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Gastrointestinal Emergencies

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Gastrointestinal Emergency	Clinical Presentation	Diagnostic Tests	Treatment
Acute Appendicitis	Periumbilical pain migrating to the right lower quadrant (McBurney's point). Anorexia, nausea, vomiting, and fever. Rebound tenderness, guarding, and positive Rovsing's sign.	Clinical diagnosis supported by elevated WBC count. Ultrasound or CT scan of the abdomen to confirm the diagnosis. Urinalysis to rule out urinary tract infections or other causes of symptoms.	Prompt surgical intervention (appendectomy). Preoperative IV fluids and antibiotics (e.g., ceftriaxone and metronidazole). Analgesia and supportive care.
Acute Pancreatitis	Sudden onset of severe epigastric pain radiating to the back. Nausea, vomiting, and abdominal tenderness. Possible signs of systemic inflammation, such as fever, tachycardia, and hypotension.	Serum amylase and lipase levels elevated (lipase more specific). Abdominal ultrasound to assess for gallstones or biliary obstruction. CT scan of the abdomen to evaluate the extent of inflammation and complications.	Supportive care with IV fluids, analgesia, and bowel rest (NPO). Management of complications such as infected pancreatic necrosis or abscess formation. ERCP if biliary obstruction or cholangitis is suspected.
Perforated Peptic Ulcer	Sudden onset of severe, sharp abdominal pain with guarding and rigidity. Signs of peritonitis, including rebound tenderness and absent bowel sounds. History of peptic ulcer disease or NSAID use.	Upright chest X-ray showing free air under the diaphragm. CT scan of the abdomen to confirm the diagnosis and assess the extent of perforation. Blood tests showing leukocytosis and possibly elevated serum amylase.	Immediate surgical intervention (exploratory laparotomy) to repair the perforation. Broad-spectrum IV antibiotics (e.g., piperacillin-tazobactam) and IV fluids. Nasogastric tube placement for gastric decompression.
Acute Mesenteric Ischemia	Sudden, severe abdominal pain out of proportion to physical findings. Nausea, vomiting, and bloody diarrhea may occur. History of atrial fibrillation, heart failure, or recent myocardial infarction.	CT angiography of the abdomen to assess mesenteric blood flow. Serum lactate levels may be elevated due to tissue ischaemia. Abdominal X-ray may show signs of bowel necrosis or perforation.	Immediate surgical exploration or angiography with possible embolectomy. Anticoagulation with heparin to prevent further thromboembolic events. IV fluids, broad-spectrum antibiotics, and supportive care.
Esophageal Perforation (Boerhaave Syndrome)	Sudden onset of severe chest pain, often following forceful vomiting. Subcutaneous emphysema (crepitus) in the neck or chest. Signs of sepsis, including fever, tachycardia, and hypotension.	Contrast oesophagography with water-soluble contrast to identify the perforation. CT scan of the chest to assess the extent of the perforation and mediastinal involvement. Blood tests showing leukocytosis and elevated inflammatory markers.	Immediate surgical consultation for repair of the perforation. IV broad-spectrum antibiotics and antifungals to prevent mediastinitis. Supportive care, including IV fluids, pain management, and NPO status.
Volvulus	Sudden onset of crampy abdominal pain, distension, and vomiting. Obstipation (inability to pass gas or stool) and signs of bowel obstruction. May present with a "whirl sign" on imaging indicating twisted bowel.	Abdominal X-ray showing a "coffee bean" sign, suggestive of sigmoid volvulus. CT scan of the abdomen to confirm the diagnosis and assess for bowel ischaemia. Contrast enema may be diagnostic and therapeutic for sigmoid volvulus.	Endoscopic decompression for sigmoid volvulus if no signs of ischaemia. Emergency surgery if there are signs of bowel ischaemia or perforation. IV fluids, electrolytes, and antibiotics as supportive care.
Upper Gastrointestinal Bleeding	Haematemesis (vomiting blood) or melena (black, tarry stools). Hypotension, tachycardia, and signs of shock in severe cases. Possible history of peptic ulcer disease, liver disease, or use of NSAIDs/anticoagulants.	Endoscopy to identify the source of bleeding (e.g., ulcer, varices). Laboratory tests including CBC, coagulation profile, and blood type and crossmatch. Nasogastric lavage may help determine the presence of active bleeding.	Endoscopic therapy (e.g., banding, clipping, or injection) to control bleeding. IV proton pump inhibitors for peptic ulcer bleeding. IV octreotide for suspected variceal bleeding, along with antibiotics and possible TIPS (transjugular intrahepatic portosystemic shunt). Resuscitation with IV fluids and blood transfusions as needed.
Acute Cholecystitis	Right upper quadrant pain, often radiating to the right shoulder or back. Fever, nausea, vomiting, and positive Murphy's sign (pain on palpation of the RUQ during inspiration). History of gallstones or biliary colic.	Abdominal ultrasound showing gallstones, gallbladder wall thickening, and pericholecystic fluid. Laboratory tests showing leukocytosis and elevated liver enzymes. HIDA scan (hepatobiliary iminodiacetic acid scan) if diagnosis is unclear.	IV antibiotics (e.g., ceftriaxone and metronidazole) and IV fluids. Cholecystectomy (surgical removal of the gallbladder) within 24-48 hours. Analgesia and supportive care.
Intestinal Obstruction	Crampy abdominal pain, vomiting, abdominal distension, and inability to pass gas or stool. High-pitched bowel sounds progressing to absent bowel sounds in later stages. Possible history of previous abdominal surgery, hernia, or malignancy.	Abdominal X-ray showing air-fluid levels and dilated bowel loops. CT scan of the abdomen to identify the site and cause of obstruction. Laboratory tests to assess for electrolyte imbalances and signs of dehydration.	NPO status and nasogastric tube for bowel decompression. IV fluids, electrolyte replacement, and pain management. Surgical intervention if there is evidence of strangulation, ischaemia, or complete obstruction.
Acute Diverticulitis	Left lower quadrant pain, fever, and altered bowel habits (diarrhea or constipation). Nausea, vomiting, and abdominal tenderness on palpation. History of diverticulosis or prior episodes of diverticulitis.	CT scan of the abdomen with contrast showing inflamed diverticula, bowel wall thickening, and possible abscess. Laboratory tests showing leukocytosis and elevated CRP. Colonoscopy is contraindicated during the acute phase due to the risk of perforation.	Outpatient management with oral antibiotics (e.g., ciprofloxacin and metronidazole) for mild cases. Hospitalization with IV antibiotics and fluids for severe cases or complications (e.g., abscess, perforation). Surgical consultation for recurrent cases or complications.

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