Conditions of the Small Intestine

Question 1

What is a key feature of many small intestine conditions?

Answer 1

Malabsorption

Question 2

Common causes of malabsorption?

Answer 2

Coeliac disease, crohn’s disease, post infectious, biliary obstruction, cirrhosis

Question 3

Surgeries or treatments that may cause malabsorption?

Answer 3

Gastric bypass
Gastric or small bowel resection
Radiation exposure

Question 4

Explain the 3 types of intestinal failure?

Answer 4

Type 1 (SHORT TERM): Self-limiting intestinal failure
Surgical Ileus post op or context of Critical illness

Type 2 (MEDIUM TERM): Significant & prolonged PN support (>28 days). Post surgery, awaiting reconstruction, vascular disaster that has compromised part of the GI tract, may have chrons, radiation problems, adhesions or fistulae so losing secretions high up.

Type 3 (CHRONIC): often due to short bowel syndrome

Question 5

Explain the difference between parenteral and enteral nutrition

Answer 5

Parenteral is nutrition given by IV in enteral nutrition you still use the GI tract

Question 6

Define short bowel syndrome

Answer 6

Bowel shorter than 200cm this results in insufficient amount of bowel to reach nutritional needs. May be due to intestinal resection, massive intestinal resection, EC fistula or bypass surgery.

Question 7

Acidosis and abdominal pain is what until proven otherwise?

Answer 7

Ischaemic small bowel

Question 8

Classic presentation of ischaemic bowel?

Answer 8

There is pain out of proportion to the clincal findings. Acidosis on gases, lactate elevated, CRP may be normal, WCCC may be up a bit, CT angiogram urgently, laparotomy.

Question 9

Chronic ischaemic bowel classic presentation?

Answer 9

Old ladies who smoke but are active and have food fear due to abdominal pain associated with eating

Question 10

4 potential causes of appendicitis?

Answer 10

obstruction of the lumen with faecolith, bacterial, viral or parasitic infection

Question 11

Classic picture of appendicitis?

Answer 11

Central pain that radiates to the RIF
Anorexia
Nausea
One or two vomits
May have not moved their bowels

Question 12

Signs of appendicitis?

Answer 12

mild pyrexia, mild tachycardia, guarding and rebound tenderness

Question 13

What test must you do in women with suspected appendicitis?

Answer 13

A pregnancy test to rule out ectopic pregnancy

Question 14

Complications of appendicitis?

Answer 14

If not treated early gangrene may occur with perforation leading to localised abscess or generalised peritonitis

Question 15

Treatment of appendicitis?

Answer 15

Analgesia
Antipyretics
Appendicectomy (laparoscopic is first line)
Antibiotics

Question 16

What happens to removed appendices?

Answer 16

Sent to pathology to check for pseudomyxoma peritonea, adenocarcinoma of caecum or carcinoid of the appendix

Question 17

Presentation of ischaemic small bowel?

Answer 17

Pain out of proportion to clinical findings
Acidosis on gases
Lactate elevated
CRP may be normal but WCC elevated a bit
CT angiogram to see vessels is done

Question 18

Treatment of ischaemic small bowel?

Answer 18

Must be done quickly
Resect if not viable and rejoin healthy part to other end of bowel
Sometimes there is nothing to be done but an open and close surgery