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Y1 GI > Diseases of the Small Bowel and Appendix > Flashcards

Diseases of the Small Bowel and Appendix Flashcards

1
Q

Causes of small bowel obstruction

A

Within the lumen (gallstone, food, bezoar)
Within the wall (tumour, crohn’s radiation)
Outside the wall (adhesions, herniation)

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2
Q

Symptoms of small bowel obstruction

A 
Pain (colicky, central) 
Absolute constipation 
Vomiting 
Burping 
Abdominal Distension
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3
Q

Investigations used for suspected small bowel obstruction

A 
Asses state of patient with 
-Urinalysis 
-Bloods 
-Gasses 
Conform the diagnosis 
-AXR 
-Contrast CT abdo 
-Gastrograffin stuffies
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4
Q

Treatment for SBO

A 
"Drip and suck" 
ABC 
Analgesia 
Fluids with potassium 
Patient usually hypokalamic and alkalotic 
Catheterise 
NG tube (ryles tube) 
Antithromboembolism measures
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5
Q

How long do you “drip and suck” in SBO

A 
Up to 72 hours standard 
Intervene earlier if: 
-strangulation 
-perforation 
-ischemia
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6
Q

Surgical management of SBO

A 
Laparotomy 
operative principles 
-antibiotics 
-antithromboembolic measures 
-midline incision 
-can be laparoscopic 
-find the obstruction by following collapsed or dilated bowel
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7
Q

What causes mesenteric ischaemia

A

Embolus, thrombosis (arterial and venous)

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8
Q

How does chronic mesenteric ischaemia present

A

superior mesenteric artery
cramps
angina of the gut
atherosclerosis

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9
Q

How does acute mesenteric ischaemia present

A

Small bowel is infarcted - dies

Colon - lives (marginal artery)

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10
Q

What causes mesenteric ischaemia

A 
Embolus that forms in left atrium from AF 
-Sticks in narrow superior mesenteric artery 
In situ thrombosis 
-Virchow's triad 
-dehydration 
-hypercoagulability 
-compression 
-vasocontricting drugs
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11
Q

How to diagnose mesenteric ischaemia

A 
Acidosis (low pH high H+) 
Lactate elevated 
CRP may be normal 
WCC may be up a bit 
CT angiogram
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12
Q

How to treat mesenteric ischaemia

A

Fix it quickly - prepare patient and family for the worst
Resect (cut out) if non-viable
Re-anastomose or staple and planned return
If viable perform SMA embolectomy

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13
Q

What is Mechel’s diverticulum

A

2 feet away from ileocaecal valve
2% of population affected, presents before 2 years old
Remnant of the omphalosmesenteric duct

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14
Q

Complications of Meckel’s diverticulum

A

Bleed
Ulcerate/meckels Diverticulitis
Obstruction
Malignant change (0.5%)

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15
Q

What can cause appendicitis

A

Obstruction of the lumen with faecfolith
Bacterial infection
Viral infection
Parasitic infection

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16
Q

Pathology of appendicitis

A 
Lumen may be occluded 
Mucosal inflammation 
Lymphoid hyperplasia 
Obstruction 
Build up of mucus and exudate 
Venus obstruction 
Ischaemia 
Perforation (hole) 
Presence of inflammation brings over the greater omentum 
small bowel adheres 
phlegmonous mass 
Peritonitis - fatal
17
Q

Symptoms of appendicitis

A 
Central pain that migrates to right iliac fossa 
Anorexia 
Nausea 
One or two vomits 
May not have moved bowels 
Rectal tenderness
18
Q

Signs of appendicitis

A 
Mild pyrexia 
Mild tachycardia 
Localised pain in RIF 
Guarding 
Rebound
19
Q

Specific signs of appendicitis

A

Rosving’s - pressing on left causes pain on right
Psoas - right hip flexed to lift inflamed appendix off the psoas
Obturator- if appendix is touching obturator inturnus flexing hip will cause pain
Pointing - where did it start, where is it now

20
Q

Investigations for appendicitis

A 
Clinical diagnosis 
Ultrasound scan 
AXR to exclude other causes 
Bloods 
Urinalysis
21
Q

What is the MANTRELS mneumonic

A 
Migration of pain to right lower quadrant 
Anorexia 
Nausea and vomiting 
Tenderness in right lower quadrant 
Rebound pain 
Elevated temp 
Leukpcytosis 
Shift of whit blood cell count to left
22
Q

Management for appendicitis

A 
Analgesia 
Antipyretics 
Theatre 
Antibiotics
Appendicectomy
23
Q

Appendix mass treatment

A

Antibiotics first line
Can operate or not
Theatre if antibiotics fail or more complicated

24
Q

Appendix abscess

A

Not an appendix mass
Usually delayed and has liquidised
Radiological drains

25
Q

What are immediate complications of anything

A 
Local 
-Haemorrhage 
-Enterotomy 
Systemic 
-anaphylaxis
26
Q

Early complications of anything

A 
Local 
-Wound infection 
-Pelvic abscess 
Systemic 
-atelectasis 
-ileus 
-portal pyaemia
27
Q

Late complications of anything

A 
Local 
-adhesive obstruction 
-faecal fistula 
-inguinal hernia 
-incisional hernia 
Systemic 
-DVT/PE

Y1 GI (41 decks)

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