Chapter 47 Flashcards
How does a patient present who has volvulus?
Colicky abdominal pain, nausea, bloating, constipation, elderly patient, with psychiatric or neuro debilitated patient may be institutionalized
What is the appropriate differential diagnosis for this patient?
Constipation, renal colic, ileus, bowel obstruction
What are the findings for physical examination for this patient
Hyperactive bowel sounds, tympanic distended abdomen, Moderate tenderness LLQ, empty rectal ampulla
How is sigmoid volvulus confirmed?
Plain abdominal film, barium enema or abdominal CT scan if equivocal plain films
What labs will assess for strangulation?
CBC, BMP electrolyte Abnormalities and left shift
Why should a urine analysis be done for this patient?
Possible kidney stones
What consist in bowel rest? When should it be ordered?
NPO, IVF, NG tube; Pending confirmation test And IV morphine should be added
What does uncomplicated sigmoid volvulus mean? Who should be consulted when confirmed?
No strangulation or perforation. Gastroenterology
What should be done while waiting for confirmatory test? We should be done when confirmed?
Bowel rest. Admit
For this uncomplicated patients what should be done?
Initial non-operative management to relieve obstruction and prevent gangrene … by Consulting Gastro, sigmoidoscopy
Why consult gastroenterology?
For derotation and decompression
What is the procedure of choice? What is it followed by?
Sigmoidoscopy; Followed by rectal tube placement and 2-3 days of close monitoring for signs of ischemia
What are signs of ischemia? What is the remedy if occurs post sigmoidoscopy in uncomplicated Volvulus?
persistent pain, blood in stool; immediate surgical intervention
What is the definitive therapy? Why is this done?
(Open laparotomy with sigmoid resection and primary anastomosis) elective surgery to prevent reoccurrence
When is mechanical bowel preparation recommended?
Lower anterior rectal resection and laparoscopy colectomy
