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General Surgery > Bowel Pathologies > Flashcards

Bowel Pathologies Flashcards

1
Q

what is a bowel volvulus?

A

A twisting of a loop of bowel around its mesenteric axis, which results in a combination of obstruction together with occlusion of the main vessels at the vase of the involved mesentery

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2
Q

what are the causes of a volvulus?

A

An abnormally mobile loop of intestine, for example congenital failure of rotation of the small intestine, or a particularly long sigmoid loop
An abnormally loaded loop
A loop fixed at its apex by adhesions around which it rotates
A loop of bowel with a narrow mesenteric attachment

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3
Q

what is the pathophysiology of a sigmoid volvulus?

A

loop of sigmoid colon usually twists anticlockwise from one half to three turns, strangulated bowel undergoes gangrene

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4
Q

what are the causes of sigmoid volvulus?

A

elderly, constipated

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5
Q

what are the clinical features of sigmoid volvulus?

A

Sudden onset of colicky pain

Gross and rapid dilation of the sigmoid loop

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6
Q

what investigations can be done to diagnose sigmoid volvulus?

A

Plain Xray or CT

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7
Q

what will imaging show in sigmoid volvulus?

A

dilated oval casts shadow on left side which may be looped on itself to give typical “bent inner-tube sign” “coffee bean”

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8
Q

how can imaging distinguish between sigmoid and caecal volvulus?

A

Caecum is usually visible and dilated in the right lower quadrant, distinguishing it from caecal volvulus

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9
Q

what is the management of sigmoid volvulus?

A

Untwisting via sigmoidoscope
if fauls laparaotomy for untwisting and decompression
Excision if gangrene
Resection if recurrent

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10
Q

what is the cause of caecal volvulus?

A

congenital malformation

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11
Q

what is the pathophysiology of caecal volvulus?

A
  • the caecal and proximal ascending colon rotate beyond the right iliac fossa during development so that, instead of being fixed in the RIP, it has a persistant mesentery
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12
Q

what are the clinical features of caecal volvulus?

A

o Acute inset of pain in RIP

o Rapid abdominal distension

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13
Q

what investigations should be done to diagnose caecal volvulus?

A

Plain Xray or CT

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14
Q

what features are present in the imaging of caecal volvulus?

A

grossly dilated caecum, often ectopically placed and is frequently located n the LUQ of abdomen

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15
Q

what is the management of caecal volvulus?

A

Laparotomy to untwist

Right hemi-colectomy if infarction

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16
Q

what is the pathophysiology of small bowel volvulus?

A

SB fixed at its apex by adhesions or by a fibrous remnant of the of the Vitello intestinal duct. Occasionally, the apex of the volvulus bears a tumour

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17
Q

what are the clinical features of a SB volvulus?

A

acute intestinal obstruction

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18
Q

what is the management of small bowel volvulus?

A

early operation with simple untwisting and treatment of the underlying cause

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19
Q

what is the cause of volvulus neonatorum?

A

congenital malrotation of the bowel

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20
Q

what is the pathophysiology of volvulus neonatorum?

A

caecum remains high and the midgut mesentery is narrow and drags across the duodenum which may this be also obstructed. Because of the narrow attachment of mesentery it readily undergoes volvulus.

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21
Q

what is the treatment of neonatal volvulus?

A

laparotomy

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22
Q

in what age does intussusception commonly occur?

A

3 months and 3 years

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23
Q

what are the different types of intussusception?

A

o Ileum enters caecum

o Jejunum prolapses into itself

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24
Q

what does intussusceptum refer to?

A

The part that prolapses into the other

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25
Q

what does intussuscepiens refer to?

A

the part that receives it

26
Q

what is the consequence of intussusception?

A

Trapped section of bowel may have blood supply cut off causing ischaemia

27
Q

what are the risk factors for intussusception?

A

o CF

o Intestinal Mass – polyp, lymphoma, Meckel’s diverticulum

28
Q

what causes red current jelly stools?

A

• Mucosa – sensitive to ischaemia sloughs of into gut

29
Q

what are the clinical features of intussusception?

A
  • Abdo pain – colicky period severe pain
  • Sausage shaped mass
  • Redcurrant jelly stools
  • Abdominal distension
  • Shock
  • Peritonitis – tenderness, guarding, rigidity
30
Q

What investigations can be used for intussusception?

A

US

AXR

31
Q

what is the 1st choice imaging for intussusception?

A

US

32
Q

what features will be present in US of intussusception?

A

distended small bowel ± absence of gas in large bowel. Rarely, the actual intussusception itself may be visible

33
Q

what is the treatment of intussusception?

A
  • IV fluids
  • barium or water-soluble contrast enema or an air-contrast enema
  • Surgery - open or laparoscopy
34
Q

what are the causes of acute mesenteric ischaemia?

A

Arterial - Thrombotic, Embolic
Non-occlusive
Venous (younger, hypercoagubale)
Other: Trauma, Vasculitis, Radiotherapy, Strangulation (volvulus, herniae)

35
Q

which artery is involved in mesenteric ischameia?

A

superior mesenteric artery

36
Q

what is the triad of symptoms in acute mesenteric ischaemia?

A

Acute severe abdominal pain (constant, central or RIF)
No abdominal signs
Rapid hypovolaemia = SHOCK

37
Q

what investigations can be done for acute mesenteric ischaemia?

A

Bloods
Xray
CT/MRI angiogrpahy
Measurement of mucosal oxygen tension and MR oximetric measuremetns of superior mesenteric vein flow

38
Q

what will the bloods in acute mesenteric ischaemia show?

A
  • Increased HB
  • Raised WCC
  • Raised plasma amylase
  • Metabolic acidosis
39
Q

what AXR features will be present in acute mesenteric ischaemia?

A

Early – gasless abdomen

40
Q

what is the treatment of acute mesenteric ischaemia?

A

Fluids
Antibiotics – gentamicin + metronidazole
Heparin
Surgery – removal of dead gut, revascularisation, laparoscopy

41
Q

what are the complications of acute mesenteric ischaemia?

A
  • Septic peritonitis

* SIRS to MODS

42
Q

what is the triad of symptoms present in chronic mesenteric ischaemia

A

o Severe colicky post prandial abdominal pain (gut claudication)
o Reduced weight
o Upper abdominal bruit +/- PR bruit, malabsorption, N&V
(also a history of vascular disease)

43
Q

what investigations are used for diagnosis of chronic mesenteric ischaemia?

A
  • CT angiography and contrast enhanced MR angiography

* Doppler US

44
Q

what is the management of chronic mesenteric ischaemia?

A
  • Surgery

* Percutaneous transluminal angioplasty and stent insertion

45
Q

what is the pathophysiology of chronic colonic ischaemia?

A

Usually follows low flow in the inferior mesenteric artery territory and ranges from mild ischaemia to gangrenous colitis

46
Q

what are the clinical features of chronic colonic ischaemia?

A

Lower left sided abdominal pain +/- bloody diarrhoea

47
Q

what investigations should be done for chronic colonic ischaemia?

A

CT
Colonoscopy and biopsy
Barium enema

48
Q

what is the gold standard investigation in chronic colonic icschaemia?

A

Colonoscopy and biopsy

49
Q

what does a barium enema in chronic colonic ischaemia show?

A

characteristic “thumb printing” of submucosal swelling

50
Q

what is the treatment of chronic colonic ischaemia?

A
  • Fluid replacement
  • Antibiotics
  • Gangrenous prompt resection
51
Q

what are the categories of causes of paralytic ileus?

A

peritonitis
metabolic factors
drugs
postoperative

52
Q

how does peritonitis cause paralytic ileus?

A

toxic paralysis of intrinsic nerve plexuses bowel become atonic

53
Q

what metabolic factors can cause paralytic ileus?

A

potassium depletion, uraemia, diabetic coma

54
Q

which drugs can cause paralytic ileus?

A

anticholinergic agents and antiparkinsonian drugs

55
Q

how can post op result in paralytic ileus?

A

sympathetic overaction, effects of manipulation of the bowel, potassium depletion (post op vomiting), peritoneal irritation, atony of stomach and large bowel post op
also mechanical obstruction through adhesions

56
Q

what are the clinical features of paralytic ileus?

A
  • Abdominal distension
  • Absolute constipation
  • Vomiting
  • Absence of intestinal movements and hence absence of colicky pain
57
Q

what imaging should be done to diagnose paralytic ileus?

A

CT or Plain Xray

58
Q

what will imaging show in paralytic ileus?

A

will show gas distribution throughout the small and large bowel and some fluid levels on erect xray

59
Q

what is the prophylactic management of paralytic ileus?

A

Preoperative biochemical imbalance correction
Bowel handled gently
Post-op nasogastric suction

60
Q

what is the management of established paralytic ileus?

A

o Nasogastric suction to remove swallowed air and revent gaseous distension
o IV fluids and electrolyte therapy
o Pethidine to releve discomfort and phenothiazine for nausea
o Patience
o Gradual introduction of enteral feeding
o Metoclopramide with Erythomucin

61
Q

what is paralytic ileus?

A

• State of atony of the intestine

62
Q

what is the consequences of paralytic ileus?

A
  • Loss of fluid, electrolytes and protein into gut lumen and in the vomitus or gastric aspirate
  • Gross gaseous distension of the gut, produced mainly from swallowed air that cannot pass through the bowel, impairs the blood supply of the bowel wall and allows toxins absorption to occur

General Surgery (14 decks)

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