Bowel Path I Flashcards
small intestine
duodenum
jejunum
ileum
digest/absorb protein, carb, lipid
absorb vits, minerals
protects against intruders
resorption of water
hepatic flexure
large bowel - right side
splenic flexure
large bowel - left side
paralytic lieus
intestine has no contractions - functional obstruction
big 4 causes GI obstruction
adhesions
hernia
volvulus
intussusception
pseudo obstruction
paralytic ileus - post op
GI obstruction sx
pain
distension
vomiting
constipation
usually requiring surgery
-not paralytic ileus
small bowel obstruction
pain is colicky - cramping and intermittent
large bowel obstruction
longer lasting spasms
constipation early and vomiting less prominent
CT of obstruction
full of fluid and see air level
intussusception
part of intestine invaginated into another section
telescoping
most frequent - ileum entering cecum
dances sign
intussusception
diagnosis of intussusception
ultrasound
target like mass - 3cm in diameter
target mass
ultrasound with intussusception
tx of intussusception
barium enema - confirms dx and reduces it
surgical reduction if this doesnt work
red currant jelly
with intussusception
-ischemic mucosa is sloughed off
inguinal hernia
majority right sided
-males
cannot be reduced = incarceration
direct inguinal hernia
medial to inferior epigastric vessels - transversalis fascia
indirect inguinal hernia - deep inguinal ring - lateral to inferior epigastric vessels - fail of closure of processus vaginalis
most common cause of intestinal obstruction worldwide
hernia
in US - adhesions
volvulus
malrotation of loop of blwel
infants or adults
commonly in the sigmoid colon
diagnosis of volvulus
abdominal x-ray
coffee bean sign
x-ray of volvulus
or bent-inner tube
birds beak
diagnosis of volvulus using barium enema
adhesions
fibrous bands between tissues and organs
-internal scar tissue after surgery-injury
-most common cuase of obstruction in US
can lead to internal hernia
complete obstruction - surgical intervention
most improve conservative care within 2-5 days
ischemic bowel disease etiology
often arterial embolism
or thrombosis - second most common - superior mesenteric artery
cocaine
non-occlusive IBD
transmural bowel infarct
bad - contents can leak out with perforation in 1-4 days
rapid onset of periumbilical pain with nausea and vomiting
intestinal infarct
mesenteric ischemia
inflammation and injury of small intestine result from inadequate blood supply
common in elderly
three phases:
1 hyperactive - abdominal pain and bloody stool
2 paralytic - loss motility
3 shock - fluid leak through colon lining
superior mesenteric artery
ascending and transverse colon
inferior mesenteric artery
descending colon, sigmoid, rectum
watershed areas
weak points in blood flow to colon
-between SMA and IMA boundaries
splenic flexure and transverse colon
vulnerable to ischemia
rectum
dual blood supply
ischemic colititis diagnosis
scope
tx ischemic colitis
supportive
surgery if severe
angiodysplasia
non-neoplastic vascular lesion
cecum or prox right colon
path unknown
tortuous dilatation of malformed submucosa and mucosa blood vessels
60yo
significant bleeding can occur
resembles telangiectasia
heydes syndrome
angiodysplasia with aortic valve stenosis
vWF - protelysed with high shear stress
hemorrhoids
pregnancy
cirrosis
most commonly - straining of stool**
internal hemorrhoids
painless bleeding
external hemorrhoids
painful
secretory diarrhea
> 500mL isotonic fluid stool daily
persist during fasting**
infectious
osmotic diarrhea
> 500mL hypertonic fluid
abates with fasting**
lactase deficiency
exudative diarrhea
mucosal damage
-purulent bloody stools
- persists during fasting
- bacterial or IBD
deranged motility diarrhea
improper neuromuscular
variable during fasting**
malabsorption diarrhea
improper absorption
-bulky stool - excess fat
abates with fasting**
celiac, giardia, pancreatitis, CF
diarrhea
increase in stool mass, frequency or fluiditiy
dysentery
low volume bloody diarrhea
standard test for malabsorption
72 hour stool for fat
pt diet 100g fat day
more than 18-20g fat in stool - pt has malabsorption
malabsorption
luminal phase - pancreatitis, CF
mucosal phase - celiac sprue
postabsorptive phase - lymph obstruction
infectious enterocolitis
huge worldwide problem
viral - rotavirus
bacterial - 3 mechanisms
also parasitic
responsible for lots of death worldwide
