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GIT > 9 Feb 24 > Flashcards

9 Feb 24 Flashcards

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1
Q

Post operative ileus def

A

Delayed return of bowel function
>72h after surgery

Temporary bowel paralysis causing backup of secretions and gas that results in Abdominal distension and vomiting (hypokalemia and dehydration-elevated Cr)

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2
Q

RF for post operative ileus

A

🎙Complicated Surgery
🎙Bowel manipulation (laparotomy)
🎙Longer surgical duration (due to inc intraabd inflammation)
🎙Elevated sympathetic nervous system tone

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3
Q

Post operative ileus CF

A

NV
No flatus
Abdominal distension
Decreased or absent bowel sounds

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4
Q

Xray findings of ileus

A

No transition point
Dilated bowel loops
Air in colon / rectum

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5
Q

Xray difference between SBO and ileus

A

🎥Ileus : Uniformly dilated bowel loops throught small and large bowel.
Air is present in colon/rectum

🎥SBO : Discrete transition point
Dilated small bowel before obstruction and decompressed large bowel distally. Absent rectal gas.
Air fluid levels can be seen

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6
Q

Ttt of post operative ileus

A

Self resolves
Conservative management
Antiemetics
Bowel rest
Serial examinations

Avoid opiates

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7
Q

SBO CF.

A

NV
Obstipation
Acute abdomen
Hyperactive or absent bowel sounds.

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8
Q

Anal fissure etiology

A

Local trauma (constipation , prolonged diarrhea , anal sex )

IBD (crohn)

Malignancy

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9
Q

anal fissure CF

A

Pain with bowel movements

BRBPR on toilet paper or stool

Most common at posterior anal midline

Chronic fissure may have skin tag at distal end (sentinel pile)

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10
Q

Ttt of anal fissure

A

High fiber diet and adequate fluid intake

Stool softeners

Sitz bath

Topical anesthetics and vasodilators (nifedipine, nitroglycerin)
To reduce pressure and increase blood flow to anal sphincter causing healing

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11
Q

Evaluation of occult GI bleed

A

Do endoscopy and colonoscopy
⬇️

If source not found
⬇️
⏳ do Tc 99m pertechnetate scan in children (for meckel D)
Source not found
⬇️

⏳ capsule endoscopy (for angiodysplasia , neoplasia , ulcer)
⬇️
Still source not found
⬇️
CT /MR enterography
For CA

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12
Q

Meckel diverticulum CF

A

Cause of FOBT and fe def anemia in children

As it is found in small bowel colonoscopy or endoscopy is unremarkable.

Most happen <2y. But older kids can get it too

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13
Q

Delayed appendix presentation

A

Longer duration of SS >5 days

Indicating appendix with contained abscess

Fever leukocytosis

Anterior abd palpation unrevealing

Deep abdominal assessment is done
(Psoas sign, obturator sign, rectal exam)

Presence of psoas sign indicates abscess adj to psoas or unruptured retrocecal appendix

Dx. : CT scan

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14
Q

Complication of appendiceal abscess

A

High post surgery complications
Adhesions

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15
Q

Management if appendiceal abscess

A

If pt stable manage with
IV AB
Bowel rest
Percutaneous drainage of abscess

Do surgery 6-8w on elective basis
(Interval appendectomy)

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16
Q

Post operative ileus contributing factors

A

Peritoneal instrumentation
Local release of inf mediators
Post operative opiate analgesic use

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17
Q

How to prevent PPi post operative ileus

A

Epidural anesthesia
Minimally invasive surgery
Judicious perioperative use of IV fluids
(To minimize GI edema)

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18
Q

Most Common cause of Post op Mech Bowel Obstruction

A

Adhesions

  CF of MBO vs PPI
       🧞‍♀️Hyperactive bowels 
       🧞‍♀️Temporary return of bowel function prior to symptom onset 
       🧞Xray has clear transition point and air fluid levels
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19
Q

Complications of Primary Sclerosing Cholangitis

A

Biliary stricture

Cholangitis

Cholelithiasis

Cholangiocarcinoma. , colon CA , biliary Cancer

Cholestasis ( dec fat soluble vitamins , Osteoporosis)

20
Q

PSC associated dx

A

90% pts have IBD with UC

Annual colonoscopies (due to risk of Ca)

21
Q

CF of mild UC.

A

<4 watery bowel movements per day

Hematochezia is rare or intermittent.

22
Q

Labs of mild UC

A

No anemia
Normal ESR / CRP

23
Q

Ttt if Mild UC

A

5-ASA (meselamine , salfasalazine )

🧚🏼‍♀️For dx confined to rectosigmoid give meselamine enemas or suppositories

🧚🏼‍♀️Oral ASA for more extensive dx

🧚🏼‍♀️Corticosteroids for acute flares , severe chronic Dx.

24
Q

Pilonidal sinus RF

A

Young obese 15-30
Sedentary lifestyle
Deep gluteal clefts

25
Q

Pilonidal sinus CF

A

👼🏼Painful fluctuant mass cephalad to anus in the intergluteal region

👼🏼Mucoid , purulent , bloody drainage

👼🏼Pain worse with activity that stretch overlying skin (bending down)

26
Q

Mechanism of Pilonidal sinus

A

Edematous infected hair follicle in the intergluteal region becomes occluded

Infection spread subcut and forms abscess Which ruptures and creates pilonidal sinus.

As pt sits and stands hair and debris are force into sinus tract causing recurrent infections and foreign body reactions.

27
Q

Ttt of Pilonidal dx

A

🫁Drain abscess

🫁Collect debris followed by excision of sinus tracts

🫁Open closure preferred due to dec recurrece rates., despite longer healing times.

28
Q

Acute radiation proctitis onset
Pathogenesis , and CF

A

Post radiation onset <-8weeks

Mechanism:

       Direct mucosal damage

CF :

       Diarrhea 
       Mucosal discharge 
       Tenesmus 
       Minimal bleed
29
Q

Acute radiation proctitis Endoscopy

A

Severe erythema
Edema
Ulceration

30
Q

Ttt of radiation proctitis

A

Antidiarrheals (loperamide )

Butyrate enemas.

31
Q

Chronic radiation proctitis
Timings
Mechanism
CF

A

Onset : >3months to years
(Presents mostly for the first time within first year)

Mech :
Obliterative endarteritis
Chronic mucosal ischemia
Submucosal fibrosis

CF :

        Severe bleeding 
        Sometimes Strictures with constipation and rectal pain
32
Q

Endoscopy of chronic radiation proctitis

A

Multiple telangiectasia
Mucosal pallor
Friability

33
Q

Ttt of chronic radiation proctitis

A

Endoscopic thermal coagulation

Sucralfate or glucocorticoid enemas

34
Q

Mechanism of constipation in Chronic rectal proctitis

A

Progressive fibrosis impairs rectal compliance and cause anorectal stricture formation.

SS : Constipation , fecal incontinenece and fecal impaction.

35
Q

Mech of hemorrhage in Chronic Rectal proctitis

A

Submucosal fibrosis and obliterative endarteritis causes tissue hypoxia and promotes neovascularization and telangiectasia formation which are prone to bleeding causing hematochezia and blood loss anemia.

36
Q

Pt with LLQ pain and constipation has now guarding and rebound tenderness

A

Diverticular perforation

37
Q

Classic pain sequence of free perforation of GIT ?

A

Free perforation of Git in the setting of ongoing inflammation (diverticulitis )
Has classic pain sequence :

🍁At the moment of perforation :
Sudden severe pain (with vomiting , light headedness , syncope)

🍁After perforation to 2hrs:
Dec pain as the inflammed organ decompresses

🍁>2hrs after perforation:
Generalized constant pain due to peritonitis (+ - sepsis and shock)

Perforation
Decompression
Peritonitis.

38
Q

Ttt of diverticular perforation

A

🌞Microperforation:

Medical ttt (AB , bowel rest)

🌞Macroperforation /free perforation;
(Free air or contrast leak on CT)
Surgical Em

39
Q

Ascariasis Identification

A

Signs of SBO plus peripheral eosinophia and travel history

40
Q

Transmission of ascariasis

A

Ingested egg hatch in colon ➡️ larvae penetrate the colon wall ➡️ larvae then spread via blood to lungs ➡️ coughed up and swallowed and mature into adult worms in small intestine

41
Q

CF of ascariasis

A

A/S infection mostly.
High worm burden leads to severe features

Pulm manifestations : cough , eosinophilic pneumonitis

Intestinal S/S : 1-2 Mo later
Non specific GI symptoms (NV diarrhea , abd pain
Adult worms can cause SBO

42
Q

Ttt of ascariasis

A

NG suction
IV fluids and electrolytes

Albendazole mebendazole

43
Q

Cecal volvulus RF

A

🫂Young patient
🫂Constipation
🫂Congenital mobile cecum
(Mesentery failed to fuse with parietal peritoneum)

44
Q

Cecal volvulus

A

Cecum and ascending colon twist around their mesentery

45
Q

DX of cecal volvulus

A

CT scan (Xrays are more diagnostic in sigmoid V)

46
Q

Ttt of cecal volvulus

A

Emergency Surgical resection (right colectomy)

(Endoscopic detorsion is not advised , very low success rate)

47
Q

Signs if incarceration in hernia

A

Pain
NV
Changes in bowel habits
Inability to perform daily activities

If pt doesnt have these signs he can be counseled to seek hernia repair if it becomes symptomatic (do watchful waiting esp if pt wants to delay himself)

Most pts with AS hernias develop symptoms in 10y (70% cases)

GIT (20 decks)

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