key: cord-0034421-lwsbpyhh
authors: Banerjee, Ashis
title: Gastrointestinal Emergencies
date: 2017-03-16
journal: Emergency Clinical Diagnosis
DOI: 10.1007/978-3-319-50718-7_12
sha: 05eee1d3c765df5f8f9bebb99b68392b658c019f
doc_id: 34421
cord_uid: lwsbpyhh

Oropharyngeal: Neurological motility disorder: stroke; movement disorders (Parkinson’s disease, progressive supranuclear palsy); amyotrophic lateral sclerosis; multiple sclerosis; bulbar palsy; brainstem tumour; pseudobulbar palsy. Striated muscle disease: myasthenia gravis; myotonic dystrophy; polymyositis; dermatomyositis; inflammatory myopathy; muscular dystrophy. Reduced salivary flow leading to dry mouth (xerostomia): Sjogren’s syndrome; anticholinergics; antihistamines; ACE inhibitors; alpha-adrenergic blockers. Structural lesions: inflammatory: pharyngitis, tonsillar abscess; head and neck tumours; pharyngeal diverticula; ulcerative stomatitis; painful glossitis; anterior marginal cervical osteophytes (especially with diffuse idiopathic skeletal hyperostosis). Metabolic: hypothyroidism; hyperthyroidism; steroid myopathy.

• Echogenic objects within the echo-free gallbladder lumen • Distal acoustic shadowing • Mobile, and move with changes in position of the patient: demonstrate gravitational dependency, seeking the most dependent portion of the gallbladder • The lumen of the gallbladder may contain lithogenic bile, known as sludge, which has low-level echogenicity (it appears less white than stones), tends to layer out in the dependent portion of the gallbladder with a flat fluid: fluid interface, and fails to shadow.

• Symmetrical thickening of the entire gall bladder wall >3 mm • Dilated gall bladder: >10 cm in length;

>4 cm in width • Echo-poor halo around the gallbladder-due to intramural oedema-alternating echogenic and hypo-echoic layers within the wall • Gallstones • Impacted stone in neck of gallbladder • Gas in gallbladder wall • The sonographic Murphy sign represents local tenderness and inspiratory arrest over the sonographically visualised gallbladder • Increased flow with colour Doppler • Peri-cholecystic fluid: focal anechoic collection adjacent to the gallbladder, especially in the region of the fundus; collection >1 cm indicates gallbladder perforation 

gastritis (alcoholic)/gastroenteritis (viral, bacterial, parasitic) use: • Opiates • Cardiac glycosides: digoxin • Cancer chemotherapy • Antibiotics Drug toxicity: paracetamol; digoxin

theophylline Drug abuse: narcotics; alcohol; narcotic withdrawal CNS: • Migraine • Labyrinthine disease: acute labyrinthitis

Psychological (self-induced)-eating disorders: • Anorexia nervosa • Bulimia • Psychogenic vomiting

Metabolic/endocrine • Hyperparathyroidism • Chronic kidney disease • Acute adrenocortical insufficiency • Diabetic ketoacidosis • Acute liver failure Pregnancy: • Physiological • Hyperemesis gravidarum Genitourinary: pyelonephritis Miscellaneous

Large intestinal obstruction • Small intestinal obstruction • Paralytic ileus • Cleansing enemas • Gastroenteritis • Hypokalaemia • Uraemia • Jejunal diverticulosis • Mesenteric thrombosis • Normal (always <2.5 cm long) • Peritoneal metastases syndrome); hepatic veno-occlusive disease; portal vein thrombosis; hepatic artery thrombosis; congestive heart failure

LCAT (lecithin-cholesterol acyltransferase) deficiency

Reye's syndrome; hepatolenticular degeneration; tyrosinaemia Malignancy: primary liver tumours (hepatocellular carcinoma, cholangiocarcinoma); secondary tumours (extensive hepatic metastases from adenocarcinoma, melanoma, lymphoma); leukaemia Miscellaneous: adult-onset Still's disease; heatstroke Laboratory findings • Hepatic injury

• Hepatic dysfunction: coagulopathy not correctable with vitamin K; hypoglycaemia; hypoalbuminaemia

Cholestasis causing vitamin K malabsorption, with impaired synthesis of vitamin K-dependent coagulation factors II

Hepatocellular disease leading to failure of γ carboxylation of coagulation factors and reduced synthesis of all coagulation factors except Factor VIII and von Willebrand factor Factors precipitating hepatic encephalopathy • Gastrointestinal bleeding • Sepsis; spontaneous bacterial peritonitis • Azotemia and hypovolaemia

); opiates; tricyclic antidepressant drugs • Hepatocellular injury • Constipation • High protein diet • Hypoglycaemia • Post-portosystemic shunt placement Causes of hepatomegaly • Infection: viral: hepatitis (acute; chronic), infectious mononucleosis; parasitic: malaria; abscess: pyogenic, amoebic • Vascular congestion: supra-hepatic: congestive heart failure, right ventricular failure, constrictive pericarditis, Budd-Chiari syndrome; intra-hepatic: veno-occlusive disease • Infiltration: neoplasm (primary: hepatocellular carcinoma; metastases); haematological malignancy: lymphoma, leukaemia; granuloma: sarcoidosis, tuberculosis

Niemann-Pick; Gaucher); metals: copper (hepatolenticular degeneration), iron (haemochromatosis); abnormal protein: alpha1-antitrypsin; glycogen: glycogen storage disease • Biliary tract obstruction: extra-hepatic biliary obstruction (cholelithiasis; tumour) Causes of splenomegaly • Infection: viral: infectious mononucleosis, cytomegalovirus, HIV; bacterial: tuberculosis, infective endocarditis, brucellosis, syphilis, typhoid; fungal: histoplasmosis; parasitic: malaria, visceral leishmaniasis, hydatid disease, schistosomiasis; rickettsial: typhus • Congestive splenomegaly due to portal hypertension: cirrhosis (alcoholic liver disease; primary biliary cirrhosis; hepatitis B/C); portal vein thrombosis