Crohn’s Complications Flashcards
Apendicitis site, character, associated symptoms, exacerbating factors and severity?
- Migratory - umbilical -> RLQ
- Usually consistent with intermittent cramps
- Anorexia, nausea and vomiting, failure to pass flatus or stool, Rovsing’s sign (feel pain in RLQ when pressing down on LLQ)
- Movement and coughing
- Severe
Small bowel obstruction site, character, associated symptoms, exacerbating factors and severity?
- Umbilical
- Colicky and severe
- Anorexia, vomiting and nausea, unable to pass stool/wind, abdominal distension/bloating
- Oral intake
- Severe
Pancreatitis site, character, associated symptoms, exacerbating factors and severity?
- Epigastric/left upper quadrant pain radiating to back
- Constant and severe
- Nausea/vomiting, anorexia, dyspnoea
- Worse on movement
- Severe
Cholecystitis site, character, associated symptoms, exacerbating factors and severity?
- Constant right upper quadrant, might get right shoulder pain
- Constant and severe
- Nausea/vomiting, Murphy’s sign
- Fatty foods
- Severe
SBO symptoms?
Nausea and vomiting (early sign in SBO, late sign in LBO)
Abdominal pain
Bowels not opened
Is not passing wind
Bloated and burping
Causes of SBO?
- Adhesions (history of previous abdo surgery)
- Neoplasia (primary, metastatic, extraintestinal)
- Incarcerated hernia (external - abdo wall, internal - mesenteric defect)
- Crohn’s disease (acute - oedema, chronic - strictures)
- Other (intussusception, intraluminal - foreign body, bezoar)
LBO causes?
- Colorectal carcinoma
- Volvulus (sigmoid, caecal)
- Diverticulitis (inflammation, strictures)
- Faecal impaction
- Hirschsprung disease
can get faecal vomiting
SBO abdo X-ray?
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
LBO abdo X-ray?
Distended large bowel tends to lie peripherally
Show haustrations of taenia coli - do not extend across whole width of bowel
Adaptations to ileostomy?
Mucosal hypertrophy and hyperplasia
Aldosterone level up-regulation (Sodium retention and Sodium resorption)
Hypomotility
Universal donor?
O-
Universal acceptor?
AB+
A- blood given 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
GI perforation investigations?
Erect CXR - gas expelled from bowel will rise
Ileostomy consequences?
- electrolyte + water absorption issues
- issues with gut microbiome
Colostomy site, appearance and content?
Site - left iliac fossa
Appearance - bowel wall flush to the skin (bulging)
Content - more solid
Ileostomy site, appearance and content?
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
Renin angiotensin system?
- Drop in BP or fluid volume detected by baroreceptors -> decreased firing
- Renin released from kidney, which converts angiotensinogen (from liver) to angiotensin I
- ACE (from lungs) converts angiotensin I -> angiotensin II
Angiotensin II effects?
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
Stricture cause?
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
Strictureplasty?
Surgical procedure to repair a stricture by widening the narrowed area without removing any portion of intestine
Surgical procedures to repair stricture?
Stricturplasty
Small bowel resection
Symptoms of stricture?
Nausea
Vomiting
Severe cramping
Constipation
Where is strictureplasty most effective?
In lower sections of small intestine (ileum and jejenum)
less effective in duodenum
