6: Diseases of the small bowel and appendix

Question 1

What is a term used to describe the periodic pain caused by small bowel obstruction?

Answer 1

Small bowel colic

Question 2

If the proximal part of the small bowel is obstructed, how will this present in the patient?

Answer 2

Vomiting

Question 3

Does distension occur in proximal small bowel obstruction?

Answer 3

No - vomited out

Question 4

What presents in distal small bowel obstruction?

Answer 4

Late vomiting

Gross abdominal distension

Question 5

Which imaging modality can be used to diagnose small bowel obstruction?

Answer 5

Abdominal X-ray

Question 6

What causes small bowel obstruction?

Answer 6

Adhesions

Hernias

Cancer

Question 7

Which tube is used to remove bowel contents in the event of an uncomplicated small bowel obstruction?

Answer 7

NG tube

Question 8

What are adhesions?

Answer 8

Scar tissue joining loops of the bowel

Question 9

What is fluid resuscitation?

Answer 9

Replacement of fluids in a patient who is dehydrated for some reason

Question 10

What is strangulation of the small bowel?

Answer 10

Twisting of the bowel in loops around itself, cutting off the blood supply

Question 11

What symptom may patients present with following strangulation of the small bowel?

Answer 11

Constant pain

Question 12

Why can bowel ischaemia cause sepsis?

Answer 12

Lack of blood flow –> no immune cell circulation –> infection

Question 13

Where are the commonest sites for Crohn’s disease?

Answer 13

Small bowel, terminal ileum

Anal canal

Large bowel (Crohn’s colitis)

Question 14

Which drugs are used to treat Crohn’s disease?

Answer 14

Corticosteroids (prednisolone, budesonide, hydrocortisone, beclometasone)

Immunosuppressors (azathioprine, methotrexate)

Question 15

What communications between viscera commonly form in Crohn’s disease?

Answer 15

Fistulae

Question 16

If an elderly patient presents with poorly localised pain and signs of shock/sepsis, what should you be suspicious of?

Answer 16

Small bowel ischaemia

Question 17

Which true diverticulum can form in the small bowel?

Answer 17

Meckel’s diverticulum

Question 18

Is Meckel’s diverticulum symptomatic or asymptomatic?

Answer 18

Tends to be asymptomatic in adults and symptomatic in children

Question 19

What is appendicitis?

Answer 19

Inflammation of the appendix

Question 20

What symptoms will be seen initially in acute appendicitis?

Answer 20

Nausea

Loss of appetite

Poorly localised central abdominal pain (epigastric)

Question 21

Why is the initial pain of appendicitis diffuse and poorly localised?

Answer 21

Visceral afferents involved

Question 22

As acute appendicitis progresses, the pain spreads from the epigastrium to the ___ ___ ___.

Why?

Answer 22

right iliac fossa

Progression to peritonitis

Question 23

Why is the later pain of appendicitis sharp in the right iliac fossa?

Answer 23

Progression of peritonitis in body wall, which has somatic afferents

Question 24

Where precisely is the pain of appendicitis felt?

Answer 24

McBurney’s point

1/3rd of distance between ASIS and umbilicus

Question 25

How is acute appendicitis treated?

Answer 25

Appendicectomy

removal of the appendix by surgery

Question 26

Which types of tumours are found in the appendix?

Answer 26

Carcinoid tumours (carcinoma)

Question 27

Where are carcinoid tumours of the appendix notorious for metastasising to?

Answer 27

Liver