lined by gastric epithelium can perforate can present like appendicitis
Small IntestineSmall Intestine
Intestinal obstruction
May arise due to adhesions, hernia, tumour
Presentationcolicky abdominal pain,vomiting, constipation
Treatmentresuscitate/operate
Small IntestineSmall Intestine
Mesenteric infarct
Sudden occlusion of smallbowel arterial supply
Sudden onset of abdominal pain, shockPeritonitisTreatment
resuscitate/operate
Large bowelLarge bowel
Acute diverticulitis
Maximal in (L) colonPresentation LIF pain,
fever, tenderness,leukocytosis
Middle aged or elderlyTreatment – conservative
antibiotics, fluids, bed rest
Large bowelLarge bowel
Lower GI bleeding Diverticulum, colitis,Crohn’s tumourPresent with Fresh Red Blood P/RTendency to be more conservative than
with upper GI
resuscitate, transfusion
Large bowelLarge bowel
Perforation Diverticulum, colitis,
sudden severe abdominal pain,rigidity
Faecal peritonitisPyrexia, shockFree gas on X-ray
Treatmentresuscitate, operate
Inflammatory Bowel DiseaseInflammatory Bowel Disease
Recurrent regenerationIncreased risk of tumour formation
14.8 X
Large BowelLarge Bowel
Ulcerative colitis
Presents – bloodydiarrhoea, pyrexialeukocytosismay develop toxic megacolon
Treatment – steroidsSurgery on failure
Peritoneal cavityPeritoneal cavity
Acute peritonitis
any perforation,pancreatitisabdominal pain, tendernessguarding, silent abdomenshock
Treatment – underlying condition
Acute GI Emergencies - ConclusionsAcute GI Emergencies - Conclusions
Conditions which commonly present GI emergency, according to GI site
Typical clinical presentationUnderlying pathologyTreatment strategy