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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
What is the distinguishing factor in LBO?
Competence of ileocecal valve (can lead to massive dilation of cecum w/ increased risk of perforation)
26
Volvulus most commonly involves the...
sigmoid (70%) | cecum (30%)
27
What will you see on plain films during volvulus?
Massively dilated cecum or sigmoid w/ loss of haustral markings
28
What is seen on barium enema during volvulus?
Bird's beak
29
How do you treat partial LBO?
NG tube, IVF | Surgery
30
How do you treat complete LBO?
Laparotomy May be reduced w/ sigmoidoscopy
31
What are complications of LBO?
Perforation Peritonitis Sepsis
32
What are the primary sx of rectal disease?
Pain, bleeding, discharge
33
Describe the denate line
located at the anorectal junction Above = columnar epithelium (insensate) Below = Squamous epithelium (sensate)
34
Hemorrhoids arise from...
a plexus of dilated veins arising from the superior & inferior hemorrhoidal veins
35
What causes hemorrhoids?
Prolonged sitting, straining
36
What are the primary sx of hemorrhoids?
Bright red blood, pruritis, prolapse, pain due to thrombosis
37
Describe the different classes of internal hemorrhoids
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
How do you treat 1st & 2nd degree sx internal hemorrhoids?
Bulking agents, increase H2O Rubber band ligation Infrared coagulation
39
How do you treat 3rd degree internal hemorrhoids?
Rubber band ligation Surgical hemorrhoidectomy
40
How do you treat 4th degree internal hemorrhoids?
Surgical hemorrhoidectomy
41
What are sx of thrombosed hemorrhoids?
Severe perianal pain & a lump
42
How do you treat thrombosed hemorrhoids?
Sitz bath, analgesics Hydrocortisone (suppository, foam - Anusol or Proctofoam)
43
Abscesses are characterized by what 4 locations?
Intersphincteric Perianal* Ischiorectal* Supralevator
44
What are sx of abscesses?
Perianal pain & swelling (esp. perianal & ischiorectal) Drainage of pus Fever, redness
45
How do you treat abscesses?
I&D in the OR | Abx
46
What is a chronic perianal infection that can occur following drainage of a perirectal abscess?
Fistula-in-ano: abnormal connection btwn anus at denate line & perirectal/anal skin
47
What do you need to r/o in fistula-in-ano?
Crohn's
48
What is the clinical presentation of fistula-in-ano?
Chronic drainage of pus Occasionally stool from the fistula
49
How do you treat fistula-in-ano?
Fistulotomy Avoid damage to sphincter muscle to prevent incontinence
50
What causes anal fissures?
Trauma Constipation Severe diarrhea
51
What is the clinical presentation of anal fissures?
Pain worse during BMs (disproportionate to the size of the fissure) Bright red blood streaking stool
52
What are pathognomic findings seen w/ anal fissures?
External skin tag Exposure of sphincter Hypertrophied anal papilla
53
How do you treat anal fissures?
Bulking agents, analgesics Sitz baths Nitroglycerin or diltiazem cream If chronic --> surgery
54
What is rectal prolapse associated w/?
``` Longstanding constipation Chronic straining Pregnancy Previous surgery Neuro disease ```
55
What is the clinical presentation of rectal prolapse?
Mass protruding through anus (initially may occur w/ BMs, then retracts)
56
When do rectoceles occur?
When fascia weakens, allowing rectum to bulge into vagina

Foundations III GI (Cholley) (10 decks)

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