6: Diseases of the small bowel and appendix Flashcards
What is a term used to describe the periodic pain caused by small bowel obstruction?
Small bowel colic
If the proximal part of the small bowel is obstructed, how will this present in the patient?
Vomiting
Does distension occur in proximal small bowel obstruction?
No - vomited out
What presents in distal small bowel obstruction?
Late vomiting
Gross abdominal distension
Which imaging modality can be used to diagnose small bowel obstruction?
Abdominal X-ray
What causes small bowel obstruction?
Adhesions
Hernias
Cancer
Which tube is used to remove bowel contents in the event of an uncomplicated small bowel obstruction?
NG tube
What are adhesions?
Scar tissue joining loops of the bowel
What is fluid resuscitation?
Replacement of fluids in a patient who is dehydrated for some reason
What is strangulation of the small bowel?
Twisting of the bowel in loops around itself, cutting off the blood supply
What symptom may patients present with following strangulation of the small bowel?
Constant pain
Why can bowel ischaemia cause sepsis?
Lack of blood flow –> no immune cell circulation –> infection
Where are the commonest sites for Crohn’s disease?
Small bowel, terminal ileum
Anal canal
Large bowel (Crohn’s colitis)
Which drugs are used to treat Crohn’s disease?
Corticosteroids (prednisolone, budesonide, hydrocortisone, beclometasone)
Immunosuppressors (azathioprine, methotrexate)
What communications between viscera commonly form in Crohn’s disease?
Fistulae
If an elderly patient presents with poorly localised pain and signs of shock/sepsis, what should you be suspicious of?
Small bowel ischaemia
Which true diverticulum can form in the small bowel?
Meckel’s diverticulum
Is Meckel’s diverticulum symptomatic or asymptomatic?
Tends to be asymptomatic in adults and symptomatic in children
What is appendicitis?
Inflammation of the appendix
What symptoms will be seen initially in acute appendicitis?
Nausea
Loss of appetite
Poorly localised central abdominal pain (epigastric)
Why is the initial pain of appendicitis diffuse and poorly localised?
Visceral afferents involved
As acute appendicitis progresses, the pain spreads from the epigastrium to the ___ ___ ___.
Why?
right iliac fossa
Progression to peritonitis
Why is the later pain of appendicitis sharp in the right iliac fossa?
Progression of peritonitis in body wall, which has somatic afferents
Where precisely is the pain of appendicitis felt?
McBurney’s point
1/3rd of distance between ASIS and umbilicus
