Acute Conditions

Question 1

What defines an upper GI bleed? What are the symptoms? (5)

Answer 1

Bleeding proximal to the ligament of Treitz

1. Nausea
2. Haematemesis
3. Coffee ground vomit
4. Melaena
5. Anaemia

Question 2

What are the commonest causes of upper GI bleeds? (5)

Answer 2

1. Peptic ulcers
2. Oesophagitis
3. Mallory-Weiss tears
4. Gastroduodenal erosions
5. Ruptured varices

Question 3

What Ix are done for someone with a suspect upper GI bleed? (2)

Answer 3

1. Group and save/cross match

2. Endoscopy (to diagnose and treat)

Question 4

What are the RFs for upper GI bleeds? (4)

Answer 4

1. NSAIDs (PUD)
2. Alcoholism (cirrhosis = varices)
3. Chronic liver disease (cirrhosis = varices)
4. H. pylori

Question 5

What is the management for someone with an upper GI bleed? (2)

Answer 5

If in shock:

1. Crystalloid fluid + RBCs and FFP.
2. Emergency endoscopic surgery

Question 6

What is acute pancreatitis?

Answer 6

Inflammation and subsequent auto-digestion of the pancreas

Question 7

What are the signs/symptoms of acute pancreatitis? (4)

Answer 7

1. Severe stabbing pain radiating to the back (worse w movement)
2. N+V
3. Raised serum amylase + lipase
4. Abd. bruising (Grey-Turner’s + Cullens)

Question 8

What are Grey-Turner’s and Cullen’s signs?

Answer 8

GT= bruising on the flanks 
C = para-umbilical bruising

Question 9

What Ix are done for someone with suspected pancreatitis?

Answer 9

Serum lipase and amylase (3X normal)

Question 10

What is the management for someone with acute pancreatitis? (3)

Answer 10

1. Fluids (prevent pancreatic necrosis)
2. Analgesia
3. Anti-emetics

Question 11

What are the signs/symptoms of a bowel obstruction? (7)

Answer 11

1. Abd. pain (colicky)
2. Distension
3. Hyper-resonant on percussion
4. Complete or partial constipation
5. Tinkling sounds on auscultation
6. Vomiting bile (small bowel obstruction)
7. Weight loss and blood in stool (large bowel obstruction - malignancy)

Question 12

What are the causes of a small bowel obstruction? (4)

Answer 12

1. Previous surgery (adhesions)
2. Hernia incarceration (can’t be put back)
3. Crohn’s (inflammation = scar tissue = stricture)
4. Appendicitis

Question 13

What are the causes of a large bowel obstruction? (4)

Answer 13

1. Colorectal malignancy
2. Colonic volvulus
3. Benign stricture (from UC)
4. Severe constipation

Question 14

What Ix are done for someone with a suspected bowel obstruction? (3)

Answer 14

1. AbXR
2. CXR
3. CT abd. + pelvis

Question 15

What is the management for someone with a bowel obstruction? (3)

Answer 15

1. Fluids + NG tube to suck out gastric gastric contents to give the bowel a rest.
2. Analgesia
3. Laproscopic surgery

Question 16

What are the signs/symptoms of peritonitis? (6)

Answer 16

1. Severe pain (worse w movement)
2. Rigidity/guarding
3. Distension
4. Fever
5. WL
6. Rebound tenderness

Question 17

What are the causes of peritonitis? (4)

Answer 17

1. Perforated viscus
2. Pranceatitis
3. PU perforation
4. Ruptured appendix

Question 18

What Ix are done for someone with suspected peritonitis? (3)

Answer 18

1. AbXR (dilated bowel loops, pneumoperitoneum)
2. FBC (raised CRP + WCC)
3. CT

Question 19

What is the management for someone with peritonitis? (3)

Answer 19

1. Treat underlying cause
2. IV fluids
3. ABx (met, gent, coamox)

Question 20

What are the complications of peritonitis? (3)

Answer 20

1. Sepsis
2. Shock
3. Peritoneal abscess

Question 21

What is a perforated viscus?

Answer 21

A perforation somewhere in the GI tract (upper has more sudden onset)

Question 22

What are the symptoms of a perforated viscus? (5)

Answer 22

1. Severe pain at the site of perforation
2. N+V
3. Haematemesis/melaena
4. Fever/chills
5. Rebound tenderness

Question 23

What Ix are done for someone with suspected perforated viscus? (3)

Answer 23

1. AXR (pneumoperitoneum)
2. CT abd. + pelvis
3. FBC (raised WCC + CRP)

Question 24

What is the management for someone with a perforated viscus? (2)

Answer 24

1. IV fluids + NG tube to rest bowel

2. Laproscopic surgery to close perforation + clean peritoneum

Question 25

What would be seen on an AbXR for someone w a small bowel obstruction? (2)

Answer 25

1. Dilated intestinal loops with visible circular folds | 2. Absence of gas in rectum

Question 26

What would be seen on an AbXR for someone w a large bowel obstruction?

Answer 26

1. Gaseous distension of large bowel | 2. Kidney bean shape seen in volvulus

Question 27

Which area of the large bowel is most susceptible to perforation?

Answer 27

Caecum

Question 28

Which organs cause epigastric pain?

Answer 28

Foregut (stomach, pancreas, liver, biliary tree, 1st 2/3 duodenum)

Question 29

Which organs cause periumbilical pain?

Answer 29

Midgut (last 1/3 duodenum, jejunum, ileum and 2/3 transverse colon)

Question 30

Which organs cause hypogastric pain?

Answer 30

Hindgut (last 1/3 transverse colon to rectum)