1. Acute Gastrointestinal EmergenciesAcute Gastrointestinal Emergencies
• F C Campbell
• Dept of Surgery

2. 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

3. Acute GI Emergencies - 1Acute GI Emergencies - 1
Classify by site
Oesophagus – Acute
dysphagia
Perfusion
Bleeding
Stomach/duodenum –
Perfusion
Bleeding

4. Acute GI Emergencies - 2Acute GI Emergencies - 2
Gallbladder/Biliary Tract
Cholecystitis
Cholangitis
Obstructive jaundice
Pancreas
Acute pancreatitis

5. Acute GI Emergencies - 3Acute GI Emergencies - 3
Small intestine
Intestinal obstruction
Mesenteric Infarct
(Infectious diarrhoea)
Crohn’s Disease
Meckel’s Diverticulum

6. Acute GI Emergencies - 4Acute GI Emergencies - 4
Large Bowel (+ App)
Acute Appendicitis
Acute Diverticulitis
Lower GI bleeding
Perforation
Intestinal obstruction
Uncontrolled ulcerative colitis

7. Acute GI Emergencies - 5Acute GI Emergencies - 5
Perintoneal cavity
Peritonitis
Intra-abdominal abscess

8. Oesophagus - BleedingOesophagus - Bleeding
Oesophagitis, Mallroy Weiss,
Varices
Variceal bleeding – can be
catastrophic
Treatment - varices
Sengstaken tube
Somatostatin injection

9. Oesophagus – Acute DysphagiaOesophagus – Acute Dysphagia
Presentation – cannot swallow
May have benign stricture or cancer
Triggered by food bolus or tablet
Treatment -
remove bolus
deal with underlying
oesophageal disease

10. Oesophagus – PerforationOesophagus – Perforation
High mortality
May follow endoscopy
Presentation – acute chest/abdominal pain
Air in mediastinum and soft tissues
Treatment -
surgery - benign
intubation - malignant

11. Stomach/duodenum – Perforation
Presentation –
abdominal pain
rigidity
peritonism, shock
Air under diaphragm on X-ray
Treatment
antibiotics, resuscitate
repair

12. Stomach/duodenum – BleedingStomach/duodenum – Bleeding
Presentation –
Haematemesis +/-
Melaena
Severity
Increased PR>90
Fall BP<100
Causes
DU, erosions, GU
Treatment – transfusion
inject DU

13. Gall bladder/Biliary TractGall bladder/Biliary Tract
Obstructive Jaundice
Yellow skin, sclerae
Pale stools, dark urine
+/- Pain
+/- Courvoisier’s sign
CT – dilated bile ducts
Establish diagnosis
Gallstones
Ca Head of Pancreas
Appropriate treatment

14. Gall bladder/Biliary TractGall bladder/Biliary Tract
Acute Cholecystitis
Presentation
Acute RUQ pain
+/- Pyrexia
+/- Rigors
Diagnosis – FBC, WBCC, USS
Treatment – Antibiotics,
analgesics
Early surgery

15. PancreasPancreas
Acute pancreatitis
Constant pain, vomiting,
shock
Causes
Gallstones, or
Alcohol
Diagnosis
Serum amylase
elevation, USS
complications
pseudocyst, phlegmon
abcess

16. Small IntestineSmall Intestine
Meckel’s Diverticulum
rare
diverticulum of terminal ileum
can be lined by gastric epithelium
can perforate
can present like appendicitis

17. Small IntestineSmall Intestine
Intestinal obstruction
May arise due to
adhesions, hernia, tumour
Presentation
colicky abdominal pain,
vomiting, constipation
Treatment
resuscitate/operate

18. Small IntestineSmall Intestine
Mesenteric infarct
Sudden occlusion of small
bowel arterial supply
Sudden onset of abdominal pain, shock
Peritonitis
Treatment
resuscitate/operate

19. Large bowelLarge bowel
Acute diverticulitis
Maximal in (L) colon
Presentation LIF pain,
fever, tenderness,
leukocytosis
Middle aged or elderly
Treatment – conservative
antibiotics, fluids, bed rest

20. Large bowelLarge bowel
Lower GI bleeding
Diverticulum, colitis,
Crohn’s tumour
Present with Fresh Red Blood P/R
Tendency to be more conservative than
with upper GI
resuscitate, transfusion

21. Large bowelLarge bowel
Perforation
Diverticulum, colitis,
sudden severe abdominal pain,
rigidity
Faecal peritonitis
Pyrexia, shock
Free gas on X-ray
Treatment
resuscitate, operate

22. Inflammatory Bowel DiseaseInflammatory Bowel Disease
Recurrent regeneration
Increased risk of tumour formation
14.8 X

23. Large BowelLarge Bowel
Ulcerative colitis
Presents – bloody
diarrhoea, pyrexia
leukocytosis
may develop toxic megacolon
Treatment – steroids
Surgery on failure

24. Peritoneal cavityPeritoneal cavity
Acute peritonitis
any perforation,
pancreatitis
abdominal pain, tenderness
guarding, silent abdomen
shock
Treatment – underlying condition

25. Acute GI Emergencies - ConclusionsAcute GI Emergencies - Conclusions
Conditions which commonly present
GI emergency, according to
GI site
Typical clinical presentation
Underlying pathology
Treatment strategy