Diseases of the small bowel and appendix Flashcards
What can cause small bowel obstruction?
Fluid, gas ischaemia, perforation
What will obstruction present with?
Absolute constipation Vomiting Colicky, central pain Burping Abdominal distension
What are the 3 types of obstruction?
Within the lumen (gallstone, food, bezoar)
Within the wall (tumour, crohn’s, radiation)
Outisde the wall (adhesions, herniation)
What is borborygmi?
A rumbing or gurgling noise made by the movement of fluid and gas in the intestines
What investigations should be carried out for a suspected small bowel obstruction?
Urinalysis Bloods Gases AXR Contrast CT
What is drip and suck?
ABC
Analgeisa
Fluids with potassium - patients usually hypokalaemia and alkalotic
Catheterise
NG tube
Antithromboembolism measures - ted stockings
When should surgical intervention be used for obstruction?
Hernias
Strangulation
Perforation
Ischaemia
What can cause mesenteric ischaemia?
Embolus, thrombosis
What can cause chornic mesenteric ischaemia?
SMA
Cramps like angina of the guts
Atherosclerosis
Why will the colon live when there is mesenteric ischaemia?
Due to the marginal artery of drummond
What can cause an embolus?
AF, formed in left atrium and will stick in narrow SMA
Why will thrombosis occur in accordance with virchows triad?
Dehydration
Hypercoguable due to unwell state
Compression
Vasoconstricting drugs
How is mesenteric ischaemia diagnosed?
Pain out of proporiton to clinical findings Metabolic acidosis Elevated lactate Normal CRP WCC raised slightl CT angiogram
How is mesenteric ischaemia treated?
Quickly
Resect if non-viable
Re-anastomose or staple and planned return
SMA embolectomy
What can cause haemorrhage in the small bowel?
Vascular malformations
Ulcerations
What is meckel’s diverticulum?
Remnant of the omphalomesenteric duct - gut separates in embryo but the bud can sometimes stay
Cells at tip of meckel’s diverticulum are gastric in origin so can produce acid
What are some common complications of meckel’s diverticulum?
Bleed
Ulcerate
Obstruction
Malignant change
Where can meckel’s diverticulum be found?
2 feet from IC valve
2% of population
Presents before 2 years of age
What is the aetiology of appendicitis?
No unfiying hypothesis Obstruction of the lumen with faecolith Bacterial Viral Parasites
What is the pathology of appendicitis?
Hugh variation in macroscopic disease Lumen may or more not be occluded Mucosal inflammation Lymphoid hyperplasia Obstruction Build up of mucus and exudate Venous obstruction Ischaemia.. bacterial invasion through wall Perforation Phelgmonous mass
What are the classical symptoms of appendicitis?
Central pain that migrates to RIF Anorexia Nausea One or two vomits Ileus Pelvic pain Mild pyrexia Mild tachycardia Involulntary guarding
What are the differential diagnoses for appendicitis?
Gastroentertisi Mesenteric adenitis Mecjel's diverticulum Intusseption Henoch-schonlein purpura Lobar pneumonia
How is appendicitis investigated?
Clinical diganosis USS useful in women and kids AXR to exclud other causes Bloods (CRP, WCC) Urinalysis to ensure not UTI or ectopic pregnancy
How is appendicitis managed?
Analgesia Antipyretics Theatre Antibiotics Appendicectomy
What are complications of an appendectomy?
Pelvic abscess Wound infection Intra-abdominal abscess Ileus Respiratory DVT/PE Portal pyaemia Faecal fistula Adhesions Right sided inguinal hernia
