Bowel Presentations Flashcards
- Bowel obstruction - Bowel perforation - Gastroenteritis
What are the Ax of GIP?
Mst common
- peptic ulcer
- sigmoid diverticulum
Inflammatory/ischaemic
- diverticulitis
- meckel’s diverticulum
- cholecystitis
- mesenteric ischaemia
Trauma
- excessive vomiting
- anasto
What are the clinical features of GIP?
- Sharp onset pain
- malaise, N&V
- peritonism (rigid abdomen)
What are the Sx if thoracic perforation occurs in GIP?
- chest or neck pain - radiate to back
- resp sx
- pleural effusion signs
- crepitus
What are the differential dx for GIP?
- acute pancreatitis
- MI
- ruptured AAA
- tubo-ovarian pathology
What Ix will you order for GIP?
Bedside
- Urinalaysis - exclude tubo ovarian abcesses
Bloods
- Routine bloods
- G&S
Imaging
- CXR:
- signs of thoracic perforastion
- free air under diaphragm
- pneumomediastinum
- AXR
- pneumoperitoneum
- Rigler’s sign
- CT (gold standard)
What are the initial mx for GIP?
Drip and suck
- NBM
- NGT
- IV fluid
- Broad s[pec antibiotic
- commence individualised mx after definitive diagnosis made
What is a general surgical approach for GIP?
Thorough washout
What is Gastroenteritis (GE)?
Inflammation of GI tract. Usually caused by infection
What is the general rule with length of time of sx?
- hours: bacteria
- days: virus (most common cause in develop worl)
- weeks: bacteria
- montghs: parasite
Define diarrhoea
3 or more loose stools c inc. liquid per day
Define acute diarrhoea & chronic
- Loose stools less than 14 days
- Loose stools more than 14 days
What is dysentery?
loose stools with blood and mucys
What is traveller’s diarrhoea?
more than 3 loose stools within 24hrs of foreign travel
What are he RF for GE?
- Poor food preperation
- Poor hygiene
- Immunocompromised
What are he sx of GE?
- N&V
- Abdominal cramps
- Diarrhoea
- weight loss, opyrexia, night sweats
*to rule out traveller’s diarrhoea, ask
- recent travels
- infected family/friends
- bowel habits
Ask recent use of antibiotics
What Ix will help you with GE?
- Stool culture
- blood culture
What is the mx for GE?
* self limiting
COnservative
- rehydration
- notify appropriate body
What virus causes GE?
- Norovirus (most common in adults)
- Adenovirus (most common in children)
- Rotavirus
What bacteria causes GE?
- campylobacter (chicken, egg, milk) - most common
- E.coli (traveller’s diarrhoea)
- Salmonella (undercooked chiceken, raw eggs)
- shigella (dairy and water)
- C.diff - hospital acquired
What parasites causes GE?
- cryptosporidum - causes self limiting water diarrhea
- entamoeba histolytica - can result in liver abcess
- giardia
- Schistosoma - can lead to eosinophilia and chronic liver disease
What are the non infective causes of GE?
- radiation
- IBD
- chronic ischaemic colitis
- microsco[pic colitis
How would you manae paralytic ileus?
- electrolyte abnormality corrected
- IVF administered
- NG tube decompression
- opiate analgesia
How would you tx Acute colonic pseudo-obstruction?
- Neostigmine (cholinesterase inhibitor) given to encourage motility
- Endoscopic colonic decompression in those failing to respond.
- Surgery
