Intussusception is a medical condition in which a segment of the intestine invaginates, or telescopes, into an adjacent section of the intestine. This can lead to obstruction of the intestines and a decrease in blood flow to the affected area. It is most common in infants between 3 months and 3 years of age and can cause intermittent episodes of severe abdominal pain followed by episodes of lethargy with associated vomiting, diarrhea, and a late finding of rectal bleeding. Intussusception is considered a medical emergency and requires immediate treatment, which typically involves an air or barium enema or surgery to correct the obstruction.

The chapter describes the case of a 55-year-old male with severe abdominal pain, nausea, and vomiting, who presents with worsening abdominal distension, pain, and two episodes of vomiting. The patient has a history of hypertension, diabetes, and asthma, and has had swelling in the groin before, but it has gotten worse, more painful, and has become “hard.” The physical examination reveals a distended, diffusely tender abdomen, bowel sounds absent, and a large right inguinal hernia that is not reducible, with overlying skin that is dusky. The patient is diagnosed with an incarcerated hernia with bowel obstruction. Critical actions include recognition of the hernia, large-bore IV access and fluid bolus, upright chest x-ray, CT abdomen pelvis with IV contrast, pain management and antiemetics, nasogastric tube placement if symptoms are not controlled, broad-spectrum antibiotics, and surgery consult. The chapter provides several pearls, including the importance of fluid resuscitation, recognition of peritoneal signs, and avoiding reduction of a strangulated hernia, which can lead to perforation and sepsis.

Snakebites can be life-threatening if the snake is venomous. Venomous snakes can be classified as elapids or crotalids, with crotalid envenomation being more common. Pit vipers, a type of crotalid, can bite and deliver venom, or without envenomation, which is called a dry bite. Crotalid venom is predominantly cytolytic and may cause edema, hemorrhage, and necrosis close to and far away from the bite. Systemic signs and symptoms may include hemolysis, thrombocytopenia, disseminated intravascular coagulopathy, vomiting, and cardiovascular and respiratory failure. If no local or systemic signs are noted, the patient can be monitored for 12 hours and released if no signs or symptoms develop. Antivenom should be provided if the patient experiences signs or symptoms of envenomation.

A 7-year-old boy presents with diffuse colicky abdominal pain, emesis, and bloody diarrhea. He also complains of leg pain while walking. The patient appears uncomfortable due to pain, lying supine on the stretcher. The primary survey reveals no respiratory distress, no cyanosis, and good peripheral pulses. The secondary survey shows periarticular swelling and tenderness in bilateral knees and ankles, palpable purpura on bilateral lower extremities and buttocks, and hemoccult-positive rectal exam. The diagnosis is Henoch–Schönlein purpura with jejuno-ileal intussusception. Critical actions include fluid resuscitation, laboratory and urine testing, abdominal x-ray, abdominal ultrasound, pain management, and surgery consult. The overall prognosis is excellent, although long-term sequelae can occur in children with bowel perforation or more extensive renal involvement. Admission to the hospital may be appropriate in children with concerning symptoms.

The case examines the evaluation, diagnosis, and treatment of a woman with abdominal pain and vomiting who is found to have a small bowel obstruction.

Perforated viscus presents a life-threatening emergency requiring immediate clinical recognition and swift medical and surgical intervention. In this scenario, perforation likely arises from small bowel obstruction, causing increased intraabdominal pressure and subsequent wall rupture. Symptoms include sudden-onset abdominal pain worsened by movement. Urgent actions include focused physical assessment, detection of peritoneal signs, IV fluid resuscitation, pain management, selection of appropriate imaging, early antibiotic administration, surgical consultation, and advocating for laparotomy. Key points emphasize the superiority of upright CXR for free-air detection, the significance of peritoneal signs, and the crucial importance of timely evaluation in elderly patients with abdominal pain.

Chapter 2.9 covers drugs acting on the gastro-intestinal tract that are relevant to anaesthesia. We include antiemetic drugs, with detail on the vomiting centre and the mechanisms of action of commonly used antiemetics. We then discuss gastric acid secretion and drugs used to control this. Finally we discuss drugs used in diabetes – oral hypoglycaemic agents. Here we include detail on the diagnosis of diabetes mellitus, commonly used drugs and the perioperative management of such drugs.

Dehydration is a frequent diagnosis made in the emergency department (ED) and a common pathway in the observation unit (OU). Gastroenteritis and vomiting are two common causes of dehydration. Patients at the extremities of age are particularly vulnerable to dehydration yet still can be managed effectively in an observation setting. The evaluation of dehydration includes physical and laboratory assessment though both can be nonspecific. Management includes non-invasive versus invasive rehydration as well as electrolyte correction. The first-line therapy of intravenous rehydration is isotonic crystalloid solution. The management of dehydration in an OU is straightforward, typical and effective.

OU patients will be on track to better outcomes, reduced length of stay, all while reducing health care costs.

Hyperemesis gravidarum is considered the severe end of the spectrum of nausea and vomiting of pregnancy. While there is no agreed upon strict definition for this condition, the criteria include persistent vomiting not related to other causes, a measure of acute starvation, and documented weight loss, most often at least 5% of pre-pregnancy weight. Electrolyte, thyroid, and liver abnormalities also may be present. The incidence of hyperemesis gravidarum is approximately 0.3–3% of pregnancies, but the reported incidence varies because of different diagnostic criteria and ethnic variation in study populations. Risk factors include patients with increased placental mass (molar gestation or multiple gestation), a history of motion sickness, migraine headaches, a family history, and a history of hyperemesis gravidarum in a previous pregnancy. Daughters and sisters of patients who had hyperemesis gravidarum are more likely to have the same condition, as are patients carrying a female fetus. The workup involves ruling out other causes, and the treatment focuses on relieving symptoms and preventing serious morbidity. Hyperemesis gravidarum can significantly impact the quality of life of patients and their families and may be challenging to treat.

Clinicians begin the Explosions! with familiar routines: a Henry Heartbeat activity, reviewing homework and adding data to the Body Map, and a new ritual: checking in with our energy and seeing if we need a snack. New characters related to processes of eating and digesting food are introduced: Victor Vomit, Gaggy Greg, Gordon Gotta Go. Investigations explore activities that may induce gagging. Equipped with garbage cans and paper towels, families are prepared for any result of these disgusting but fun investigations. Body Brainstorms explore questions such as who passes the most gas in the family and what foods produce the smelliest farts. Clinicians introduce a decision-tree in the Body Clues Worksheet that helps family members notice their body sensations, figure out what those sensations may mean (e.g., is Betty the Butterfly telling me I am excited?), and design a corresponding investigation (e.g., what happens to Betty the Butterfly if I take some deep breaths while facing my fears?). Families practice using their Body Clues Worksheet to review the highs and lows of the day or to explore the meaning of an intense moment. Armed with these new investigative tools, families are prepared for any intense situation even if it’s disgusting!

Overview of gastrointestinal complications including constipation, diarrhea, nausea, and vomiting, feeding tube complications, bowel perforation and obstruction, and neutropenic enterocolitis

Overview of gastrointestinal complications including constipation, diarrhea, nausea, and vomiting, feeding tube complications, bowel perforation and obstruction, and neutropenic enterocolitis

Overview of gastrointestinal complications including constipation, diarrhea, nausea, and vomiting, feeding tube complications, bowel perforation and obstruction, and neutropenic enterocolitis

Overview of gastrointestinal complications including constipation, diarrhea, nausea, and vomiting, feeding tube complications, bowel perforation and obstruction, and neutropenic enterocolitis

Overview of gastrointestinal complications including constipation, diarrhea, nausea, and vomiting, feeding tube complications, bowel perforation and obstruction, and neutropenic enterocolitis

Overview of gastrointestinal complications including constipation, diarrhea, nausea, and vomiting, feeding tube complications, bowel perforation and obstruction, and neutropenic enterocolitis

Overview of gastrointestinal complications including constipation, diarrhea, nausea, and vomiting, feeding tube complications, bowel perforation and obstruction, and neutropenic enterocolitis

Overview of gastrointestinal complications including constipation, diarrhea, nausea, and vomiting, feeding tube complications, bowel perforation and obstruction, and neutropenic enterocolitis

Overview of gastrointestinal complications including constipation, diarrhea, nausea, and vomiting, feeding tube complications, bowel perforation and obstruction, and neutropenic enterocolitis

Overview of gastrointestinal complications including constipation, diarrhea, nausea, and vomiting, feeding tube complications, bowel perforation and obstruction, and neutropenic enterocolitis