| 🪱 Acute Appendicitis |
- Periumbilical pain migrating to right iliac fossa.
- Anorexia, nausea, vomiting and fever.
- McBurney’s point tenderness, guarding, rebound or Rovsing’s sign.
- Children, older adults and pregnancy may present atypically.
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- Clinical assessment and observations.
- FBC, CRP, U&E, pregnancy test in people of childbearing potential.
- Urinalysis to assess urinary differential.
- Ultrasound in children/pregnancy where appropriate.
- CT abdomen/pelvis often used in adults if diagnosis uncertain.
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- Nil by mouth, IV fluids, analgesia and antiemetics.
- Early surgical review.
- IV antibiotics if perforation, sepsis or surgery planned according to local policy.
- Appendicectomy is standard for many patients; selected uncomplicated cases may be managed non-operatively under specialist guidance.
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| 🔥 Acute Pancreatitis |
- Severe epigastric pain radiating to the back.
- Nausea, vomiting and abdominal tenderness.
- May have fever, tachycardia, hypotension or ileus.
- Common causes: gallstones and alcohol.
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- Serum lipase or amylase ≥3 times upper limit supports diagnosis.
- LFTs: raised ALT may suggest gallstone pancreatitis.
- U&E, calcium, glucose, FBC, CRP, VBG/ABG if severe.
- Ultrasound gallbladder to look for gallstones/biliary obstruction.
- CT if diagnostic uncertainty or complications/severe disease, usually not immediately required in mild clear cases.
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- IV fluids, strong analgesia and antiemetics.
- Early nutrition as tolerated; prolonged “bowel rest” is usually avoided unless vomiting/ileus.
- Assess severity and organ failure; involve HDU/ICU if severe.
- ERCP if gallstone pancreatitis with cholangitis or persistent biliary obstruction.
- Cholecystectomy during index admission for mild gallstone pancreatitis where suitable.
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| 💥 Perforated Peptic Ulcer / Perforated Viscus |
- Sudden severe abdominal pain.
- Generalised peritonitis: rigid abdomen, guarding, rebound.
- Shoulder-tip pain may occur from diaphragmatic irritation.
- History of ulcer disease, NSAIDs, steroids or smoking.
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- Erect CXR may show free air under diaphragm.
- CT abdomen/pelvis is more sensitive and defines site/extent.
- FBC, U&E, CRP, lactate, clotting, group and save/crossmatch.
- VBG/ABG if shocked or septic.
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- Urgent surgical review.
- Nil by mouth, IV fluids, IV broad-spectrum antibiotics.
- IV PPI if peptic ulcer suspected.
- NG tube may be used for decompression.
- Emergency surgery or interventional management depending on stability and perforation.
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| 🩸 Acute Mesenteric Ischaemia |
- Sudden severe abdominal pain, often out of proportion to examination.
- Nausea, vomiting, diarrhoea or bloody stool.
- Risk factors: AF, heart failure, atherosclerosis, recent MI, low-flow shock states.
- Late signs: peritonism, sepsis, acidosis and shock.
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- Urgent CT angiography abdomen/pelvis.
- Lactate and metabolic acidosis may be present but can be late.
- FBC, U&E, clotting, group and crossmatch.
- ECG for AF/MI.
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- Urgent surgical and vascular/interventional radiology input.
- IV fluids, oxygen, broad-spectrum antibiotics.
- Anticoagulation with IV heparin unless contraindicated.
- Revascularisation, embolectomy, angioplasty/stenting or laparotomy depending on cause and bowel viability.
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| 🤮 Oesophageal Perforation / Boerhaave Syndrome |
- Severe chest or upper abdominal pain after forceful vomiting.
- Dyspnoea, fever, tachycardia or sepsis.
- Subcutaneous emphysema/neck crepitus may occur.
- Can rapidly cause mediastinitis.
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- CT chest/abdomen with water-soluble oral contrast if stable.
- Water-soluble contrast swallow may show leak.
- FBC, CRP, U&E, lactate, cultures if septic.
- Avoid blind NG tube insertion.
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- Nil by mouth and urgent upper GI/thoracic surgical review.
- IV broad-spectrum antibiotics.
- IV fluids, analgesia and critical care if septic.
- Endoscopic stent, drainage or surgical repair depending on timing, site and stability.
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| 🌀 Volvulus |
- Crampy abdominal pain, distension and vomiting.
- Absolute constipation/obstipation.
- Sigmoid volvulus more common in older/frail patients.
- Caecal volvulus often more acute and surgical.
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- AXR: coffee-bean sign in sigmoid volvulus.
- CT abdomen/pelvis confirms diagnosis and assesses ischaemia/perforation.
- Bloods: FBC, U&E, CRP, lactate.
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- Nil by mouth, IV fluids, analgesia.
- Sigmoid volvulus without peritonitis/ischaemia: urgent endoscopic decompression.
- Surgery if perforation, ischaemia, peritonitis, failed decompression or caecal volvulus.
- Definitive surgery often needed to prevent recurrence.
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| 🩸 Upper GI Bleeding |
- Haematemesis, coffee-ground vomiting or melaena.
- Syncope, tachycardia, hypotension or shock if severe.
- Risk factors: NSAIDs, anticoagulants, liver disease, varices, alcohol, peptic ulcer disease.
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- FBC, U&E, LFT, clotting, group and save/crossmatch.
- Risk stratify using Glasgow-Blatchford score.
- Urgent upper GI endoscopy after resuscitation.
- Consider ECG/troponin in older/high-risk patients.
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- ABCDE, IV access, blood transfusion if needed.
- Correct coagulopathy where appropriate and review anticoagulants/antiplatelets.
- Endoscopic therapy for high-risk bleeding lesions.
- If variceal bleed suspected: give terlipressin/vasoactive therapy and IV antibiotics according to local policy.
- Discuss with gastroenterology urgently; ICU if unstable.
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| 🟡 Acute Cholecystitis |
- Right upper quadrant pain, often radiating to right shoulder/back.
- Fever, nausea, vomiting.
- Positive Murphy’s sign.
- Usually due to gallstone obstruction of cystic duct.
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- FBC, CRP, LFTs, U&E.
- Abdominal ultrasound: gallstones, wall thickening, pericholecystic fluid, sonographic Murphy sign.
- MRCP if common bile duct stone suspected.
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- Analgesia, IV fluids, antiemetics.
- Antibiotics if systemic infection or moderate/severe disease according to local policy.
- Early laparoscopic cholecystectomy where suitable.
- Percutaneous cholecystostomy may be considered in high-risk unfit patients.
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| 🚧 Intestinal Obstruction |
- Colicky abdominal pain, vomiting, distension.
- Absolute constipation suggests complete obstruction.
- High-pitched bowel sounds early; quiet abdomen late.
- Causes: adhesions, hernia, malignancy, volvulus, strictures.
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- CT abdomen/pelvis identifies level, cause and complications.
- AXR may show dilated loops/air-fluid levels but is less definitive.
- Bloods: FBC, U&E, CRP, lactate, group and save.
- Examine hernial orifices.
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- Nil by mouth, IV fluids and electrolyte correction.
- NG tube decompression if vomiting/distended.
- Urgent surgical review.
- Surgery if strangulation, ischaemia, perforation, closed-loop obstruction, peritonitis, obstructed hernia or failure of conservative management.
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| 🔥 Acute Diverticulitis |
- Left lower quadrant pain, fever and altered bowel habit.
- Nausea, vomiting and localised tenderness.
- May complicate with abscess, perforation, fistula or obstruction.
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- FBC, CRP, U&E.
- CT abdomen/pelvis if diagnosis uncertain, severe symptoms, immunosuppression or complications suspected.
- Urinalysis and pregnancy test where relevant.
- Avoid colonoscopy during acute severe episode due to perforation risk.
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- Analgesia and fluids.
- Mild uncomplicated cases may not always need antibiotics; follow local/NICE guidance.
- Antibiotics if systemically unwell, immunosuppressed or complicated disease.
- Drain abscess if large/accessible; surgery if perforation or generalised peritonitis.
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| 🟡 Ascending Cholangitis |
- Charcot triad: fever, jaundice, RUQ pain.
- Reynolds pentad: add hypotension and confusion.
- Usually due to infected obstructed biliary tree, often CBD stone.
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- FBC, CRP, U&E, LFTs, clotting, lactate, blood cultures.
- Ultrasound may show duct dilatation/gallstones.
- MRCP or CT if diagnosis uncertain.
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- Sepsis pathway: IV fluids, cultures, IV antibiotics.
- Urgent gastroenterology/HPB review.
- ERCP for biliary drainage/source control, especially if severe or not improving.
- ICU if shock or organ dysfunction.
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| 🩸 Lower GI Bleeding |
- Fresh rectal bleeding, maroon stool or clots.
- May have abdominal pain, diarrhoea or shock.
- Causes: diverticular bleed, angiodysplasia, colitis, cancer, haemorrhoids, ischaemic colitis.
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- FBC, U&E, clotting, group and save/crossmatch.
- Assess haemodynamic stability.
- CT angiography if active major bleeding.
- Colonoscopy after stabilisation depending on pathway.
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- ABCDE, IV access, fluids and blood if needed.
- Reverse anticoagulation if appropriate with senior advice.
- Urgent GI/surgical/interventional radiology input if unstable or ongoing major bleed.
- Treat underlying cause once identified.
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| 🧬 Acute Severe Colitis |
- Frequent bloody diarrhoea, abdominal pain, fever, tachycardia.
- May be IBD flare, infective colitis or ischaemic colitis.
- Toxic megacolon: systemic toxicity plus colonic dilatation.
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- FBC, CRP, U&E, LFT, albumin, stool culture and C. difficile testing.
- AXR if severe/distended to assess megacolon.
- Flexible sigmoidoscopy with minimal insufflation if indicated.
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- Admit under gastroenterology/surgery if acute severe colitis suspected.
- IV fluids, VTE prophylaxis unless contraindicated.
- Avoid loperamide/opioids if severe colitis or megacolon risk.
- IV steroids for acute severe ulcerative colitis after infection assessment, under specialist care.
- Early surgical input if toxic megacolon, perforation, haemorrhage or failure to respond.
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