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JazGI > Bowel obstruction and herniae > Flashcards

Bowel obstruction and herniae Flashcards

1
Q

Bowel __ to obstruction dilates

A

proximal

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2
Q

Presents within hrs of obstruction, vomit large volumes (___) =

A

small bowel obstruction

gut secretions

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3
Q

present gradually with colicky abdo pain, distension and faeculent vomiting

A

distal small bowel/colon obstruction

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4
Q

The more ___ the obstruction the earlier vomiting occurs

A

proximal

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5
Q

vomiting of semi-digested food eaten 1/2 days ago (no bile) suggests

A

gastric outflow syndrome

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6
Q

The ileocaecal valve being ___ delays onset of symptoms of obstruction

A

incompetent (50:50 whether comp/not)

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7
Q

in a closed loop obstruction the ileocaecal valve is ___ results in ___

A

competent

distention and perforation of the caecum

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8
Q

If tenderness is present in suspected bowel obstruction then ____ is occuring

A

strangulation

usually obstructions are relatively non-tender

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9
Q

colicky episodes in incomplete bowel obstruction can be ___ prominent that in complete because

A

more

if chronic then proximal bowel hypertrophies

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10
Q

Investigations for bowel obstruction =

A 
supine AXR (shows gas and dilated loops)
then CT if needed
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11
Q

Management of bowel obstruction =

A

nil by mouth
NG tube to decompress stomach
IV cannula for bloods, fluids and electrolytes

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12
Q

small bowel dilations on supine AXR =

A

central and have valvulae coniventes

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13
Q

colon dilations on supine AXR =

A

round periphery of abdomen and have haustra

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14
Q

Mechanical causes of bowel obstruction =

A 
strictures
volvulus
hernias
adhesions
tumours
bolus
intussusception
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15
Q

Inflammatory strictures in Crohn’s/diverticula usually cause ___ obstruction

A

incomplete

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16
Q

If bowel is strangulated venous/arterial flow is cut off first?

A

venous (then arterial backP => gangrene)

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17
Q

In mechanical causes of obstruction can see ___

this is not true for adynamic causes

A

clear cut off between dilated and non-dilated bowel

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18
Q

Risk factors for paralytic ileus =

A

recent GI surgery, inflammation with peritonitis, diabetic ketoacidosis

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19
Q

Paraltic ileus present’s similarly to small bowel obstruction but __+__ not present

A

pain

tinkling

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20
Q

Treatment of paralytic ileus =

A

drip and suck

wait for peristalsis to return

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21
Q

Ogilvie’s syndrome =

A

Pseudo-obstruction of the colon

acute dilatation of colon wo an obstruction makes patient acutely unwell

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22
Q

Pseudo-obstruction of the colon is associated with

A 
hip replacement surgery
CABG
pneumonia
# of spine
frail and elderly
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23
Q

Pseudo-obstruction mechanism behind it =

A

sympathetic overrides parasympathetic and colon distends with gas

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24
Q

If pseudo-obstruction causes respiratory problems(diaphragm splinting)/pain then treatment =

A

colonoscopy to decompress

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25
Q

Hernia =

A

abnormal protrusion of a viscus outwith its normal body cavity

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26
Q

Commonest to least common 4 hernias

A

inguinal (80%)
umbilical (8%)
incisional(7%)
femoral (5%)

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27
Q

majority of abdominal hernias are from natural openings/weak areas

A

weak areas

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28
Q

Risk factors for herniae is anything that ___

A

increases intra-abdo pressure

29
Q

reducible/ireducible hernia cause problems and need surgery?

A

irreducible

30
Q

Incarcerated irreducible hernia =

A

too big to fit back in

31
Q

obstructed irreducible hernia ->___ where __ is occluded

A

strangulation

venous drainage occluded first then arterial inflow back P => gangrene and friable

32
Q

Most important modifiable risk factor for incisional herniae

A

suture technique

to prevent use tension suture and mass closure of linea alba

33
Q

vertical/transverse incisions are morely to cause an incisional hernia

A

vertical

34
Q

True umbilical hernia only occur in ___

A

kids congenitally

35
Q

If true umbilical hernia don’t resolve by age __ only then will you operate

A

3yrs

36
Q

Paediatric inguinal herniae are more common in M/F and ___

High risk of strangulation in under 1yos so

A

M 9:1
low birth wt/prem babies
operate within 24hrs

37
Q

hydrocele =

A

peritoneal fluid in the testis

can occur due to patent processus vaginalis

38
Q

hydrocele treatment =

A

not operated on unless large/aesthetics

usually recede by themselves

39
Q

Epigastric hernia are more common in ___
usually contain
arise from

A

M3:1
extraperitoneal fat
congenital linea albus weakness

40
Q

treatment of epigastric herniae =

A

sutures/mesh

41
Q 
Femoral canal is made up of
anteriorly=
medially=
laterally=
posteriorly =
A

ant = inguinal ligament
medial - lacunar lig
lateral = femoral vein
post = pectinate lig

42
Q

inferior and lateral to pubic tubercle and flatten groin crease =

A

femoral hernia

43
Q

Thin, elderly female hernia =

A

femoral hernia

44
Q

femoral hernia are more common in M/F

A

F 10:1

however if see a groin hernia in a female is still more likely it will be inguinal, get me?

45
Q

superior and medial to pubic tubercle and increases groin crease =

A

inguinal hernia

46
Q

Inguino-scrotal herniae are most likely to be direct/indirect?

A

indirect

47
Q

deep ring of inguinal canal location =

A

mid inguinal point

more superior and lateral than superficial

48
Q

superficial ring of inguinal canal location =

A

above and medial to pubic tubercle

49
Q

anterior wall of inguinal canal =

A

external oblique aponeurosis

50
Q

floor of inguinal canal =

A

inguinal and lacunar lig

51
Q

roof of inguinal canal =

A

conjoint tendon

52
Q

posterior wall of inguinal canal =

A

transversalis fascia and conjoint tendon(medially)

53
Q

Hesselbach’s triangle =

A

inguinal lig inferiorly
inferior epigastric vessels laterally
leteral border of rectus sheath medially

54
Q

__ inguinal herniae occur through Hesselbach’s triangle

A

direct

55
Q

Inguinal herniae that go through posterior wall

are medial to inferior epigastric vessels

A

direct

56
Q

direct/indirect are often bilateral inguinal herniae

A

direct

57
Q

inguinal herniae that is poorly controlled by finger over deep ring - comes back out

A

direct

58
Q

inguinal herniae more common in old men =

don’‘t usually get surgery because ___

A

direct

low strangulation risk and are old

59
Q

Indirect inguinal herniae go through ___

lie ___ to inferior epigastric vessels and go with the ___

A

deep inguinal ring
lateral
cord

60
Q

Congenital (eg. PPV) inguinal hernia are usually

A

indirect

61
Q

indirect inguinal herniae occur more commonly in ___

A

M 10:1

younger males

62
Q

hernia controlled by digital P over deep ring = stays in =

A

indirect inguinal hernia

63
Q

indirect/direct inguinal herniae have more risk of complications and so are more likely to get ___

A

indirect

surgery

64
Q

Operations for inguinal herniae (more commonly for indirect)

A

suture (eg. Bassini), open mesh (Lichtenstein), TAPS/TEPS, herniotomy (for congenital), herniorraphy (repair wall defect)

65
Q

Post-op after hernia repair = 2 things

A

no driving for a wk

no heavy lifting for 1 month

66
Q

Testicular scrotal swelling indicates

A

testicular cancer

67
Q

scrotal swellings could be due to (4)

A

testicular cancer
epidydymal cyst
hydrocele
inguino-scrotal hernia

68
Q

in scrotal swellings if can get above it then it is in the ___ and is not a ___

A

scrotum eg. a hydrocele

not a hernia

69
Q

If can feel scrotal swelling is separate to testiicles then it is a ___

A

epididymal cyst

JazGI (26 decks)

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