Colorectal Flashcards
What are the symptoms of a bowel obstruction?
Constipation, vomiting green bile, diffuse abdominal pain and distention
What is a closed loop obstruction?
there are 2 points of obstruction along the bowel, there is a middle section sandwiched in between the two points of obstruction
give 3 examples of closed loop obstructions
volvulus (sigmoid and caecum)
hernias
adhesions
What can be seen in an abdominal x ray in the small bowel?
the small bowel lies more central and has mucosal folds called valvulae conniventes
What can be seen in abdominal x ray of the large bowel?
frames the small bowel, has small pouches called haustra
What can be found upon ABG in a patient with a bowel obstruction?
metabolic alkalosis due to loss of hydrogen ions from vomiting stomach acid
raised lactate
In an erect chest x ray, what does air under the diaphragm indicate?
a perforation
What surgical treatments are available for bowel obstructions?
adhesiolysis, hernia repair and emergency resection (Depedent on the type of bowel obstruction) e.g. volvulus = hartmann’s,
What is ileus?
The paralysis of peristalsis caused by handling of the bowel, inflammation and hypokalaemia
What are the symptoms of ileus?
abdominal distention, absolute constipation and no flatulence as well as some abdominal pain
How is ileus managed?
- patient is nil by mouth
- NG tube if vomiting
- PEG feed while waiting for bowel function to return
What are the 3 main types of hernia?
Indirect inguinal hernia
Direct inguinal hernia
Femoral hernia
What causes an indirect inguinal hernia?
the incomplete closure of the processus vaginalis so bowel contents can move through the inguinal canal
what makes indirect inguinal hernia distinctive?
it is reducible
What is a direct inguinal hernia caused by?
an area of weakness called the Hesselbach’s triangle
What is a femoral hernia?
movement of bowel throught femoral canal
why is a femoral canal concerning?
it has a very narrow neck so is at risk of encarceration, strangulation and obstruction
What is the difference between diverticulosis and diverticulitis?
Diverticulosis is the presence of diverticula (little sacs on the bowel wall) and diverticulitis is inflammation of these sacs
How does diverticular disease occur?
Increased pressure over time from straining and over use allows for gaps to form in the bowel and allows for mucosa to push through
Who gets diverticulosis
older patients with a low fibre diet, who use NSAIDs, obesity
Presentation of diverticulosis symptoms
lower abdo pain on the left
constipation
rectal bleeding
How is diverticulosis managed
stimulant laxatives e.g. senna and bulk forming laxatives e.g. isphagula husk
surgery to the sigmoid may be necessary too
How does diverticulitis present?
- pain, tenderness over left the iliac fossa
- fever
- diarrhoea
- nausea
- palpable abdo masses
- raised CRP
How is diverticulitis managed?
5 day course of co-amoxiclav, analgesia avoiding NSAIDs and opiates
