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
emergenc...
Acute GI Emergencies - 1Acute GI Emergencies - 1
Classify by site
Oesophagus – Acute
dysphagia
Perfusion
Bleeding
Stomach/...
Acute GI Emergencies - 2Acute GI Emergencies - 2
Gallbladder/Biliary Tract
Cholecystitis
Cholangitis
Obstructive jaundice
...
Acute GI Emergencies - 3Acute GI Emergencies - 3
Small intestine
Intestinal obstruction
Mesenteric Infarct
(Infectious dia...
Acute GI Emergencies - 4Acute GI Emergencies - 4
Large Bowel (+ App)
Acute Appendicitis
Acute Diverticulitis
Lower GI blee...
Acute GI Emergencies - 5Acute GI Emergencies - 5
Perintoneal cavity
Peritonitis
Intra-abdominal abscess
Oesophagus - BleedingOesophagus - Bleeding
Oesophagitis, Mallroy Weiss,
Varices
Variceal bleeding – can be
catastrophic
Tr...
Oesophagus – Acute DysphagiaOesophagus – Acute Dysphagia
Presentation – cannot swallow
May have benign stricture or cancer...
Oesophagus – PerforationOesophagus – Perforation
High mortality
May follow endoscopy
Presentation – acute chest/abdominal ...
Stomach/duodenum – Perforation
Presentation –
abdominal pain
rigidity
peritonism, shock
Air under diaphragm on X-ray
Treat...
Stomach/duodenum – BleedingStomach/duodenum – Bleeding
Presentation –
Haematemesis +/-
Melaena
Severity
Increased PR>90
Fa...
Gall bladder/Biliary TractGall bladder/Biliary Tract
Obstructive Jaundice
Yellow skin, sclerae
Pale stools, dark urine
+/-...
Gall bladder/Biliary TractGall bladder/Biliary Tract
Acute Cholecystitis
Presentation
Acute RUQ pain
+/- Pyrexia
+/- Rigor...
PancreasPancreas
Acute pancreatitis
Constant pain, vomiting,
shock
Causes
Gallstones, or
Alcohol
Diagnosis
Serum amylase
e...
Small IntestineSmall Intestine
Meckel’s Diverticulum
rare
diverticulum of terminal ileum
can be lined by gastric epitheliu...
Small IntestineSmall Intestine
Intestinal obstruction
May arise due to
adhesions, hernia, tumour
Presentation
colicky abdo...
Small IntestineSmall Intestine
Mesenteric infarct
Sudden occlusion of small
bowel arterial supply
Sudden onset of abdomina...
Large bowelLarge bowel
Acute diverticulitis
Maximal in (L) colon
Presentation LIF pain,
fever, tenderness,
leukocytosis
Mi...
Large bowelLarge bowel
Lower GI bleeding
Diverticulum, colitis,
Crohn’s tumour
Present with Fresh Red Blood P/R
Tendency t...
Large bowelLarge bowel
Perforation
Diverticulum, colitis,
sudden severe abdominal pain,
rigidity
Faecal peritonitis
Pyrexi...
Inflammatory Bowel DiseaseInflammatory Bowel Disease
Recurrent regeneration
Increased risk of tumour formation
14.8 X
Large BowelLarge Bowel
Ulcerative colitis
Presents – bloody
diarrhoea, pyrexia
leukocytosis
may develop toxic megacolon
Tr...
Peritoneal cavityPeritoneal cavity
Acute peritonitis
any perforation,
pancreatitis
abdominal pain, tenderness
guarding, si...
Acute GI Emergencies - ConclusionsAcute GI Emergencies - Conclusions
Conditions which commonly present
GI emergency, accor...
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Acute gastrointestinal-emergencies-1232208980905009-3

  1. 1. Acute Gastrointestinal EmergenciesAcute Gastrointestinal Emergencies • F C Campbell • Dept of Surgery
  2. 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. 3. Acute GI Emergencies - 1Acute GI Emergencies - 1 Classify by site Oesophagus – Acute dysphagia Perfusion Bleeding Stomach/duodenum – Perfusion Bleeding
  4. 4. Acute GI Emergencies - 2Acute GI Emergencies - 2 Gallbladder/Biliary Tract Cholecystitis Cholangitis Obstructive jaundice Pancreas Acute pancreatitis
  5. 5. Acute GI Emergencies - 3Acute GI Emergencies - 3 Small intestine Intestinal obstruction Mesenteric Infarct (Infectious diarrhoea) Crohn’s Disease Meckel’s Diverticulum
  6. 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. 7. Acute GI Emergencies - 5Acute GI Emergencies - 5 Perintoneal cavity Peritonitis Intra-abdominal abscess
  8. 8. Oesophagus - BleedingOesophagus - Bleeding Oesophagitis, Mallroy Weiss, Varices Variceal bleeding – can be catastrophic Treatment - varices Sengstaken tube Somatostatin injection
  9. 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. 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. 11. Stomach/duodenum – Perforation Presentation – abdominal pain rigidity peritonism, shock Air under diaphragm on X-ray Treatment antibiotics, resuscitate repair
  12. 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. 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. 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. 15. PancreasPancreas Acute pancreatitis Constant pain, vomiting, shock Causes Gallstones, or Alcohol Diagnosis Serum amylase elevation, USS complications pseudocyst, phlegmon abcess
  16. 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. 17. Small IntestineSmall Intestine Intestinal obstruction May arise due to adhesions, hernia, tumour Presentation colicky abdominal pain, vomiting, constipation Treatment resuscitate/operate
  18. 18. Small IntestineSmall Intestine Mesenteric infarct Sudden occlusion of small bowel arterial supply Sudden onset of abdominal pain, shock Peritonitis Treatment resuscitate/operate
  19. 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. 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. 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. 22. Inflammatory Bowel DiseaseInflammatory Bowel Disease Recurrent regeneration Increased risk of tumour formation 14.8 X
  23. 23. Large BowelLarge Bowel Ulcerative colitis Presents – bloody diarrhoea, pyrexia leukocytosis may develop toxic megacolon Treatment – steroids Surgery on failure
  24. 24. Peritoneal cavityPeritoneal cavity Acute peritonitis any perforation, pancreatitis abdominal pain, tenderness guarding, silent abdomen shock Treatment – underlying condition
  25. 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

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