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Gastroenterology > Bowel Obstructions > Flashcards

Bowel Obstructions Flashcards

1
Q

Causes of small bowel obstruction outside the bowel

A

Adhesions - previous operations, intraabdominal hernias

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2
Q

Causes of small bowel obstruction from the bowel wall

A

Crohn’s, appendicitis

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3
Q

Causes of SBO inside the bowel

A

Malignancy, foreign body ingestion, gallstone ileus

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4
Q

Common causes of SBO in children

A

Intussusception, volvulus, intestinal atresia, appendicitis

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5
Q

Presentation of SBO

A

Initial colicky pain which becomes continuous, distention, vomiting (bilious), failure to pass stool, tympanic high pitched bowel sound, empty rectum, fever, fluid depleted

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6
Q

Blood results in SBO

A

FBC showing leukocytosis and anaemia, U&E’s showing organ dys and hypovolaemia, high lactate for bowel ischaemia or necrosis, amylase

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7
Q

Imaging in SBO

A

Sit upright to look for pneumoperitoneum, absence of air in rectum

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8
Q

What are signs of emergency in SBO

A

Signs of peritonitis

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9
Q

Investigations to conduct if the patient is stable with SBO

A

CT abdo and pelvis for best diagnosis, contrast SB using gastrogaffin, MRI, US, diagnostic laparotomy

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10
Q

Management of SBO

A

Correct of fluid and electrolyes, fluid resus, NG tube to aspirate content for decompression, sugery if conservative measurements fail

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11
Q

Presentation of large bowel obstruction

A

Abdominal cramping pain, bloating, absolute constipation, nausea, vomiting in late stages

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12
Q

Causes of LBO

A

Colonic tumour, strictures from IBD or diverticular disease, vovulus, hernias, adhesions

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13
Q

Investigations into LBO

A

Abdominal Xr and CT

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14
Q

Management of LBO

A

Analgesia, fluids, antiemetics, decompression of sigmoid volvulis, 70% require surgical intervention.

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15
Q

Definition of Diverticular disease

A

Clinical conition resulting from the presence of diverticular which are outpouchings of the mucosa and submucosa, typically sigmoid colon

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16
Q

What is diverticulitis

A

Inflammation of diverticular, typically age >50

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17
Q

Presentation of diverticular disease

A

Constipation, LLQ pain, some rectal bleeding

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18
Q

Presentation of diverticulitis

A

Acutely with LLQ pain, fever, nausea, vomiting, pyrexia

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19
Q

Complications of diverticulitis

A

Abscess formation, perforation (if diffuse tenderness/peritonitis), fistulas (especially colovesical fistulas)

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20
Q

Management of diverticular disease

A

Increased dietary fibre, hydration, analgeisa

21
Q

Management of diverticulitis

A

Initially managed with oral antibiotics - 7 day amoxiclav

22
Q

Indications for surgery in diverticular disease

A

Option if rectal bleeding uncontrolled, unresponsive to anti-biotics, abscess, perfoartion, stricture or obstruction

23
Q

Definition of diverticulosis

A

Diverticula found incidentally

24
Q

What is vovulus

A

Twisting of a loop of intestine around its mesenteric attachment, resulting in a closed loop bowel obstruction.

25
Q

What can happen in the affected bowel of vovulus

A

Affected bowel can become ischaemic due to a compromised blood supply, rapidly leading to bowel necrosis and perforation

26
Q

Risk factors for vovulus

A

Increasing age, neuropsychiatric disorders, nursing homes, chronic constipation or laxative use, male, previous abdominal operations

27
Q

Symptoms of vovulus

A

Colicky pain, distension, absolute distension, vomiting is a late sign

28
Q

Investigations into suspected volvulus

A

CT scan, abdo pelvis with contrast - dilated sigmoid colon with ‘whirl’

29
Q

Conservative management of vovulus

A

Decompression with sigmoidoscope and insertion of flatus tube

30
Q

Sugical management of vovulus

A

Hartmann’s procedure in cases of perforation or ischaemia, failed decompression attempts, necrotic bowel. If recurrent sigmoidectomy.

31
Q

Most common site of vovulus

A

Most common sigmoid colon, then caecum

32
Q

Management of caecal vovulus

A

Laparotomy and ileocaecal resection

33
Q

Definition of intusussception

A

Invagination of proximal bowel into a distal segment passing into the caecum through the ileocaecal valve

34
Q

Complications of intussusception

A

Bowel perforation, peritonitis, gut necrosis

35
Q

Presentation of vovulus

A

Paroxysmal, severe colicky pain and the child characteristically draws up legs. Increasingly lethargic, vomiting, refuse feeds, jelly stools, distention, sausage-shaped mass in abdomen

36
Q

Management of vovulus

A

Rectal air insufflation or contrast enema, operative reduction

37
Q

Clinical features of haemorrhoids

A

Bright red PR bleed associated with defecation. If painful suggests thrombosis external haemorrhoid or alternative diagnosis.

38
Q

How to diagnose haemorrhoids

A

Anascopic examination, palpable mass present with prolapsing

39
Q

Grade 1 haemorrhoid

A

No prolapse

40
Q

Grade 2 haemorrhoid

A

Prolapse on straining but spontanouesly reduces

41
Q

Grade 3 haemorrhoid

A

Prolapse requiring manual reduction

42
Q

Grade 4 haemorrhoid

A

Cannot be manually reduced (external)

43
Q

Management of haemorrhoid

A

Conservatively with or without topical steroids for pruritis. Rubber band ligation, slerotherapy or IR photocoagulation. Haemorrhoidectomy

44
Q

What is mesenteric ichaemia

A

Acute mesenteric ischaemia is a severe a lige threatening surgical emergency where there is sudden intestinal hypoperfusion. Chronic is more common in elderly

45
Q

Which vessel is normally occluded in mesenteric ichaemia

A

Superior mesenteric artery

46
Q

Acute presentation of mesenteric ischaemia

A

Severe abdo pain and guarding, nausea and vomiting, signs of shock, metabolic acidosis on ABG, PR bleeding in advanced

47
Q

Presentation of chronic mesenteric ichaemia

A

Diffuse colicky pain, worse after eating, weight loss, diarrhoea, meleana

48
Q

Risk factors for mesenteric ischaemia

A

Smoking, diabetes, high cholesterol, AF - emboli risk factors and atherosclerosis risk factors

Gastroenterology (19 decks)

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