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Acute Gastrointestinal EmergenciesAcute Gastrointestinal Emergencies
F C Campbell
Dept of Surgery
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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
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Acute GI Emergencies - 1Acute GI Emergencies - 1
Classify by site
Oesophagus !cute
dysphagia
"erfusion#leeding
Stomach$duodenum
"erfusion
#leeding
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Acute GI Emergencies - 2Acute GI Emergencies - 2
Gallbladder$#iliary %ract
Cholecystitis
Cholangitis
Obstructi&e 'aundice
"ancreas
!cute pancreatitis
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Acute GI Emergencies - 3Acute GI Emergencies - 3
Small intestine
Intestinal obstruction
(esenteric Infarct
)Infectious diarrhoea*
Crohn+s Disease
(ecel+s Di&erticulum
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Acute GI Emergencies - 4Acute GI Emergencies - 4
-arge #owel ). !pp*
!cute !ppendicitis
!cute Di&erticulitis
-ower GI bleeding
"erforation
Intestinal obstruction
/ncontrolled ulcerati&e colitis
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Acute GI Emergencies - 5Acute GI Emergencies - 5
"erintoneal ca&ity
"eritonitis
Intra0abdominal abscess
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Oesophagus - BleeingOesophagus - Bleeing
Oesophagitis, (allroy 1eiss,2arices
2ariceal bleeding can becatastrophic
%reatment 0 &arices
Sengstaen tube
Somatostatin in'ection
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Oesophagus ! Acute "#sphagiaOesophagus ! Acute "#sphagia
"resentation cannot swallow
(ay ha&e benignstrictureor cancer
%riggered by food bolus or tablet%reatment 0
remo&e bolus
deal with underlying
oesophageal disease
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Oesophagus ! $er%orationOesophagus ! $er%oration
3igh mortality
(ay follow endoscopy
"resentation acute chest$abdominal pain!ir in mediastinum and soft tissues
%reatment 0
surgery 0 benign
intubation 0 malignant
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&tomach'uoenum ! $er%oration
"resentation
abdominal pain
rigidity
peritonism, shoc
!ir under diaphragm on 40ray
%reatment
antibiotics, resuscitate
repair
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&tomach'uoenum ! Bleeing&tomach'uoenum ! Bleeing
"resentation
3aematemesis .$0
(elaena
Se&erity
Increased "5678
Fall #"9:88
Causes
D/, erosions, G/
%reatment transfusion
in'ect D/
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Gall blaer'Biliar# (ractGall blaer'Biliar# (ract
Obstructi&e ;aundice
Yellow skin, sclerae
Pale stools, dark urine
.$0 "ain
.$0 Cour&oisier+s sign
C% dilated bile ducts
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Gall blaer'Biliar# (ractGall blaer'Biliar# (ract
!cute Cholecystitis
"resentation
!cute 5/= pain
.$0 "yre>ia
.$0 5igors
Diagnosis F#C, 1#CC, /SS
%reatment !ntibiotics,
analgesics
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$ancreas$ancreas
!cute pancreatitis
Constant pain, &omiting,
shoc
Causes
Gallstones, or
!lcohol
Diagnosis
Serum amylaseele&ation, /SS
complications
pseudocyst, phlegmon
abcess
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&mall Intestine&mall Intestine
(ecel+s Di&erticulum
rare
di&erticulum of terminal ileum
can be lined by gastric epithelium
can perforate
can present lie appendicitis
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&mall Intestine&mall Intestine
Intestinal obstruction
(ay arise due to
adhesions, hernia, tumour
"resentation
colicy abdominal pain,
&omiting, constipation
%reatment
resuscitate$operate
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&mall Intestine&mall Intestine
(esenteric infarct
Sudden occlusion of small
bowel arterial supply
Sudden onset of abdominal pain, shoc
"eritonitis
%reatment
resuscitate$operate
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)arge bo*el)arge bo*el
!cute di&erticulitis
(a>imal in )-* colon
"resentation -IF pain,
fe&er, tenderness,
leuocytosis
(iddle aged or elderly
%reatment conser&ati&e
antibiotics, fluids, bed rest
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)arge bo*el)arge bo*el
-ower GI bleeding
Di&erticulum, colitis,
Crohn+s tumour"resent with Fresh 5ed #lood "$5
%endency to be more conser&ati&e thanwith upper GI
resuscitate, transfusion
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)arge bo*el)arge bo*el
"erforation
Di&erticulum, colitis,
sudden se&ere abdominal pain,rigidity
Faecal peritonitis
"yre>ia, shoc
Free gas on 40ray
%reatment
resuscitate, operate
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In%lammator# Bo*el "iseaseIn%lammator# Bo*el "isease
5ecurrent regeneration
Increased ris of tumour formation
:?@A 4
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)arge Bo*el)arge Bo*el
/lcerati&e colitis
"resents bloody
diarrhoea, pyre>ialeuocytosis
may de&elop to>ic megacolon
%reatment steroids
Surgery on failure
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$eritoneal cavit#$eritoneal cavit#
!cute peritonitis
any perforation,
pancreatitisabdominal pain, tenderness
guarding, silent abdomen
shoc
%reatment underlying condition
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Acute GI Emergencies - +onclusionsAcute GI Emergencies - +onclusions
Conditions which commonly present
GI emergency, according to
GI site
%ypical clinical presentation/nderlying pathology
%reatment strategy
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