Chapter 25 Gastrointestinal emergencies
The aim of emergency department assessment of patients with gastrointestinal (GIT) emergencies is to rapidly detect and stabilise those patients requiring urgent surgical or procedural intervention. In pursuing this aim the processes of assessment, investigations appropriate to the disease and management should be followed in an orderly and purposeful manner and must be performed simultaneously in the seriously ill.
ACUTE ABDOMEN
Assessment
History
Examination
Abdomen
Special signs
Note: Cervical excitation is a ‘classic’ sign of ectopic pregnancy and pelvic inflammatory disease but is an observer-dependent sign.
OTHER SYSTEMS
Investigations
Immediate
Value of investigations
Abdominal ultrasound is usually indicated for right upper quadrant pain and cholelithiasis, obstructive uropathy, pelvic pathology, suspected abdominal aortic aneurysm (in stable patients) and abdominal masses. It is the investigation of choice in many paediatric patients, e.g. intussusception, pyloric stenosis, appendicitis. Pelvic ultrasound is essential for the diagnosis of gynaecological and pregnancy-related diseases.