Week 8 GI Emergencies Flashcards
Describe the flow of blood that leads to oesophageal varices
What is meant by the coronary vein re. oesophageal varices
Also known as the left gastric vien
What could lead to gastric varices
Portal hypertension in the coronary/left gastric vein + splenic vein
What is the commonest emergency for a Gastroenterologist
Upper GI bleed
Two most common causes in upper GI bleed
Peptic ulcer disease 36%
Varices 11%
What is the prognosis for a variceal bleed?
1/3 episodes are fatal
Amongst suvivors1/3 will re-bleed within 6 months
Only 1/3 will survive over 1 y
Takehome message: NO GOOD
What is the prefered treatment for both:
OESOPHAGEL VARICES
GASTRIC/ ECTOPIC VARICES
For both:
Endoscopy
Endotracheal intubation /critical care management to avoid aspiration
OESOPHAGEL VARICES: Banding ligation preferred
GASTRIC/ ECTOPIC VARICES: histoacryl or thrombin injection
When does an erosion become an ulcer?
When it penetrates the muscularis mucosae (interna)
What are the two acute risks of a GI ulcer?
Bleed
Perforate
What are the signs of a perforated ulcer?
Peritonitis
Shock
Sudden severe pain
Shoulder tip pain
Air under the diaphragm (bilateral)
What are the signs of acute pancreatitis
- Acute epigastric pain back (50%), RUQ or LUQ (right/left upper quadrant)
Colicy (extreme abdominal continuous pain) - Nausea, vomiting (75%)
- Collapse or hypotension
- Fever
- Tachycardia
- Obstructive Jaundice (30%)
High Amylase > x 3 normal or Lipase ( longer ½ life)
Causes of acute pancreatitis
- **Gallstones (small)
- Alcohol**
- post ERCP (Endoscopic Retrograde Cholangiopancreatography) pancreatitis ( 3-8 % of ERCPs)
- Metabolic (hyperlipidaemia- high triglycerides, hypercalcaemia)
- Drug induced (azathioprine, steroids)
- Viral
- Pancreatic Ca
- Idiopathic
- Autoimmune
What is a risk of a ERCP (Endoscopic Retrograde Cholangiopancreatography)
Acute pancreatisis
3-8 % of ERCPs
What are Cullen’s sign and Grey Turner’s sign?
Cullen’s sign and Grey Turner’s sign are both clinical signs indicating internal bleeding, often associated with severe acute pancreatitis.
Why can you get hypoxia in acute pancreatitis?
Acute pancreatitis triggers a systemic inflammatory response.
This leads to increased capillary permeability, pulmonary edema, and possibly Acute Respiratory Distress Syndrome (ARDS).
This leads ot hypoxia
Why can you get hypocalcaemia in acute pancreatitis?
- In acute pancreatitis, pancreatic enzymes (especially lipase) escape into the surrounding tissue.
- These enzymes break down fat (lipolysis), releasing free fatty acids.
- Free fatty acids bind to calcium to form insoluble calcium soaps (saponification).
- This process lowers circulating calcium levels → hypocalcaemia.
Why can you end up with hypovolaemia in acute pancreatitis?
- Vascular permiability -> loos of fluid into third space
- Reduced fluid intake/ vomiting
- Paralytic ileus -> diarrhoea
Why can you end up with renal failure in acute pancreatitis?
From the hypovolaemia
Complications of acute pancreatitis
- Hypocalcaemia and hypoxia.
- Paralytic ileus
- Hypovolaemia
- Renal failure
- Disseminate Intravascular Coagulation
- Effusions
Whatis McBurney’s point?
Surface landmark 2/3 from navel to anteiror superior iliac spine.
Represent appendix
What might a blood test show in appendicitis?
Elevated white blood cell count
What stimuli do abdominal visceral nociceptors respond to?
mechanical and chemical (substances released in response to local injury)
What kind of mechanical stimulus are abdominal visceral nociceptors responsive to?
Stretch
Cutting, tearing, or crushing of viscera does not result in pain
How is a diagnoses made for acute pancreatitis
Raised amylase/lipase
