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Surgical placement > Bowel obstruction > Flashcards

Bowel obstruction Flashcards

1
Q

3 classifications of bowel obstruction

A

mechanical/paralytic
open/closed
simple/strangulated

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2
Q

3 categories of mechanical bowel obstruction and example

A

luminal e.g. gall stones
within the wall e.g. stricture
outside the wall e.g. adhesion, hernia, volvulus

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3
Q

4 categories of paralytic ileus

A

sympathetic activity
local
bioechemical
pharmacological

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4
Q

3 causes of sympathetic activity induced colon paralysis

A

reflex- post op
retroperitoneal- bleed
malignant infiltration

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5
Q

Example of local cause of paralytic ileus

A

bacterial infection

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6
Q

2 biochemical causes of paralytic ileus

A

K, urea

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7
Q

2 pharm causes of paralytic ileus

A

loperamides, anticholinergics

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8
Q

Pathophysiology of bowel obstruction fluid loss

A

oedematous bowel causes the loss of fluid into the lumen, no reabsorption due to the obstruction

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9
Q

Motility proximal to the obstruction is

A

flaccid and non-functional

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10
Q

Motility distal to the obstruction is

A

normal

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11
Q

clinical px of mechanical obstruction

A 
colicky pain in waves
distension
vomiting
constipation
dehydration
active bowel sounds
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12
Q

Px of small bowel mechanical obstruction compared to lg bowel

A

high freq pain centrally
late distension
early vomiting
late constipation

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13
Q

where is the pain in a large bowel mechanical obstruction?

A

lower abdomen

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14
Q

px of a paralytic obstruction

A 
diffuse discomfort
small and large bowel distension
gastric distension
constipation
dehydration 
abdominal distension
non-tender
no BS
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15
Q

Px of strangulation obstruction

A

persistent localised pain
locally tender
local oedema

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16
Q

4 questions to consider when faced with a bowel obstruction

A

is there an obstruction?
location- which bowel?
level?
cause?

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17
Q

3 main causes of bowel obstruction

A

adhesions, hernia, masses

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18
Q

diagnosis of bowel obstruction

A

plain radiology- AXR, erect CXR

CT to confirm diagnosis and elicit more info

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19
Q

3 steps to bowel obstruction management

A

Resuscitate- dip and suck: replace fluids, NG tube to remove fluid and air
Plan- operative or non-operative
Intervention- options available

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20
Q

5 indications for surgical mx of bowel obstruction

A 
established or suspected strangulation
failure of resolution post non-operative mx
virgin abdomen
hernia
adhesive obstruction
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21
Q

6 aspects of non-operative care of bowel obstruction

A 
NG suction
analgesia
fluid and electrolyte replacement 
repeated evaluation
limited time period
dexamethasone for metastatic lesions
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22
Q

5 things to consider when assessing bowel viability

A 
colour
mobile
peristalsis 
pulse in mesentery
bleeding
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23
Q

2 scenarios for stent use?

A

bridge to surgery

palliative care

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24
Q

What is a volvulus?

A

twist or abnormal rotation

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25
Q

Tx for volvulus

A

flexible sigmoidoscopy to decompress

26
Q

define shock

A

a pathological condition that can suddenly affect the haemodynamic equilibrium, usually manifested by the failure to perfuse or oxygenate vital organs.

27
Q

3 main categories of shock

A

hypovolemic
cardiogenic
distributive

28
Q

5 investigation for PR bleeding causing shock

A 
gastroscopy
CT angiogram
mesenteric angiogram
colonoscopy 
surgery
29
Q

4 benefits of colonoscopy compared to angiography

A

widely available
cheap
less invasive
biopsy can be taken

30
Q

3 benefits of angiography compared to colonscopy

A

can detect small bowel lesions
unprepared colon
detection of angiodysplasia

31
Q

5 causes of lower GI bleeding

A 
diverticular disease
haemorrhoids
ischaemic colitis
rectal ulcer
ulcerative colitis
32
Q

5 causes of haematemesis

A 
peptic ulcer
gastroduodenal ulcer
oesophagitis 
varices
Mallor Weiss tear
33
Q

3 Ix for haematemesis

A

bloods
AXR, CXR, erect CXR
endoscopy

34
Q

Tx for oesophageal varices

A

banding

35
Q

Tx for Mallory Weiss tear

A

adrenaline injection

36
Q

Tx for ulcers

A

adrenaline injection and mechanical clips

37
Q

4 aspects to ulcer follow up

A

PPI
H. pylori eradication
stop NSAIDs
repeat endoscopy

38
Q

How do oesophageal varices develop?

A

if there is liver disease then there is backflow of blood from the portal circulation down the path of least resistance. This means that there is redistribution of blood into the oesophageal vessels causing dilations.

39
Q

3 tx for oesophageal varices

A

monitoring
anti hypertensives e.g propanolol
banding

40
Q

Tx of perianal abscess

A

incision and drainage

41
Q

2 symptoms of perianal abscess

A

erythematous, painful to touch

42
Q

what is a fistula?

A

abnormal connection between 2 epithelial surfaces

43
Q

complication of fistula

A

repeated infections

44
Q

3 tx of fistula

A

cut it open to prevent repeated infection
fistula glue
fistula plug
LIFT procedure to dissect it out

45
Q

what is a perianal haematoma ?

A

thrombosed external haemorrhoid

46
Q

tx for perianal haematoma?

A

analgesic, laxative, ice packs, compression

47
Q

risk factors for haemorrhoids

A

constipation, straining, poor bowel habits, sitting on the toilet for too long

48
Q

tx for haemorrhoids

A

banding, excision

49
Q

where do anal fissures occur?

A

anterior and posteriorly

50
Q

what is an anal fissure?

A

tearing of the perianal skin

51
Q

2 causes of anal fissure

A

trauma

hard stool

52
Q

2 symptoms of anal fissure

A

painful, glass like tearing

53
Q

Mx of anal fissure

A

laxative, anaglesia, cream to relax the muscle, surgery

54
Q

Which HPV virus causes low grade anal warts?

A

6 and 11

55
Q

Which HPV virus causes high grade anal warts?

A

16, 18, 31, 33

56
Q

anal warts can lead to what

A

anal cancer

57
Q

tx of anal warts

A

excision, cryotreatment, topical

58
Q

2 risk factors for anal cancer

A

HIV+

anal sex

59
Q

what type of surgery is used to excise anal cancer?

A

ELAPE

60
Q

Tx for rectal prolapse

A

reduce, ice packs, gel, laxatives, surgery

Surgical placement (13 decks)

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