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GI Extra > 9.1 GI Emergencies > Flashcards

9.1 GI Emergencies Flashcards

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1
Q

what is the peritoneal cavity?

A

potential space between visceral and parietal peritoneum contains nothing other than approx 20mLs peritoneal fluid

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2
Q

visceral peritoneum

A

serial membrane not lining abdo wall

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3
Q

is a mesentery visceral peritoneum?

A

yes

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4
Q

parietal peritoneum

A

serial membrane lining abdo wall

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5
Q

what connects the greater and lesser sac?

A

foramen of Winslow, under free edge of lesser omentum

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6
Q

define primary peritonitis

A

spontaneous bacterial peritonitis is infection of ascitic fluid, cant be attributed to anything else. commonly associated with end stage liver disease (cirrhosis)

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7
Q

what causes large amounts of ascites fluid in cirrhosis?

A

fibrosis = portal HTN, increases hydrostatic pressure in veins draining gut
also less albumin so lower intravascular oncotic pressure

so fluid moves into peritoneal cavity

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8
Q

symptoms of primary peritonitis
and compare to secondary

A

abdo pain (gradual/acute), fever, vomiting. Lie still
milder

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9
Q

diagnosis of primary peritonitis

A

aspirate ascitic fluid, neutrophil count >250 cells/cm3

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10
Q

define secondary peritonitis

A

result of inflammatory process secondary to inflammation, perforation, gangrene

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11
Q

common causes of secondary bacterial peritonitis

A

-perforated peptic ulcer
-perforated appendix
-perforated diverticulum
-post surgery

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12
Q

non bacterial causes of secondary peritonitis

A

-tubal pregnancy that bleeds
-ruptured ovarian cyst

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13
Q

treatment of peritonitis

A

control infection
surgery if viscera ruptured
maintain organ functions

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14
Q

common causes of bowel obstruction in children

A

-intususseption
-intestinal atresia

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15
Q

common causes of bowel obstruction in adults

A

-adhesions
-incarcerated hernias

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16
Q

intestinal atresia

A

failure of recanalisation (especially duodenum) during development, presents soon after birth (cant have milk, vomit)

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17
Q

intussusception

A

one part of gut telescopes into adjacent section

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18
Q

best explanation for intussusception

A

lead point created by mass, that precipitates telescoping action

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19
Q

symptoms of intussusception

A

vomiting
abdo pain
haematochezia

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20
Q

treatment of intussusception

A

air enema- pushes it back
surgery- if air didn’t work, put it back/remove part of bowel

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21
Q

symptoms of small bowel obstruction

A

nausea, vomiting
abdo distension
absolute constipation

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22
Q

bilious vomiting

A

if small bowel obstruction is distal to where bile enters at 2nd part of duodenum

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23
Q

causes of small bowel obstruction

A

adhesions
hernias
IBD

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24
Q

what are adhesions?

A

abnormal fibrous bands between organs/tissues in abdo cavity that are normally separated

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25
consequence of adhesions
abdo pain due to reduced peristalsis
26
does surgery help adhesions?
yes can, but can also cause more
27
diagnosis of small bowel obstruction
-Hx of colicky pain 3-5mins for small int, 10-15 mins large int -abdo distension, increased/absent bowel sounds, hernia -CT abdo+pelvis
28
finding on CT for small bowel obstruction
>3cm (central position, place circulares)
29
common causes of large bowel obstruction
-colon cancer -strictures from diverticular disease -volvulus (sigmoid mainly, can be caecal)
30
symptoms of large bowel obstruction
gradual if cancer, acute with volvulus -change in bowel habit (overflow diarrhoea, cancer) -abdo distension -crampy abdo pain -nausea/vomiting (late)
31
what's a volvulus?
part of colon twists. around its mesentery (cuts off venous drainage, then arterial)
32
how do high fibre diets contribute to volvulus?
bulks up stool, sigmoid overloads and twists
33
which bowel does caecal volvulus obstruct?
both
34
investigations of volvulus, and typical sign
CT abdo and pelvis coffee bean sign due to distended sigmoid colon
35
relevance of competent oleo-caecal valve
colon cant distend proximally, so worsens large bowel obstruction as perforation more likely
36
compare appearance of small and large bowel xray
small -plica circulares (all way round) -<3cm -central large -<6cm -haustra incomplete -peripheral
37
what's acute mesenteric ischaemia?
symptomatic reduction in bood supply to GI tract
38
arterial compromise causes acute mesenteric ischaemia. give some ways
-arterial embolism/thrombosis affecting SMA -vasculitis narrowing artery -low CO e.g HF
39
where's the splenic flexure?
where transverse colon meets descending
40
venous compromise causes acute mesenteric ischaemia. give some ways
-mesenteric venous thrombosis -systemic coaguloptahy e.g malignancy
41
why could blood supply be limited at splenic flexure?
furthest from direct blood supply, anastomoses may not be enough
42
Why can acute mesenteric ischaemia be difficult to diagnose?
Symptoms fairly non specific e.g. pain (typocally L sided as splenic flexure fragile), nausea, vomiting
43
Typical presentation leading you to suspect acute mesenteric ischaemia
Older patient, agony, no onbvious issue on plapation, worse pain after eating
44
Why is the pain in acute mesenteric ischaemia worst 30mins after eating?
Need for Increased blood supply to gut for digestion
45
Investigations for acute mesenteric ischaemia
Bloods: metabolic acidosis and high lactate CT abdo and pelvis, CT angiography (Erect CXR air under diaphragm suggests perforation)
46
Treatment of acute mesenteric ischaemia
Surgery to resect ischaemic bowel Thrombolysis/angioplasty
47
Mortality in acute mesenteric ischaemia
Can be 70%
48
Define ulcer
Disruption in the mucosa, through to submucosa (muscularis mucosa)
49
Why can duodenal ulcers be bad?
Erode posteriorly in first part of duodenum and interrupt gastroduodenal artery
50
Pre, intra, and post hepatic causes of oesophageal varices
Pre: portal vein thrombosis Intra: cirrhosis, schistomiasis Post: RHF, hepatic vein thrombosis
51
Normal pressure in portal vein
5-10 mmHg
52
Portal and systemic drainage of oesophageal veins
Portal: L gastric, then portal Systemic: azygous, then SVC
53
2 ways to stop oesophageal varices bleeding
1. Banding- around base, necrosis 2. Transjugular intrahepatic porto systemic shunt- bridges portal to helatic vein by expanding metal
54
Typical presentation leading you to suspect AAA
Age over 60, abdo and back pain maybe smoker Dilated aorta on palpation
55
Define AAA
Permanent pathological dilation of aorta diameter >1.5 normal AP, usually 3cm or more
56
Usual cause of AAA
Degeneration of tunica media so elastin and collagen degrade and lumen dilates
57
Risk factors for AAA
Male Inherited Age Smoking
58
Symptoms of AAA
Asymptomatic normally, until rupture But also -back pain -abdo pain -pulsatile abdo mass -nausea if compress stomach -urinary frequency if compress bladder -back pain if compress vertebra
59
Where are most AAAs?
Infrarenal (90%)
60
Diagnosis of AAA
Physical exam -pulsatile abdo mass US -can detect free peritoneal blood CT -good for planning surgery
61
Non surgical treatment of AAA
Smoking cessation Control HTN Surveillance if less than 5.5cm
62
Surgical treatment of AAA
Endovascular metallic stent -via femoral artery If more then 5.5cm Open -clamp aorta, synthetic graft sutured in to replace diseased segment

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