General Surgery - Intestines Flashcards
what is a paralytic ileus?
adynamic bowel due to no peristaltic contractions
no mechanical obstruction
risk factors for paralytic ileus?
abdo surgery
electrolyte imblances
Tx for paralytic ileus?
NG tube decompression
Fluids
what happens in pseudo obstruction? how to manage?
mechanical GI obstruction with no cause found
AXR and decompress
features of bowel obstruction?
pain
vomiting
abdo distension
tinkling bowel sounds
what is a volvulus?
mobile loop of bowel that has rotated on its mesentery
common sites of volvulus?
sigmoid colon
Ix for volvulus? what is the sign?
AXR
coffee bean appearance
Tx for volvulus?
sigmoidoscopy + flatus tube
risk factors for mesenteric ischaemia?
AF
what 3 types of mesenteric ischaemia exist?
acute mesenteric
chronic
chronic colonic
what causes chronic ischaemia?
low flow state and atheroma
Ix for mesenteric ischaemia?
FBC ABG (metabolic acidosis) AXR (gassless abdo) CT/MRI angio colonoscopy + biopsy (for chronic colonic)
what causes chronic colonic mesenteric ischaemia?
low flow in IMA
ischaemic colitis results
e.g bloody diarrhoea
Tx for mesenteric ischaemia?
fluids
Abx
heparin
surgery (revascularise/resect)
features of appendicitis?
fever diarrhoea umbilical abdo pain localising to RIF mcburney's point rosving's sign
most common position of the appendix?
retrocaecal
what anatomical landmark helps distinguish the appendix during surgery?
taenia coli (smooth muscle) converge at the base
what is the appendixes blood supply and why is it high risk?
appendicular artery
sole mesentery so high risk of gangrene if interrupted
Ix for appendicitis?
FBC U+Es CRP IV fluids CT/US
Tx for appendicitis?
appendicectomy
Abx if perforated - gent + met
what are colonic polyps?
adenomas arising from the colonic mucosa
can become neoplastic
features of polyps?
bleeding mucus tenesmus anaemia asymptomatic
what genetic conditons are at risk of polyps?
FAP
peutz jegher syndrome
Ix and Tx for polyps?
colonoscopy
biopsy/removal
what is the screening regime after polyp removal?
low = 5 medium = 3 high = 1
what type is most common for colorectal cancer?
adenocarcinoma
risk factors for colon cancer?
polyps meat low fibre diet smoking alcohol Hx of cancer FHx
left side symptoms for colorectal cancer?
bleeding mucus altered habit tenesmus mass
right side symptoms for colorectal cancer?
weight loss
anaemia
abdo pain
what type of anaemia results from blood loss?
iron deficiency
microcytic (low MCV)
Ix for colorectal cancer?
FBC
FIT
colonoscopy
CT
what is CAE used for?
confirms presence of disease in colorectal cancer
NOT a screening test
what are the Dukes stages?
A - muscularis mucosae
B - extension throughout
C - LNs
D - metastases
Tx for colorectal cancer?
hemicolectomy anterior resection (rectum + diseased bowel)
at what Dukes stage can chemo be added?
C - LNs involved
who gets bowel screening?
50-74yrs
every 2 years
what is diverticular disease?
herniations of mucosa and submucosa through the colonic wall (outpouchings)
what is meckel’s diverticulum? where is it found?
outpouching due to incomplete regression of the viteline duct
above ileocaecal valve
Ix for diverticular disease?
colonoscopy
CT
features of diverticular disease?
abdo pain worse after eating
bleeding
bloating
Tx for diverticular disease?
high fibre diet
hartmann’s
what happens in hartmann’s procedure?
rectosigmoid colon resected
anorectal stump closed
end colostomy out tummy
what is a complication of diverticular disease? Tx?
diverticulitis
fluids, Abx
may need CT guided abscess drainage
features of peritonitis?
shock
guarding
rebound tenderness
no bowel sounds
