Acute GI conditions 

1. Acute Pancreatitis 

Definition 
Inflammation of the pancreas that can be mild (self-limiting) or severe (life-threatening with systemic complications). Amylase >1000

Common Causes 

Gallstones (most common) 
Alcohol abuse 
Hypertriglyceridemia 
Drugs (e.g., azathioprine, steroids) 
Trauma or post-ERCP procedure 

Clinical Features 

Sudden severe epigastric pain radiating to the back 
Nausea and vomiting 
Fever, tachycardia (in severe cases) 
Abdominal tenderness, sometimes guarding 
Grey Turner sign (flank bruising) or Cullen sign (periumbilical bruising) – rare 

Investigations 

Bloods: ↑ serum amylase/lipase (lipase more specific), ↑ CRP, ↑ WBC 
Imaging: Ultrasound (to detect gallstones), CT abdomen (to assess severity/necrosis) 
Other: Liver function tests if gallstones suspected 

Management 

Supportive care: IV fluids, analgesia, anti-emetics 
Nil by mouth initially; gradually reintroduce diet 
Address cause: ERCP for biliary obstruction, stop causative drugs, manage triglycerides 
Monitor for complications: Infection, necrosis, organ failure 

Complications 

Pancreatic necrosis or abscess 
Shock, ARDS 
Pseudocyst formation 
Multi-organ failure in severe cases 
 
2. Acute Gastrointestinal Bleeding (GI Bleed) 

Definition 

Bleeding from the upper or lower GI tract, potentially life-threatening. 

Types 

Upper GI bleed (UGIB): Above ligament of Treitz – common causes: peptic ulcers, oesophageal varices 
Lower GI bleed (LGIB): Below ligament of Treitz – common causes: diverticulosis, haemorrhoids 

Clinical Features 

Hematemesis (vomiting blood) – UGIB 
Melena (black tarry stool) – UGIB 
Haematochesia (bright red blood per rectum) – LGIB 
Signs of shock in severe bleed: hypotension, tachycardia, pallor 

Investigations 

FBC: ↓ Hb 
Coagulation profile 
Liver function tests (if varices suspected) 
Endoscopy: diagnostic and therapeutic 
Imaging (CT angiography) if endoscopy fails 

Management 

Resuscitation: IV fluids, blood transfusion as needed 
Correct coagulopathy if present 
Acid suppression: IV PPI for peptic ulcer bleed 
Endoscopic therapy: Banding for varices, injection for ulcers 
Address underlying cause: e.g., H. pylori eradication 

Complications 

Hypovolemic shock 
Re-bleeding 
Mortality if uncontrolled 

3. Oesophageal Varices 

Definition 
Dilated submucosal veins in the lower oesophagus, usually due to portal hypertension, commonly from liver cirrhosis. 

Risk Factors 

Chronic liver disease (alcohol, hepatitis B/C) 
Portal vein thrombosis 

Clinical Features 

Often asymptomatic until bleeding occurs 
Acute variceal bleed: massive hematemesis, melena, shock 

Investigations 

Endoscopy (diagnostic and therapeutic) 
Liver function tests, coagulation profile 
Ultrasound or CT: liver morphology, portal hypertension 

Management 

Acute bleed: ABC resuscitation, blood transfusion 
Pharmacological: IV octreotide or terlipressin to reduce portal pressure 
Endoscopic therapy: Band ligation 
Secondary prophylaxis: Non-selective beta-blockers, repeated banding 

Complications 
Recurrent bleeding 
Hypovolemic shock 
Hepatic encephalopathy 
Death if uncontrolled 

4. Duodenal Ulcer (Acute Complication) 

Definition 
Peptic ulcer in the first part of the duodenum,  commonly caused by H. pylori infection or NSAID use. 

Clinical Features 

Epigastric pain relieved by food (classically) 
Nausea, vomiting, bloating 
Complications: bleeding, perforation, obstruction 
Signs of perforation: sudden severe pain, rigid abdomen, rebound tenderness 

Investigations 

Endoscopy (diagnostic and therapeutic) 
H. pylori testing (urea breath test, stool antigen) 
FBC (anaemia if bleeding) and crossmatch blood 
Abdominal X-ray for perforation (free air under diaphragm) 

Management 

Acid suppression: PPI therapy 
H. pylori eradication: triple therapy (PPI + antibiotics) 
Acute bleeding: endoscopic therapy, IV PPI 
Perforation: urgent surgical repair 
Avoid NSAIDs 

Complications 

GI bleeding (can lead to shock) 
Perforation → peritonitis 
Gastric outlet obstruction 
Malignant transformation (rare in duodenal ulcers) 

Key Nursing Considerations across Acute GI Conditions 

Monitoring: Vital signs, urine output, mental status for early shock detection 
Fluid management: IV fluids for resuscitation and hydration 
Pain management: Adequate analgesia without masking clinical signs 
Nutrition: NBM initially if indicated, gradual reintroduction 
Patient education: Avoid alcohol, NSAIDs; medication adherence 
Prevent complications: DVT prophylaxis, infection monitoring