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Acute gastrointestinal-emergencies-1232208980905009-3

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  • 1. Acute Gastrointestinal EmergenciesAcute Gastrointestinal Emergencies • F C Campbell • Dept of Surgery
  • 2. 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
  • 3. Acute GI Emergencies - 1Acute GI Emergencies - 1 Classify by site Oesophagus – Acute dysphagia Perfusion Bleeding Stomach/duodenum – Perfusion Bleeding
  • 4. Acute GI Emergencies - 2Acute GI Emergencies - 2 Gallbladder/Biliary Tract Cholecystitis Cholangitis Obstructive jaundice Pancreas Acute pancreatitis
  • 5. Acute GI Emergencies - 3Acute GI Emergencies - 3 Small intestine Intestinal obstruction Mesenteric Infarct (Infectious diarrhoea) Crohn’s Disease Meckel’s Diverticulum
  • 6. Acute GI Emergencies - 4Acute GI Emergencies - 4 Large Bowel (+ App) Acute Appendicitis Acute Diverticulitis Lower GI bleeding Perforation Intestinal obstruction Uncontrolled ulcerative colitis
  • 7. Acute GI Emergencies - 5Acute GI Emergencies - 5 Perintoneal cavity Peritonitis Intra-abdominal abscess
  • 8. Oesophagus - BleedingOesophagus - Bleeding Oesophagitis, Mallroy Weiss, Varices Variceal bleeding – can be catastrophic Treatment - varices Sengstaken tube Somatostatin injection
  • 9. Oesophagus – Acute DysphagiaOesophagus – Acute Dysphagia Presentation – cannot swallow May have benign stricture or cancer Triggered by food bolus or tablet Treatment - remove bolus deal with underlying oesophageal disease
  • 10. Oesophagus – PerforationOesophagus – Perforation High mortality May follow endoscopy Presentation – acute chest/abdominal pain Air in mediastinum and soft tissues Treatment - surgery - benign intubation - malignant
  • 11. Stomach/duodenum – Perforation Presentation – abdominal pain rigidity peritonism, shock Air under diaphragm on X-ray Treatment antibiotics, resuscitate repair
  • 12. Stomach/duodenum – BleedingStomach/duodenum – Bleeding Presentation – Haematemesis +/- Melaena Severity Increased PR>90 Fall BP<100 Causes DU, erosions, GU Treatment – transfusion inject DU
  • 13. Gall bladder/Biliary TractGall bladder/Biliary Tract Obstructive Jaundice Yellow skin, sclerae Pale stools, dark urine +/- Pain +/- Courvoisier’s sign CT – dilated bile ducts Establish diagnosis Gallstones Ca Head of Pancreas Appropriate treatment
  • 14. Gall bladder/Biliary TractGall bladder/Biliary Tract Acute Cholecystitis Presentation Acute RUQ pain +/- Pyrexia +/- Rigors Diagnosis – FBC, WBCC, USS Treatment – Antibiotics, analgesics Early surgery
  • 15. PancreasPancreas Acute pancreatitis Constant pain, vomiting, shock Causes Gallstones, or Alcohol Diagnosis Serum amylase elevation, USS complications pseudocyst, phlegmon abcess
  • 16. Small IntestineSmall Intestine Meckel’s Diverticulum rare diverticulum of terminal ileum can be lined by gastric epithelium can perforate can present like appendicitis
  • 17. Small IntestineSmall Intestine Intestinal obstruction May arise due to adhesions, hernia, tumour Presentation colicky abdominal pain, vomiting, constipation Treatment resuscitate/operate
  • 18. Small IntestineSmall Intestine Mesenteric infarct Sudden occlusion of small bowel arterial supply Sudden onset of abdominal pain, shock Peritonitis Treatment resuscitate/operate
  • 19. Large bowelLarge bowel Acute diverticulitis Maximal in (L) colon Presentation LIF pain, fever, tenderness, leukocytosis Middle aged or elderly Treatment – conservative antibiotics, fluids, bed rest
  • 20. Large bowelLarge bowel Lower GI bleeding Diverticulum, colitis, Crohn’s tumour Present with Fresh Red Blood P/R Tendency to be more conservative than with upper GI resuscitate, transfusion
  • 21. Large bowelLarge bowel Perforation Diverticulum, colitis, sudden severe abdominal pain, rigidity Faecal peritonitis Pyrexia, shock Free gas on X-ray Treatment resuscitate, operate
  • 22. Inflammatory Bowel DiseaseInflammatory Bowel Disease Recurrent regeneration Increased risk of tumour formation 14.8 X
  • 23. Large BowelLarge Bowel Ulcerative colitis Presents – bloody diarrhoea, pyrexia leukocytosis may develop toxic megacolon Treatment – steroids Surgery on failure
  • 24. Peritoneal cavityPeritoneal cavity Acute peritonitis any perforation, pancreatitis abdominal pain, tenderness guarding, silent abdomen shock Treatment – underlying condition
  • 25. Acute GI Emergencies - ConclusionsAcute GI Emergencies - Conclusions Conditions which commonly present GI emergency, according to GI site Typical clinical presentation Underlying pathology Treatment strategy