acute gastrointestinal emergencies
TRANSCRIPT
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Acute Gastrointestinal EmergenciesAcute Gastrointestinal Emergencies
• F C Campbell
• Dept of Surgery
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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
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Acute GI Emergencies - 1Acute GI Emergencies - 1
Classify by siteOesophagus – Acute
dysphagia
Perfusion
Bleeding
Stomach/duodenum –
Perfusion
Bleeding
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Acute GI Emergencies - 2Acute GI Emergencies - 2
Gallbladder/Biliary TractCholecystitisCholangitisObstructive jaundice
Pancreas
Acute pancreatitis
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Acute GI Emergencies - 3Acute GI Emergencies - 3
Small intestineIntestinal obstructionMesenteric Infarct(Infectious diarrhoea)Crohn’s DiseaseMeckel’s Diverticulum
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Acute GI Emergencies - 4Acute GI Emergencies - 4
Large Bowel (+ App)Acute AppendicitisAcute DiverticulitisLower GI bleedingPerforationIntestinal obstructionUncontrolled ulcerative colitis
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Acute GI Emergencies - 5Acute GI Emergencies - 5
Perintoneal cavityPeritonitis
Intra-abdominal abscess
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Oesophagus - BleedingOesophagus - Bleeding
Oesophagitis, Mallroy Weiss, Varices
Variceal bleeding – can be catastrophic
Treatment - varicesSengstaken tubeSomatostatin injection
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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
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Oesophagus – PerforationOesophagus – Perforation
High mortality
May follow endoscopy Presentation – acute chest/abdominal painAir in mediastinum and soft tissuesTreatment -
surgery - benignintubation - malignant
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Stomach/duodenum – Perforation
Presentation – abdominal painrigidityperitonism, shock Air under diaphragm on X-rayTreatment
antibiotics, resuscitaterepair
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Stomach/duodenum – BleedingStomach/duodenum – Bleeding
Presentation – Haematemesis +/-MelaenaSeverity
Increased PR>90Fall BP<100
Causes DU, erosions, GU
Treatment – transfusioninject DU
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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
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Gall bladder/Biliary TractGall bladder/Biliary Tract
Acute Cholecystitis Presentation
Acute RUQ pain+/- Pyrexia+/- RigorsDiagnosis – FBC, WBCC, USSTreatment – Antibiotics,
analgesicsEarly surgery
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PancreasPancreas
Acute pancreatitis Constant pain, vomiting,
shock
CausesGallstones, orAlcohol
DiagnosisSerum amylaseelevation, USScomplications
pseudocyst, phlegmonabcess
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Small IntestineSmall Intestine
Meckel’s Diverticulum rarediverticulum of terminal ileumcan be lined by gastric epithelium can perforate can present like appendicitis
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Small IntestineSmall Intestine
Intestinal obstruction
May arise due to adhesions, hernia, tumour
Presentationcolicky abdominal pain,vomiting, constipation
Treatmentresuscitate/operate
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Small IntestineSmall Intestine
Mesenteric infarct
Sudden occlusion of smallbowel arterial supply
Sudden onset of abdominal pain, shockPeritonitisTreatment
resuscitate/operate
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Large bowelLarge bowel
Acute diverticulitis
Maximal in (L) colonPresentation LIF pain,
fever, tenderness,leukocytosis
Middle aged or elderlyTreatment – conservative
antibiotics, fluids, bed rest
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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
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Large bowelLarge bowel
Perforation Diverticulum, colitis,
sudden severe abdominal pain,rigidity
Faecal peritonitisPyrexia, shockFree gas on X-ray
Treatmentresuscitate, operate
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Inflammatory Bowel DiseaseInflammatory Bowel Disease
Recurrent regenerationIncreased risk of tumour formation
14.8 X
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Large BowelLarge Bowel
Ulcerative colitis
Presents – bloodydiarrhoea, pyrexialeukocytosismay develop toxic megacolon
Treatment – steroidsSurgery on failure
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Peritoneal cavityPeritoneal cavity
Acute peritonitis
any perforation,pancreatitisabdominal pain, tendernessguarding, silent abdomenshock
Treatment – underlying condition
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Acute GI Emergencies - ConclusionsAcute GI Emergencies - Conclusions
Conditions which commonly present GI emergency, according to GI site
Typical clinical presentationUnderlying pathologyTreatment strategy