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 emergency, according to GI site

• Know typical clinical presentation• Know underlying pathology• Know treatment strategy

Acute GI Emergencies - 1Acute GI Emergencies - 1

Classify by siteOesophagus – Acute

dysphagia

Perfusion

Bleeding

Stomach/duodenum –

Perfusion

Bleeding

Acute GI Emergencies - 2Acute GI Emergencies - 2

Gallbladder/Biliary TractCholecystitisCholangitisObstructive jaundice

Pancreas

Acute pancreatitis

Acute GI Emergencies - 3Acute GI Emergencies - 3

Small intestineIntestinal obstructionMesenteric Infarct(Infectious diarrhoea)Crohn’s DiseaseMeckel’s Diverticulum

Acute GI Emergencies - 4Acute GI Emergencies - 4

Large Bowel (+ App)Acute AppendicitisAcute DiverticulitisLower GI bleedingPerforationIntestinal obstructionUncontrolled ulcerative colitis

Acute GI Emergencies - 5Acute GI Emergencies - 5

Perintoneal cavityPeritonitis

Intra-abdominal abscess

Oesophagus - BleedingOesophagus - Bleeding

Oesophagitis, Mallroy Weiss, Varices

Variceal bleeding – can be catastrophic

Treatment - varicesSengstaken tubeSomatostatin injection

Oesophagus – Acute DysphagiaOesophagus – Acute Dysphagia

Presentation – cannot swallow

May have benign stricture or cancer Triggered by food bolus or tabletTreatment -

remove bolusdeal with underlying

oesophageal disease

Oesophagus – PerforationOesophagus – Perforation

High mortality

May follow endoscopy Presentation – acute chest/abdominal painAir in mediastinum and soft tissuesTreatment -

surgery - benignintubation - malignant

Stomach/duodenum – Perforation

Presentation – abdominal painrigidityperitonism, shock Air under diaphragm on X-rayTreatment

antibiotics, resuscitaterepair

Stomach/duodenum – BleedingStomach/duodenum – Bleeding

Presentation – Haematemesis +/-MelaenaSeverity

Increased PR>90Fall BP<100

Causes DU, erosions, GU

Treatment – transfusioninject DU

Gall bladder/Biliary TractGall bladder/Biliary Tract

Obstructive Jaundice Yellow skin, scleraePale stools, dark urine+/- Pain+/- Courvoisier’s signCT – dilated bile ducts

Establish diagnosisGallstonesCa Head of Pancreas

Appropriate treatment

Gall bladder/Biliary TractGall bladder/Biliary Tract

Acute Cholecystitis Presentation

Acute RUQ pain+/- Pyrexia+/- RigorsDiagnosis – FBC, WBCC, USSTreatment – Antibiotics,

analgesicsEarly surgery

PancreasPancreas

Acute pancreatitis Constant pain, vomiting,

shock

CausesGallstones, orAlcohol

DiagnosisSerum amylaseelevation, USScomplications

pseudocyst, phlegmonabcess

Small IntestineSmall Intestine

Meckel’s Diverticulum rarediverticulum of terminal ileumcan be lined by gastric epithelium can perforate can present like appendicitis

Small IntestineSmall Intestine

Intestinal obstruction

May arise due to adhesions, hernia, tumour

Presentationcolicky abdominal pain,vomiting, constipation

Treatmentresuscitate/operate

Small IntestineSmall Intestine

Mesenteric infarct

Sudden occlusion of smallbowel arterial supply

Sudden onset of abdominal pain, shockPeritonitisTreatment

resuscitate/operate

Large bowelLarge bowel

Acute diverticulitis

Maximal in (L) colonPresentation LIF pain,

fever, tenderness,leukocytosis

Middle aged or elderlyTreatment – conservative

antibiotics, fluids, bed rest

Large bowelLarge bowel

Lower GI bleeding Diverticulum, colitis,Crohn’s tumourPresent with Fresh Red Blood P/RTendency to be more conservative than

with upper GI

resuscitate, transfusion

Large bowelLarge bowel

Perforation Diverticulum, colitis,

sudden severe abdominal pain,rigidity

Faecal peritonitisPyrexia, shockFree gas on X-ray

Treatmentresuscitate, operate

Inflammatory Bowel DiseaseInflammatory Bowel Disease

Recurrent regenerationIncreased risk of tumour formation

14.8 X

Large BowelLarge Bowel

Ulcerative colitis

Presents – bloodydiarrhoea, pyrexialeukocytosismay develop toxic megacolon

Treatment – steroidsSurgery on failure

Peritoneal cavityPeritoneal cavity

Acute peritonitis

any perforation,pancreatitisabdominal pain, tendernessguarding, silent abdomenshock

Treatment – underlying condition

Acute GI Emergencies - ConclusionsAcute GI Emergencies - Conclusions

Conditions which commonly present GI emergency, according to GI site

Typical clinical presentationUnderlying pathologyTreatment strategy