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Foundations III GI (Cholley) > Bowel Obstruction & Rectal Disease > Flashcards

Bowel Obstruction & Rectal Disease Flashcards

1
Q

The small intestine receives blood supply mostly from the…

A

SMA

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2
Q

The large bowel consists of what?

A

Cecum –> ascending colon –> hepatic flexure –> transverse colon –> splenic flexure –> descending colon –> sigmoid –> rectum

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3
Q

The large bowel receives blood supply from…

A

SMA & IMA

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4
Q

What is the primary fxn of the small bowel?

A

Digestion w/ absorption of H2O, electrolytes, & nutrients

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5
Q

What is the primary fxn of the large bowel?

A

Absorbs H2O & electrolytes from liquid stool

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6
Q

What is the indication for a KUB?

A

Gas patterns

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7
Q

What is the MC cause of SBO?

A

Worldwide = hernias

US = post-op surgical adhesions

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8
Q

What is the clinical presentation of SBO?

A 
Hx of abd surgery 
Hx of hernia 
Periumbilical abd pain 
Abd distention 
N/V
Constipation
Obstipation
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9
Q

What are PE findings in SBO?

A 
Tachycardia, hypotension 
Dry MMs, poor skin turgor
Surgical scars, hernias**
High pitched bowel sounds
Diffuse abd tenderness
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10
Q

How do you dx SBO?

A

Plain films

CT

Upper GI & small bowel

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11
Q

How do you treat a partial SBO?

A

IVF, decompression w/ NG tube

80% resolve! Observe 24-48hrs

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12
Q

What should you monitor in SBO?

A

For signs of strangulation

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13
Q

How do you treat a complete SBO?

A

Laparotomy

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14
Q

What are complications of SBO?

A 
Infection
Abscess
Fistula 
Anastomosis leak
Peritonitis 
Short bowel syndrome
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15
Q

Describe paralytic ileus

A

Decreased bowel motility due to systemic or inflammatory process

Bowel becomes distended w/out mechanical obstruction

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16
Q

What causes paralytic ileus?

A 
Narcotics
Bedrest
Trauma
Hypothyroid
Electrolyte abnormalities
Anesthesia
Sepsis
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17
Q

How does paralytic ileus present?

A
  • Abd distension
  • N/V
  • Obstipation
  • Decreased/absent bowel sounds
  • Gas in both small & large intestine
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18
Q

How do you dx paralytic ileus?

A

Plain films: diffuse bowel dilation involving small & large bowel

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19
Q

How do you treat paralytic ileus? When does it resolve?

A

NPO, NG tube, IVF

Resolves within 4 days

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20
Q

What is the MC site of LBO?

A

Sigmoid colon

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21
Q

What are the causes of LBO? (3)

A

Adenocarcinoma (MC)
Scarring
Volvulus

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22
Q

What is the clinical presentation of LBO?

A

Crampy abd pain
Abd distention w/ tympany
N/V
Obstipation

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23
Q

How does LBO look like on PE?

A

High pitched bowel sounds

Localized, tender, palpable mass (strangulated loop)

24
Q

How do you dx LBO?

A

Plain films

25
Q

What is the distinguishing factor in LBO?

A

Competence of ileocecal valve (can lead to massive dilation of cecum w/ increased risk of perforation)

26
Q

Volvulus most commonly involves the…

A

sigmoid (70%)

cecum (30%)

27
Q

What will you see on plain films during volvulus?

A

Massively dilated cecum or sigmoid w/ loss of haustral markings

28
Q

What is seen on barium enema during volvulus?

A

Bird’s beak

29
Q

How do you treat partial LBO?

A

NG tube, IVF

Surgery

30
Q

How do you treat complete LBO?

A

Laparotomy

May be reduced w/ sigmoidoscopy

31
Q

What are complications of LBO?

A

Perforation
Peritonitis
Sepsis

32
Q

What are the primary sx of rectal disease?

A

Pain, bleeding, discharge

33
Q

Describe the denate line

A

located at the anorectal junction

Above = columnar epithelium (insensate)

Below = Squamous epithelium (sensate)

34
Q

Hemorrhoids arise from…

A

a plexus of dilated veins arising from the superior & inferior hemorrhoidal veins

35
Q

What causes hemorrhoids?

A

Prolonged sitting, straining

36
Q

What are the primary sx of hemorrhoids?

A

Bright red blood, pruritis, prolapse, pain due to thrombosis

37
Q

Describe the different classes of internal hemorrhoids

A

1st degree: bulge in anal canal lumen

2nd degree: protrudes w/ defecation, reduces spontaneously

3rd degree: protrudes w/ defecation, manually reduced

4th degree: protrudes permanently, incarcerated

38
Q

How do you treat 1st & 2nd degree sx internal hemorrhoids?

A

Bulking agents, increase H2O

Rubber band ligation

Infrared coagulation

39
Q

How do you treat 3rd degree internal hemorrhoids?

A

Rubber band ligation

Surgical hemorrhoidectomy

40
Q

How do you treat 4th degree internal hemorrhoids?

A

Surgical hemorrhoidectomy

41
Q

What are sx of thrombosed hemorrhoids?

A

Severe perianal pain & a lump

42
Q

How do you treat thrombosed hemorrhoids?

A

Sitz bath, analgesics

Hydrocortisone (suppository, foam - Anusol or Proctofoam)

43
Q

Abscesses are characterized by what 4 locations?

A

Intersphincteric
Perianal*
Ischiorectal*
Supralevator

44
Q

What are sx of abscesses?

A

Perianal pain & swelling (esp. perianal & ischiorectal)

Drainage of pus

Fever, redness

45
Q

How do you treat abscesses?

A

I&D in the OR

Abx

46
Q

What is a chronic perianal infection that can occur following drainage of a perirectal abscess?

A

Fistula-in-ano: abnormal connection btwn anus at denate line & perirectal/anal skin

47
Q

What do you need to r/o in fistula-in-ano?

A

Crohn’s

48
Q

What is the clinical presentation of fistula-in-ano?

A

Chronic drainage of pus

Occasionally stool from the fistula

49
Q

How do you treat fistula-in-ano?

A

Fistulotomy

Avoid damage to sphincter muscle to prevent incontinence

50
Q

What causes anal fissures?

A

Trauma
Constipation
Severe diarrhea

51
Q

What is the clinical presentation of anal fissures?

A

Pain worse during BMs (disproportionate to the size of the fissure)

Bright red blood streaking stool

52
Q

What are pathognomic findings seen w/ anal fissures?

A

External skin tag
Exposure of sphincter
Hypertrophied anal papilla

53
Q

How do you treat anal fissures?

A

Bulking agents, analgesics
Sitz baths

Nitroglycerin or diltiazem cream

If chronic –> surgery

54
Q

What is rectal prolapse associated w/?

A 
Longstanding constipation 
Chronic straining 
Pregnancy
Previous surgery 
Neuro disease
55
Q

What is the clinical presentation of rectal prolapse?

A

Mass protruding through anus (initially may occur w/ BMs, then retracts)

56
Q

When do rectoceles occur?

A

When fascia weakens, allowing rectum to bulge into vagina

Foundations III GI (Cholley) (10 decks)

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