17-4 -- obstruction/ischemic bowel disease

Question 1

What is the most common site of intestinal obstruction?

Answer 1

SI - due to narrow lumen

Question 2

What are the 4 most common reasons for an intestinal obstruction?

Answer 2

Hernia - most common reason worldwide
Adhesion - most common in US
Volvulus
Intussusception

Question 3

What are the 4 most common reasons for an intestinal obstruction?

Answer 3

Hernia
Adhesion
Volvulus
Intussesception

Question 4

Defect in an abdominal wall that causes a protrusion of peritoneum and bowel

Answer 4

Hernia

Question 5

If the neck of a hernia is constricted and venous stasis occurs, what will that cause to happen to the protruded bowel?

Answer 5

Hernia increases in size and edema occurs

Question 6

What can cause Adhesions?

Answer 6

Surgery, infections, endometriosis

Question 7

Volvulus

Answer 7

Bowel twists around its mesenteric attachment

Question 8

If a volvulus occurs, the bowel segment is at risk for obstruction and?

Answer 8

Infarction

Question 9

Intussusception

Answer 9

Segment of intestine telescopes into the segment of bowel immediately distal to it
- once trapped, peristalsis propels it along and it takes its mesentary with it

Question 10

In what age group for intestinal obstructions is intussusception the most common etiology?

Answer 10

CHILDREN < 2 years old

Question 11

If a child less than 2 years old presents with an intestinal obstruction, what should you consider that caused it?

Answer 11

Intussusception

Question 12

What can cause Intussusception?

Answer 12

Idiopathic
Virus
Rotovirus vaccine
Intraluminal mass

Question 13

Air/contrast enemas can treat?

Answer 13

Intussusception

Question 14

Main symptoms of intestinal obstructions?

Answer 14

Abdominal pain and distention

Vomiting and constipation

Question 15

Main symptoms of intestinal obstructions?

Answer 15

Abdominal pain and distention

Vomiting and constipation

Question 16

Functional obstruction is usually?

Answer 16

Post-operative Ileus

Question 17

What artery mainly supplies the right side of the colon?

Answer 17

Superior mesenteric

Question 18

What artery mainly supplies the left side of the colon?

Answer 18

Inferior mesenteric

Question 19

All of the ______ between the arteries make it possible for the intestines to withstand slow blood loss (chronic hypoperfusion)

Answer 19

Interconnections

Question 20

Acute compromise of the arterial supply to the intestines usually causes infarction of?

Answer 20

Several meters of intestine (more severe)

Question 21

What usually causes Acute obstruction of vascular supply to intestines?

Answer 21

Thrombosis/embolism

Question 22

What usually causes slow Chronic hypoperfusion of intestines?

Answer 22

CHF, dehydration, shock, vasoconstricting drugs

Question 23

Pathogenesis of Ischemic Bowel Disease

Answer 23

1. Hypoxic injury

2. Reperfusion injury (restoration of blood flow)

Question 24

What can cause the Reperfusion injury with Ischemic Bowel Disease?

Answer 24

Leakage of bacteria, infiltration of neutrophils and free radicals

Question 25

Watershed zones

Answer 25

Intestinal segments at the end of arterial supplies

Question 26

Watershed zones are more susceptible to ischemic bowel disease. What is an example of a zone?

Answer 26

Splenic flexure

Question 27

Besides watershed zones, what else in the intestines is susceptible to ischemic bowel disease?

Answer 27

Epithelium

Question 28

There will be worse outcomes if what artery is occluded with ischemic bowel disease?

Answer 28

Superior mesenteric

Question 29

Symptoms of Acute obstruction causing ischemic bowel disease?

Answer 29

Sudden cramping, passage of bloody stool, shock, presents like other GI emergencies

Question 30

Symptoms of Chronic hypoperfusion causing ischemic bowel disease?

Answer 30

Abdominal pain 30 mins after eating that improves after a few hours

Question 31

Angiodysplasia

Answer 31

Malformed mucosal/submucosal blood vessels that are thin and dilated

Question 32

Angiodysplasia

Answer 32

Malformed and mucosal/submucosal blood vessels taht are thin and dilated

Question 33

Where is Angiodysplasia most common?

Answer 33

Cecum or right colon

Question 34

What does Angiodysplasia look like?

Answer 34

Nests of torturous capillaries

Question 35

Symptom range for Angiodysplasia?

Answer 35

Chronic, intermittent – Acute, massive hemorrhage