Gastro and HepatoBilliary Critical Care​

Upper Gastrointestinal Bleeding

Gastro and HepatoBilliary Critical Care​, Gastroenterology / /

Upper Gastrointestinal Bleeding (UGIB)  Definition Upper GI bleeding refers to hemorrhage originating proximal to the ligament of Treitz (esophagus, stomach, duodenum). Anatomical Classification Site Examples Esophagus Varices, Mallory–Weiss tear, esophagitis Stomach Peptic ulcer, erosive gastritis, malignancy Duodenum Peptic ulcer, Dieulafoy lesion Etiology 1. Non-Variceal UGIB (≈ 80–85%) Peptic Ulcer Disease (most common) Duodenal ulcer > […]

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Refeeding Syndrome

Gastro and HepatoBilliary Critical Care​, Gastroenterology / /

Refeeding Syndrome  Refeeding syndrome is a potentially fatal metabolic complication that occurs after rapid reintroduction of nutrition (especially carbohydrates) in malnourished or starved patients, characterized by acute shifts of phosphate, potassium, magnesium, fluids, and vitamins (notably thiamine) due to insulin surge. Core hallmark: Hypophosphatemia after refeeding. diagnosis of exclusion Pathophysiology  1️⃣ Starvation State ↓ Insulin,

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Ascites

Gastro and HepatoBilliary Critical Care​, Gastroenterology / /

Ascites  Normal peritoneal cavity contains <50 mL fluid which is usually not visible on routine abdominal ultrasound. Clinically detectable ascites usually requires >1.5 L fluid. Most common cause worldwide: Liver cirrhosis (~80–85% cases). Epidemiology Among patients with cirrhosis: Ascites is the most common complication. Approximately 50% develop ascites within 10 years of diagnosis. Development of

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Hepatorenal Syndrome

Gastro and HepatoBilliary Critical Care​ / /

Hepatorenal Syndrome (HRS) Definition Hepatorenal syndrome (HRS) is a functional, potentially reversible acute kidney injury (AKI) occurring in patients with advanced cirrhosis and portal hypertension(Ascites), in the absence of intrinsic renal disease or structural kidney damage. Epidemiology  Occurs in advanced decompensated cirrhosis (often Child-Pugh C) Triggers: Refractory ascites Spontaneous bacterial peritonitis (SBP) Large-volume paracentesis without

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Portopulmonary Hypertension

Gastro and HepatoBilliary Critical Care​ / /

Portopulmonary Hypertension (PoPH) Definition Portopulmonary Hypertension (PoPH) is a form of pulmonary arterial hypertension (PAH, Group 1 PH) that develops in patients with: Portal hypertension (with or without cirrhosis) Increased pulmonary vascular resistance due to pulmonary arteriopathy Normal left-sided filling pressures Diagnosis requires: 1. Portal Hypertension Evidence of: Cirrhosis Non-cirrhotic portal hypertension Portosystemic shunts AND

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Acute Cholangitis

Gastro and HepatoBilliary Critical Care​ / /

 Acute Cholangitis  1. Definition Acute cholangitis is a life-threatening ascending infection of the biliary tree occurring due to biliary obstruction + bacterial infection. Classic triad = Charcot’s triad Fever Jaundice Right upper quadrant pain Severe disease = Reynolds pentad Charcot triad Hypotension Altered mental status Charcot triad present in ~50–70% only → absence does NOT

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Peritonitis

Gastro and HepatoBilliary Critical Care​ / /

Peritonitis  Definition Peritonitis is inflammation of the peritoneum caused by infection, chemical irritation, ischemia, foreign material, or sterile inflammatory processes. Anatomy Relevant to Peritonitis The peritoneum is a serous membrane consisting of: Layer Description Parietal peritoneum Lines abdominal wall Visceral peritoneum Covers abdominal organs The peritoneal cavity normally contains:<50–100 mL sterile fluid Classification of Peritonitis

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