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CSI 1b > Crohn’s Complications > Flashcards

Crohn’s Complications Flashcards

1
Q

Apendicitis site, character, associated symptoms, exacerbating factors and severity?

A
  1. Migratory - umbilical -> RLQ
  2. Usually consistent with intermittent cramps
  3. Anorexia, nausea and vomiting, failure to pass flatus or stool, Rovsing’s sign (feel pain in RLQ when pressing down on LLQ)
  4. Movement and coughing
  5. Severe
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2
Q

Small bowel obstruction site, character, associated symptoms, exacerbating factors and severity?

A
  1. Umbilical
  2. Colicky and severe
  3. Anorexia, vomiting and nausea, unable to pass stool/wind, abdominal distension/bloating
  4. Oral intake
  5. Severe
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3
Q

Pancreatitis site, character, associated symptoms, exacerbating factors and severity?

A
  1. Epigastric/left upper quadrant pain radiating to back
  2. Constant and severe
  3. Nausea/vomiting, anorexia, dyspnoea
  4. Worse on movement
  5. Severe
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4
Q

Cholecystitis site, character, associated symptoms, exacerbating factors and severity?

A
  1. Constant right upper quadrant, might get right shoulder pain
  2. Constant and severe
  3. Nausea/vomiting, Murphy’s sign
  4. Fatty foods
  5. Severe
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5
Q

SBO symptoms?

A

Nausea and vomiting (early sign in SBO, late sign in LBO)
Abdominal pain
Bowels not opened
Is not passing wind
Bloated and burping

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6
Q

Causes of SBO?

A
  1. Adhesions (history of previous abdo surgery)
  2. Neoplasia (primary, metastatic, extraintestinal)
  3. Incarcerated hernia (external - abdo wall, internal - mesenteric defect)
  4. Crohn’s disease (acute - oedema, chronic - strictures)
  5. Other (intussusception, intraluminal - foreign body, bezoar)
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7
Q

LBO causes?

A
  1. Colorectal carcinoma
  2. Volvulus (sigmoid, caecal)
  3. Diverticulitis (inflammation, strictures)
  4. Faecal impaction
  5. Hirschsprung disease

can get faecal vomiting

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8
Q

SBO abdo X-ray?

A

Ladder pattern of dilated loops and central position
Striations that pass completely across the width of distended loop produced by circular mucosal folds
Valvulae conniventes

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9
Q

LBO abdo X-ray?

A

Distended large bowel tends to lie peripherally
Show haustrations of taenia coli - do not extend across whole width of bowel

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10
Q

Adaptations to ileostomy?

A

Mucosal hypertrophy and hyperplasia
Aldosterone level up-regulation (Sodium retention and Sodium resorption)
Hypomotility

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11
Q

Universal donor?

A

O-

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12
Q

Universal acceptor?

A

AB+

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13
Q

A- blood given A+?

A

For women with RhD negative blood type, exposure to RhD antigen could be problematic for a future pregnancy or transfusions as rhesus antibodies could be made
Could cause haemolytic disease of foetus and newborn

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14
Q

GI perforation investigations?

A

Erect CXR - gas expelled from bowel will rise

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15
Q

Ileostomy consequences?

A
  • electrolyte + water absorption issues
  • issues with gut microbiome
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16
Q

Colostomy site, appearance and content?

A

Site - left iliac fossa
Appearance - bowel wall flush to the skin (bulging)
Content - more solid

17
Q

Ileostomy site, appearance and content?

A

Site - right iliac fossa
Appearance - bowel wall not touching skin because contents of bowel more alkali so more irritating to skin, more of a spout
Content - more liquid contents

18
Q

Renin angiotensin system?

A
  1. Drop in BP or fluid volume detected by baroreceptors -> decreased firing
  2. Renin released from kidney, which converts angiotensinogen (from liver) to angiotensin I
  3. ACE (from lungs) converts angiotensin I -> angiotensin II
19
Q

Angiotensin II effects?

A

A) acts on adrenal gland (zoma glomerulosa) to stimulate release of aldosterone. Aldosterone acts on kidneys to stimulate reabsorption of salt (NaCl) and water.
B) angiotensin II acts directly on blood vessels, stimulating vasoconstriction

20
Q

Stricture cause?

A

Chronic inflammation of intestines can cause walls of digestive tract to thicken or form scar tissue
This can narrow a section of intestine called a stricture

21
Q

Strictureplasty?

A

Surgical procedure to repair a stricture by widening the narrowed area without removing any portion of intestine

22
Q

Surgical procedures to repair stricture?

A

Stricturplasty
Small bowel resection

23
Q

Symptoms of stricture?

A

Nausea
Vomiting
Severe cramping
Constipation

24
Q

Where is strictureplasty most effective?

A

In lower sections of small intestine (ileum and jejenum)

less effective in duodenum

25
Q

Removing portions of your small intestine (in small bowel resection) can cause…

A

Short bowel syndrome - body unable to absorb adequate amounts of nutrients and water

26
Q

Strictureplasty procedure?

A

Surgeon makes cuts lengthwise along the narrowed areas of your intestine, then sew up the intestine crosswise

27
Q

Fistulas?

A

Abnormal connections between intestines and a nearby organ or skin formed due to inflammation or infection

can form anywhere along GI tract

28
Q

Most common fistula in Crohn’s?

A

Perianal fistula - between anal canal/rectum and skin

29
Q

Perianal fistula symptoms?

A

Rectal pain
Redness
Swelling
Leakage of stool, puss or blood

30
Q

Anal fistula investigations?

A

MRI
Endoscopic ultrasound
Examination under anaesthesia

31
Q

Fistula treatment?

A

Medication - antibiotics (metronidazole, ciprofloxacin), biologics (anti-TNF, azathioprine)
Surgical - seaton, fistulotomy, advancement flaps, LIFT procedure

32
Q

Symptoms of abscess?

A

Severe pain in abdomen
Painful bowel movements
Discharge of pus from anus
Lump at end of anus that is swollen, red, and tender
Fever

33
Q

Abscess drainage procedure?

A

Surgeon will make a small cut into the abscess and insert a thin tube to drain pus
Tube may be left in for a week or more to allow the abscess to completely drain and begin healing

34
Q

Strictures vs adhesions?

A

Adhesions - scar tissue (due to surgery or inflammation) causes two things to adhere together

Strictures - narrowing of lumen of intestine

35
Q

Width of small and large bowel distension?

A

369 rule
3cm - small bowel more than 3cm = distension
6cm - large bowel
9cm - caecum

36
Q

Adaptations to ileostomy?

A

Mucosal hypertrophy and hyperplasia
Aldosterone level up-regulation (for sodium retention and absorption)
Hypomotility

CSI 1b (8 decks)

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