o. n. m. panton, mb, bs, frcsc, facs, head, ubc division of general surgery, vgh/ubch
TRANSCRIPT
![Page 1: O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH](https://reader036.vdocuments.site/reader036/viewer/2022062409/56649cda5503460f949a4dc9/html5/thumbnails/1.jpg)
CATASTROPHIC ABDOMINAL EMERGENCIES
O. N. M. Panton, MB, BS, FRCSC, FACS,Head, UBC Division of General Surgery,
VGH/UBCH
![Page 2: O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH](https://reader036.vdocuments.site/reader036/viewer/2022062409/56649cda5503460f949a4dc9/html5/thumbnails/2.jpg)
WHAT ARE ABDOMINAL CATASTROPHIES?
![Page 3: O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH](https://reader036.vdocuments.site/reader036/viewer/2022062409/56649cda5503460f949a4dc9/html5/thumbnails/3.jpg)
CATASTROPHIC EMERGENCIES
HAEMORRHAGE SEPSIS
![Page 4: O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH](https://reader036.vdocuments.site/reader036/viewer/2022062409/56649cda5503460f949a4dc9/html5/thumbnails/4.jpg)
HAEMORRAHGE
Upper GI Small Bowel Colorectal Solid organ
![Page 5: O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH](https://reader036.vdocuments.site/reader036/viewer/2022062409/56649cda5503460f949a4dc9/html5/thumbnails/5.jpg)
Massive UGI Bleed
Gastric or duodenal ulcer Varices Mallory-Weiss tear Oesophageal ulcer
![Page 6: O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH](https://reader036.vdocuments.site/reader036/viewer/2022062409/56649cda5503460f949a4dc9/html5/thumbnails/6.jpg)
Oesophageal Bleeding
Varices Mallory-Weiss tear Esophagitis/ulcer – acid reflux, infection Neoplasia Trauma
![Page 7: O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH](https://reader036.vdocuments.site/reader036/viewer/2022062409/56649cda5503460f949a4dc9/html5/thumbnails/7.jpg)
![Page 8: O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH](https://reader036.vdocuments.site/reader036/viewer/2022062409/56649cda5503460f949a4dc9/html5/thumbnails/8.jpg)
![Page 9: O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH](https://reader036.vdocuments.site/reader036/viewer/2022062409/56649cda5503460f949a4dc9/html5/thumbnails/9.jpg)
Gastric Bleeding
Gastritis Superficial Stress ulceration Mechanical
![Page 10: O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH](https://reader036.vdocuments.site/reader036/viewer/2022062409/56649cda5503460f949a4dc9/html5/thumbnails/10.jpg)
Gastric Bleeding
Gastric Ulcer Benign or malignant
(10%) Initial biopsy if safe Repeat OGD to assess
healing & repeat bx Benign: drug-induced,
hypersecretors +/- H. pylori infection
![Page 11: O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH](https://reader036.vdocuments.site/reader036/viewer/2022062409/56649cda5503460f949a4dc9/html5/thumbnails/11.jpg)
Duodenal Bleeding
Duodenitis Benign ulcer Crohn’s Neoplasia Vascular Malformation Dieulafoy
![Page 12: O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH](https://reader036.vdocuments.site/reader036/viewer/2022062409/56649cda5503460f949a4dc9/html5/thumbnails/12.jpg)
Duodenal Bleeding
Haemobilia Aortoduodenal fistula
![Page 13: O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH](https://reader036.vdocuments.site/reader036/viewer/2022062409/56649cda5503460f949a4dc9/html5/thumbnails/13.jpg)
Duodenal Bleeding
Benign ulcer May have all the
same etiology as stomach
Major bleeding usually gastroduodenal artery
![Page 14: O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH](https://reader036.vdocuments.site/reader036/viewer/2022062409/56649cda5503460f949a4dc9/html5/thumbnails/14.jpg)
SB Haemorrhage accounts for 2-3% of GI bleeds
![Page 15: O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH](https://reader036.vdocuments.site/reader036/viewer/2022062409/56649cda5503460f949a4dc9/html5/thumbnails/15.jpg)
Jejunal diverticulosis
![Page 16: O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH](https://reader036.vdocuments.site/reader036/viewer/2022062409/56649cda5503460f949a4dc9/html5/thumbnails/16.jpg)
Meckel’s Diverticulum
![Page 17: O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH](https://reader036.vdocuments.site/reader036/viewer/2022062409/56649cda5503460f949a4dc9/html5/thumbnails/17.jpg)
CLINICAL SCENARIO MASSIVE UGI BLEED
32 year old male found at home in a pool of blood & still vomiting blood
VGH ER pulse140 BP 60/0 Hb 32 Massive resuscitation/transfusion protocol Codes x 2 in ER OGD bleeding ++++
![Page 18: O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH](https://reader036.vdocuments.site/reader036/viewer/2022062409/56649cda5503460f949a4dc9/html5/thumbnails/18.jpg)
UGI BLEED
OR STAT laparotomy Codes shortly after laparotomy Duodenotomy/gastrotomy Watermelon stomach torrential
haemorrhage Blood gushing from duodenum Died on table
![Page 19: O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH](https://reader036.vdocuments.site/reader036/viewer/2022062409/56649cda5503460f949a4dc9/html5/thumbnails/19.jpg)
Colon Bleeding
Angiodysplasia Diverticular disease Neoplasia: Adenocarcinoma, GIST’s Ischemia Hemmorhoids IBD Infection: Campylobacter, Shigella,
Salmonella, Enteropathogenic E. coli
![Page 20: O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH](https://reader036.vdocuments.site/reader036/viewer/2022062409/56649cda5503460f949a4dc9/html5/thumbnails/20.jpg)
LGI Bleed
Acute bleeding occurs in 20-30 cases/100,000 annually
20-30% of GI bleeds
![Page 21: O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH](https://reader036.vdocuments.site/reader036/viewer/2022062409/56649cda5503460f949a4dc9/html5/thumbnails/21.jpg)
Angiodysplasia
![Page 22: O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH](https://reader036.vdocuments.site/reader036/viewer/2022062409/56649cda5503460f949a4dc9/html5/thumbnails/22.jpg)
Diverticulosis
![Page 23: O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH](https://reader036.vdocuments.site/reader036/viewer/2022062409/56649cda5503460f949a4dc9/html5/thumbnails/23.jpg)
Barium enema - diverticulosis
![Page 24: O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH](https://reader036.vdocuments.site/reader036/viewer/2022062409/56649cda5503460f949a4dc9/html5/thumbnails/24.jpg)
![Page 25: O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH](https://reader036.vdocuments.site/reader036/viewer/2022062409/56649cda5503460f949a4dc9/html5/thumbnails/25.jpg)
![Page 26: O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH](https://reader036.vdocuments.site/reader036/viewer/2022062409/56649cda5503460f949a4dc9/html5/thumbnails/26.jpg)
Lower gi bleed red cell scan
![Page 27: O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH](https://reader036.vdocuments.site/reader036/viewer/2022062409/56649cda5503460f949a4dc9/html5/thumbnails/27.jpg)
CLINICAL SCENARIO MASSIVE LGI BLEED
67 year old female found down at home in a pool of blood passed per rectum
VGH ER pulse 156 BP 50/0 Hb 36 Resuscitated/massive transfusion
protocol Previous LAR/TME rectal ca neoadjuvant
short course radiorx Leak/Hartmann
![Page 28: O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH](https://reader036.vdocuments.site/reader036/viewer/2022062409/56649cda5503460f949a4dc9/html5/thumbnails/28.jpg)
LGI BLEED
STAT OR Pre-sacral ulcer communicating with
rectal stump Packed/controlled ICU plan for IR angio/embolization DIC ICU & died
![Page 29: O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH](https://reader036.vdocuments.site/reader036/viewer/2022062409/56649cda5503460f949a4dc9/html5/thumbnails/29.jpg)
SOLID ORGAN HAEMORRHAGE
56 year old male presents VGH ER sudden (R) flank pain
Pulse 148 BP 210/110 Hb 88 Resuscitated then STAT laparotomy (R) suprarenal ruptured tumour
![Page 30: O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH](https://reader036.vdocuments.site/reader036/viewer/2022062409/56649cda5503460f949a4dc9/html5/thumbnails/30.jpg)
![Page 31: O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH](https://reader036.vdocuments.site/reader036/viewer/2022062409/56649cda5503460f949a4dc9/html5/thumbnails/31.jpg)
SEPSIS
Perforated appendicitis Colonic perforations Gasrtro-duonenal perforations Mesenteric ischaemia with infarcted gut Gangrenous cholecystitis Necrotizing pancreatitis Ascending cholangitis
![Page 32: O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH](https://reader036.vdocuments.site/reader036/viewer/2022062409/56649cda5503460f949a4dc9/html5/thumbnails/32.jpg)
![Page 33: O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH](https://reader036.vdocuments.site/reader036/viewer/2022062409/56649cda5503460f949a4dc9/html5/thumbnails/33.jpg)
![Page 34: O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH](https://reader036.vdocuments.site/reader036/viewer/2022062409/56649cda5503460f949a4dc9/html5/thumbnails/34.jpg)
![Page 35: O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH](https://reader036.vdocuments.site/reader036/viewer/2022062409/56649cda5503460f949a4dc9/html5/thumbnails/35.jpg)
INTRA-ABDOMINAL SEPSIS
47 male HIV + 24 hour hx severe abdominal pain
CT dx terminal ileitis Rx IV antibiotics GS consulted next night Temp 39 pulse 120 BP 115/68 Generalized peritonitis WBC 18 creatinine
110-169
![Page 36: O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH](https://reader036.vdocuments.site/reader036/viewer/2022062409/56649cda5503460f949a4dc9/html5/thumbnails/36.jpg)
SEPSIS
DL RLQ abscess Laparotomy: gangrenous
appendicitis/faecolith Appendectomy & drainage of abscess