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Gastroenetrology > Diseases of the small bowel and appendix > Flashcards

Diseases of the small bowel and appendix Flashcards

1
Q

What are the symptoms of obstructed bowel?

A 
Pain (colicky)
Absolute constipation
Vomiting
Burping
Abdominal distension
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2
Q

What are the three sites of bowel obstruction and what causes these?

A

Lumen - gallstone, food, bezoar
Within the wall - tumour, Crohn’s, Radiation
Outside the wall - Adhesions (previous surgery), Herniation

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3
Q

What do patients with small bowel obstruction present with?

A 
Distension
Vomiting
Borborygmi
Pain
Faeculent vomiting
Presence of a cause - scars
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4
Q

When no scar is present on the stomach and small bowel is obstructed what should be checked for?

A

Hernias

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5
Q

What investigations are done for small bowel obstruction?

A 
Urinalysis
Bloods
Gases
AXR
Contrast CT of abdomen
Gastrogaffin studies
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6
Q

What is the treatment of small bowel obstruction that is down to adhesions?

A

Drip and suck

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7
Q

What are the steps of ‘Drip and suck’

A 
ABC
Analgesia
Fluids with potassium
Catheterise
NG Ryles tube
Antithromboembolism measures
TED stockings
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8
Q

How long do you do drip and suck?

A

72 hours

Should be stopped earlier if Strangulation, Perforation or Ischaemia

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9
Q

What is the surgical management of small bowel obstruction?

A

Laparotomy

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10
Q

What are the operative principles of laparotomy?

A 
Antibiotics
Antithromboembolic measures
Usually a midline incision
Can be laparoscopic
Find the obstruction by following collapsed or dilated bowel
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11
Q

What is mesenteric ischeamia?

A

Dead gut

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12
Q

How is the small bowel different from the large bowel?

A

There is not Marginal artery in the small bowel

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13
Q

What are the symptoms of chronic mesenteric ischaemia?

A

SMA
Cramps
Like angina of the gut
Atherosclerosis

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14
Q

What are the consequences of acute mesenteric ischaemia?

A

Small bowel infarcts

Colon lives

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15
Q

What are the causes of mesenteric ischaemia?

A 
Embolus usually from AF - forms in left atrium, sticks in narrow SMA
In situ thrombosis
Virchows triad
-Dehydrated
-Hypercoagulable
-Compression
-Vasoconstricting drugs
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16
Q

How is mesenteric ischaemia diagnosed?

A 
Pain out of proportion with clinical findings
Acidosis of gases
Lactate elevated
CRP may be normal
WCC may be elevated
CT angiogram
At Laparotomy
Intervene before your patient is moribound
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17
Q

How is mesenteric ischaemia treated?

A

QUICKLY
Prepare the patient and family for the worst
Resect if non-viable
Re-anastomise and planned return
If viable you can rarely perform an SMA embolectomy

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18
Q

How much small bowel is required to live?

A

At least 30cm

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19
Q

How much of an icon is this lecturer?

A

A massive icon

20
Q

How is small bowel haemorrhage diagnosed?

A 
ABC
Exclude upper source
Vascular malformation
Ulceration
CT angiogram
Interventional radiology
21
Q

How is small bowel haemorrhage managed?

A

Interventional radiology

22
Q

Describe Meckels Diverticulum

A 
60cm from IC valve (2 feet)
2% of population
Present before 2 years of age
Usually incidental
Remnant of the omphalomesenteric duct
Complications	
Bleed (haematochezia)
Ulcerate/meckels diverticulitis
Obstruction
Malignant change (0.5%)
23
Q

What is the appendix and where are they found?

A

Vestigal organ
Most are retrocaecal
Tip can vary in location
Base in constant at the convergence of the 3 taeni coli

24
Q

Which artery supplies the appendix and what type of artery is it?

A

Apendicular Artery

End artery

25
Q

When does appendicitis usually occur?

A

Usually in childhood/young adulthood
Rare in infancy
Peak in elderly

26
Q

What are the 5 causes of appendicitis?

A 
No unifying hypothesis
Obstruction of the lumen with faecolith
Bacterial
Viral
Parasites
27
Q

What is the pathology of appendicitis?

A 
Huge variation in macroscopic disease
Lumen may or may not be occluded
Mucosal inflammation
Lymphoid hyperplasia
Obstruction 
Build up of mucus and exudate
Venous obstruction
Ischaemia - bacteria invasion through wall
Perforation
Presence of inflammation in the abdomen
Small bowel adheres
Phlegmonous mass
Peritonitis can be fatal
28
Q

What are the characteristics of appendicular related pain?

A

Midgut colicky pain that moves to the right iliac fossa becoming sharp and localised

29
Q

What are the risk factors for peritonitis?

A

Age
Immunosuppression
Diabetes
Absence of omentum

30
Q

What are the symptoms of appendicitis?

A 
Central pain that migrates to RIF
Anorexia
Nausea
One or two vomits
May not have moved bowels
Pelvic: vaguer pain localisation: rectal tenderness
Elderly
31
Q

What are the signs of appendicitis?

A 
Mild pyrexia - never over 39/40
Mild tachycardia
Localised pain in RIP
Guarding
Rebound
32
Q

What are the specific signs of appendicitis?

A

Rosving’s - pressing on the left hurts the right
Psoas - patient keeps right hip flexed as this lifts an inflamed appendix off the psoas
Obturator - if appendix is touching obturator internus, flexing the hip and internally rotting will cause pain
Pointing - where did it start, where is it now?

33
Q

What are three special cases of appendicitis that do not follow classic signs?

A

Retrocaecal appendix - may have few signs
Pelvic appendix - Diarrhoea, frequency of micturation
Postileal - rare diarrhoea, vomiting

34
Q

What are 4 groups of people that present with cases of appendicitis that don’t present with normal signs?

A

Obese - difficult, will still claim hunger
Elderly - gangrene and perforate more frequently, usually have co-morbidities
Children - don’t sleep, wont eat
Pregnancy - appendix moves up and out, foetal loss in 3-5%. 20% if perforation, operate early, MRI useful

35
Q

What are the differential diagnoses of RIF pain in children?

A 
Gastroenteritis
Mesenteric adenitis
Meckel’s diverticulum
Intususseption
Henoch-Schonlein Purpura
Lobar pneumonia
36
Q

What are the differential diagnoses of RIF pain in Adults?

A 
Terminal ileitis
Ureteric colic
Acute pyelonephritis
Perforated ulcer
Pancreatitis
Rectus sheath haemotoma
37
Q

What are the differential diagnoses of RIF pain in Women?

A

Mittelschmerz
Ovarian cyst
Salpingitis
Ectopic pregnancy

38
Q

What are the differential diagnoses of RIF pain in the Elderly?

A

Sigmoid diverticulitis
Intestinal obstruction
Carcinoma of the caecum

39
Q

What are the differential diagnoses of RIF pain in Strange cases?

A

Pophyria
Diabetic ketoacidosis
typhilitis

40
Q

What are the investigations for appendicitis?

A 
CLINICAL diagnosis
USS useful in women and kids
AXR to exclude other causes
Bloods (important CRP, WCC)
Urinalysis
41
Q

What scoring system is used for appendicitis?

A 
Alvarado score
MANTRELS PNEUMONIC
-sore to move/cough
-Flushed red face
-Foeter oris
42
Q

What is the management of appendicitis?

A 
Analgesia	
Antipyretics
Theatre
Antibiotics
Appendicectomy
Laparascopic (best)
Convert to open sometimes (not first line)
Laparotomy sometimes
43
Q

What is the treatment of appendicular mass?

A

Antibiotics first line
Can operate or not
Theatre if fails or complicated

44
Q

What are the symptoms of appendix mass?

A 
Tachycardia
Worsening pain
Increase in size
Vomiting
Copious NG aspirates
45
Q

What are the complications of appendicitis?

A 
Pelvic abscess
Wound infection
Intra-abdominal abscess
Ileus
Respiratory
DVT/PE
Portal pyaemia
Faecal fistula
Adhesions
Right sided inguinal hernia
46
Q

What is an appendix abscess?

A

Not an appendix mass
Usually delayed
Usually has liquidised
Radiological drains

47
Q

What is a carcinoid of the appendix and what is their epidemiology>

A 
1 in every 300 to 400 appendixes
Crypts of Lieberkuhn
Stains for chromagrannin
Metastatic risk relates to size
92% 5 year survival for local disease
If less than 1cm appendicectomy alone
If greater than 2cm completion right hemi

Gastroenetrology (17 decks)

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