1 (E): Acute Abdomen, GI Bleeding Flashcards by Grace Poole

Define acute abdomen

Surgical emergency characterised by acute-onset abdominal pain and tenderness

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Describe visceral pain

Diffuse pain - hard to localise

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Describe parietal pain

More intense pain

Easier to localise

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What are 3 differentials for epigastric pain

Peptic Ulcer
ACS
3.

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What are 2 differentials for left hypogastric pain

Splenic rupture

2. Pneumonia

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What are 6 differentials for left hypogastric pain

Biliary Colic
Acute cholecystitis
Ascending cholangitis
Hepatitis
Liver abscess
Pneumonia

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What are 2 differentials for right lumbar pain

Renal Colic

2. Pyelonephritis

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What are 2 differentials for left lumbar pain

Renal Colic

2. Pyelonephritis

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What are 2 gender-independent cause of right iliac fossa pain

Appendicitis

2. Inguinal hernia strangulation

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What are 3 causes of RIF pain in a female

Ecoptic
Ovarian torsion
PID

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What is a cause of RIF in a male

Testicular Torsion

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What are 3 causes of umbilical pain

Acute mesenteric ischaemia
Ruptured AAA
Intestina obstruction

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What are 2 causes of supra-pubic pain

2. Retention

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What is a gender-independent differential for LIF pain

Diverticulitis

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Give 3 causes of LIF pain in females

Ecoptic
Ovarian torsion
PID

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Give a differential for LIF pain in a male

Testicular torsion

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What does initial assessment of acute abdomen involve

A-E approach

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What is the most common cause of upper GI bleeding

Peptic ulcer (50-70%)

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What are 5 causes of upper GI bleeding

Oeseophagitis
Gastroduodenal erosion
Malignancy 
Mallory-Weiss tear 
Oesophageal Varices 
AV malformation

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What is an AV malformation causing upper GI bleeding called

Dieulafoy lesion

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What are 3 risk factors for upper GI bleeds

NSAID
Corticosteroids
H.pylori

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How does GI bleeds present

Haematemesis
Melena
Iron-deficiency anaemia

Acute:

Tachycardia
Hypotension = dizziness, LOC
Cold peripheries

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How does bleeding from peptic ulcer present

Small amounts of bleeding

- Usually presents as iron-deficiency anaemia

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When may a peptic ulcer cause massive haemorrhage

Posterior duodenal ulcer extends into gasproduodenal.a - present as massive haemorrhage and haematemesis

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How will diffuse erosive gastritis present

Haematemesis and epigastric discomfort

What is diffuse gastric erosions

ulcer that extends through stomach wall

How may oeseophagitis present

Small volumes fresh blood streaked in vomit. Background of GORD

How do mallory-weiss tears present clinically

Fresh blood on repeated vomiting. Typical history starts as vomits with no blood and then contains blood

How do oesophageal varices present clinically

Large volumes of blood (teaspoons) haematemesis. Meleana | Haemodynamically compromised

How will upper GI malignancies present

haematemesis

What score is used prior to endoscopy to predict patients risk of requiring intervention

Glasgow-Blatchford score | : pre-endoscopy score used to predict patient's need of intervention

If individual has a glasgow blatchford of 0 what does it mean

Consider early discharge

what is rockall score and what does it predict

Based on pre and post-endoscopy findings. It is used to predict an individuals risk of re-bleeding and death

How are individuals with GI-bleed categorised

1. Acute severe 2. High-risk stable 3. Low risk

What are the 4-features of acute severe GI bleed

1. HR >100 2. BP <100 3. Haematemesis 4. Co-morbidities

What are three steps in management for acute-severe GI bleed

1. Resuscitate 2. Inform GI Team 3. Immediate endoscopy

What are the 3 features of high-risk stable GI bleed

1. HR >100 2. Postural Hypotension 3. Co-morbidities

How should a high risk stable GI bleed be managed

1. Resuscitate 2. Inform GI team 3. Endoscopy in 12h

What are the 3 features of a low risk GI bleed

1. <60 2. Coffee ground vomiting 3. CVS stable

What is the management of low risk GI bleed

Add to routine endoscopy

How soon should endoscopy be requested in the following a. Acute severe b. High-risk c. Low-risk

a. Immediate b. 12h c. Routinely

How should low-risk GI bleeds be managed

Oral Fluids Observe for evidence re-bleed PPI Routine endoscopy

What is the initial management of someone with high-risk bleed

- A-E - IV Access: G&S, Cross-match - Resuscitation fluids - Platelet transfusion if <50 - FFP if fibrinogen <1 or PTT > 1.5 - Immediate OGD

What is a mallory weiss tear

tear in oesophageal mucosa - often causing shearing of submucosal blood vessels

What causes a mallory weiss tear

increase in oeseophageal luminal pressure: vomiting caused by alcoholism or bulimia

How will mallory weiss tear present clinically

repeated vomiting, followed by an episode of Haematemesis which is usually self-limiting

How is a mallory weiss tear investigated

OGD

How is a mallory weiss tear managed

Conservatively

What are oesophageal varices

dilation of porto-systemic veins secondary to portal HTN

What causes oesophageal varices

portal HTN- often secondary to liver cirrhosis form alcoholic liver disease

How will variceal haemorrhage present

teaspoons of blood

Explain emergency management of oesophageal varices

1. A-E 2. Insert two IV large-bore cannulas, G+S, Cross-match 3. Fluid resuscitation 4. Terlipressin 5. Prophylactic antibiotics (in cirrhosis patients) 6. OGD and immediate endoscopic variceal band ligation If large haemorrhage and EVBL is not an option: - Sengstaken-Blakemore tube - If both fail, transjugular intrahepatic porto-systemic shunt (TIPSS)

What tube is used for large haemorrhage in oesophageal varices

Sengstaken-Blakemore Tube

What is used for prophylaxis of oesophageal varices

Propanolol | Endoscopic Variceal Band Ligtation

What are are lower GI haemorrhages also referred to as

Rectal Bleeding

What are 6 causes of rectal bleeding

1. Colorectal Cancer 2. IBD 3. Haemorrhoids 4. Fissure in-ano 5. Gastroenteritis 6. Diverituclosis

What does haematochezia indicate

Rectum or Colon

What does dark red blood indicate

Proximal source

What does Melena indicate

Upper GI Bleed

How may an anal fissure present

- Small amounts of bright red blood following defecation | - Painful defecation

How may haemorrhoids present

- Bright red blood on wiping - History of straining - May be pain on wiping

What exam may be performed for rectal bleeding

Rectal Exam

What 5 blood tests are ordered for rectal bleeding

1. FBC 2. LFT 3. Group and Save, Cross-Match 4. U+E 5. Coagulation studies

What is important about U+Es

High urea (30:1) - indicate upper GI Bleed

What imaging may be performed

Sigmoidoscopy - Colonoscopy | CT

Explain management of person with rectal bleed

1. A-E 2. Two large-bore IV cannulas 3. Fluid resuscitation Majority settle - then investigate outpatient If patient unstable may need injection adrenaline.

1 (E): Acute Abdomen, GI Bleeding Flashcards

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