Gastrointestinal Flashcards
1
Q
What are psuedo-bowel obstructions?
A
- identical presentation to SBO or LBO → depends on location
- entire bowel can be obstructed → both presentations
2
Q
Causes of psuedo-bowel obstructions
A
- intra-abdominal trauma-
- post-op states eg paralytic ileus
- intra-abdominal sepsis
- drugs eg opiates, antidepressants
- electrolyte imbalances
3
Q
Treatment of pseudo-bowel obstructions
A
treat underlying cause
4
Q
What are the 3 main types of ischaemic bowel disease?
A
- acute mesenteric ischaemia → SB
- chronic mesenteric ischaemia → SB
- ischaemic colitis → LB
5
Q
What areas are most susceptible to ischaemia?
A
watershed areas
- splenic flexure
- caecum
6
Q
Causes of AMI
A
- SMA thrombosis
- SMA embolism due to AF
- mesenteric vein thrombosis
- non-occlusive disease → poor blood flow/CO
7
Q
Presentation of AMI
A
classic triad
- acute, severe abdominal pain → constant, central
- no abdominal signs on exam
- rapid hypovolaemia → shock
AF and sever abdominal pain = AMI
8
Q
Diagnosis of AMI
A
blood
- high Hb
- metabolic acidosis
abdominal xray → rule out obstruction
laparoscopy → visualise necrosis
CT/MRI angiography → visualise blockages in arteries
9
Q
Management of AMI
A
- fluid resuscitation
- Abs → metronidazole, gentamicin
- IV heparin
- surgery → remove necrotic bowel
10
Q
Complications of AMI
A
- sepsis
- peritonitis
11
Q
Chronic mesenteric ischaemia
A
- very similar to AMI
- symptoms on a lower level, persist for much longer
- abdominal angina
12
Q
Causes of IC
A
- thrombosis, emboli
- low flow states → low CO, arrhythmias
- surgery
- vasculitis
- coagulation disorders
- the pill
- idiopathic
13
Q
Presentation of IC
A
- sudden onset LIF pain
- passage of bright red blood
- signs of hypovolaemic shock
14
Q
Diagnosis of IC
A
- urgent CT → rule out perforation
- flexible sigmoidoscopy with biopsy
- barium enema
GOLD STANDARD = colonoscopy with biopsy
- after recovery
- exclude strictures at site, confirm mucosal healing
15
Q
Management of IC
A
- most patients fine with symptomatic treatment
- fluid replacement
- Abs
