Appendix and bowel Flashcards
What could be the causes of appendicitis?
- faecolith (hard stool)
- bacterial
- viral
- parasitic
Explain the pathology of appendicitis
- mucosal inflammation
- lymphoid hyperplasia
- obstruction
What happens between the appendix and the greater omentum during appendicitis?
- as the appendix swells it sticks to the greater omentum
What type of infection can occur if the appendix bursts?
- peritonitis
What are the symptoms of appendicitis?
- start of with central pain, then shifts to right ileac fossa
- sore when the laugh/cough
- gone off food
- Rosving Sign
- Psoas sign
What are the clinical symptoms of appendicitis?
- mild pyrexia
- mild tachycardia
- localised right ileac fossa pain
What manouvers can be carried out to investigate appendicitis?
- rebound- pressure applied, and then released quickly, pain will be felt when pressure removed
- rosvings sign –> pressure applied to the left abdomin and pain felt in the right
What tests can be carried out to confirm appendicitis?
- AXR
- USS
- Bloods
- Urinalysis
Management of appendicitis?
- pain relief
- surgery
- antibiotics
What are the symptoms of small bowel obstruction?
- pain (Bowel dilates)
- absolute constipation
- vomiting
- abdominal distension
What investigations should be done to test for small bowel obstruction?
- urinalysis
- bloods
- AXR
- Contrast CT scan of abdo
Treatment of a small bowel obstruction?
- drip and suck
- fluids with potassium
- drain with NG tube
What may be some risk factors for small bowel obstruction?
- post operative adhesions –> fibrous scar tissue
- hernias
- IBD
What is a complication of bowel obstruction?
- may cause blood vessels to collapse
- leads to ischaemia
- necrosis and perforation
What is the pathophysiology of bowel obstruction?
- any part of the GI tract
- dilation of bowel proximal
- peristalsis is disrupted
Explain the symptoms of upper small bowel obstruction?
- acute presentation
- large volumes vomited
Explain the symptoms of distal small bowel/large bowel obstruction?
- colicky abdo pain and distension
- vominting
When does vomiting occur in bowel obstruction?
- the more proximal the obstruction the earlier vomiting develops
What causes constipation during bowel obstruction?
- propulsion of bowel contents is arrested
What does chronic incomplete obstruction leads to?
- gradual hypertrophy of the muscle of bowel wall proximally
- peristaltic activity in this hypertrophic muscle is responsible for bouts of colicky pain
Why do symptoms of large bowel obstruction develop more gradually?
- due to the large capacity of the colon and caecum and their absorptive activity
What may be the clinical observations of an intestinal obstruction?
- dehydration
- abdominal distension
- visible peristalsis
- obstructing abdominal mass may be palpable
What is the management of intestinal obstruction?
- nil by mouth
- IV cannula and fluids
- NG tube to decompress the stomach
What are some causes of bowel obstruction?
- adhesions or bands
- incarcerated abdominal wall hernia
- internal hernia
- volvulus
- tumout
- inflammatory strictures
Explain a volvulus?
- a mobile loop of bowel rotates causing obstruction at its neck
Explain intussusception
- a segment of bowel wall becomes telescoped into the segment distal to it
Explain Ogilvie’s syndrome
- acute dilation of the colon in the absence of colonic instruction in acutely unwell patients
