82. Small intestine

Question 1

External lesions causing SBO

Answer 1

adhesions
hernias
volvulos
compressive masses

Question 2

Intrinsic masses causing SBO

Answer 2

neoplasm
inflammatory
infectious
intusseception
trauma
intraluminal
bezoars
FBs
stones

Question 3

simple vs. closed loop SBO

Answer 3

	Simple – at single point
	Closed loop – 2 location
•	Segment with no blood flow
•	Twist
•	Can infarct and necrose

Question 4

AXR crit for sBO

Answer 4

> 3cm

Question 5

US finding for SBO

Answer 5

o Fluid filled loops >2.5 cm

o Absent peristalsis

Question 6

MGMT of SBO

Answer 6

• Resus PRN
• If strangulation – surgery ASAP
• NG not well supported
• Anti-emetics
• No Abx empirically
• If planned OR, or suspect perf, then 2nd gen ceph or mero

Question 7

4 main types of mesenteric ischemia

Answer 7

o Arterial embolus
o Arterial thrombosis
o Venous thrombosis
o Non-occlusive ischemia

Question 8

RF for arterial emboli

Answer 8

o MI
o Cardiomyopathies
o Aneurysms
o Afib

Question 9

RF for arterial thrombosis

Answer 9

o Age
o HTN
o DM
o Smoking

Question 10

causes of non-occlusive inschemia

Answer 10

o	Sepsis
o	Dehydration
o	Pancreatitis
o	Shock
o	Cocaine of vasopressors

Question 11

Clinical trial of ischemia

Answer 11

o Sudden abdo pain
o Vomiting or diarrhea
o Cardiac patient

Question 12

MGMT of non-occlusive

Answer 12

o	Reverse cause 
o	Possible paperivine injection via angio cath
o	IV heparin to prevent thrombosis 
o	If peritoneal signs
	OR

Question 13

MGMT of arterial

Answer 13

-	Resus PRN
o	May need pressors
-	If evidence of infarct of peritonitis
o	Cerftri or cipro + flagyl
o	Urgent laparotomy

Question 14

MGMT of venous

Answer 14

o If no pertoneal signs, heparin alone may suffice

o Lap if worsen