GI Disorders Flashcards
Can you survive without your stomach (without support)?
What percentage of stomach do you need before you require support (0-100%)?
In short, yes you can survive without your stomach without support – so 0%.
Can you survive without your small bowel (without support)?
How much small bowel do you need before you require support (in cm)?
In short, no you can’t survive without your small bowel.
Short bowel syndrome (SBS) is often defined as a symptom complex which occurs in adults who have < 200 cm of combined jejunum-ileum. What physiological problems would you expect in SBS?
SBS is characterised by diarrhoea, weight loss, dehydration, malnutrition, and malabsorption of macro- and micronutrients.
Can you survive without your large bowel (without support)?
What percentage of large bowel do you need before you require support (0-100%)?
In short, yes you can survive without your large bowel without support – so 0%.
Are you happy with these issues that can occur along your GI tract?
Y or N
Mr Floyd Pepper, a previously fit and well 67-year old man, has presented with sudden onset of massive bright red bleeding per rectum (PR). He also reports colicky abdominal pain. On clinical examination he is cold and clammy to the touch, tachycardic (pulse 140 bpm), and hypotensive (BP 80/40).
What immediate management should be instigated?
He is obviously shocked so requires resuscitation, this includes:
o Protect his airway; insert 2 large-bore cannulas; send bloods & a crossmatch for blood; give high- flow O2.
o Give intravenous (IV) colloid quickly then blood (can give ORh -ve blood if required until the cross- match ready)
o Correct clotting abnormalities (vitamin K, fresh frozen plasma (FFP), platelets)
o Insert a central venous pressure (CVP) line to guide fluid replacement.
o Put in a urinary catheter and monitor urine output.
What are the commonest causes of massive PR bleeding (as opposed to low volume bright red bleeding)?
Common causes of low volume PR bleeding are (in order of frequency):
Internal haemorrhoids
Anal fissure
Large bowel carcinoma
Commonest causes of massive PR bleeding are:
Diverticular disease
Angiodysplasia (congenital vascular malformation)
Upper GI bleeding
Aortoenteric fistula (herald bleed)
Less common causes of massive PR bleeding are:
Meckel’s diverticulum
Intussusception
Mesenteric infarction & tumours (small intestine)
Ulcerative colitis, Crohn’s disease & ischaemic colitis (large bowel)
PR= blood passed per rectum
Although you manage to resuscitate him (his pulse rate decreases & his blood pressure normalises), Mr Pepper continues to bleed heavily PR. What investigations would you request (in order of relevance) to establish a source of his bleeding?
OGD & colonoscopy
CT angiogram
Label this.
Label this.
Are there any possible complications associated with embolising the arterial supply to the duodenum, small bowel or large bowel?
Risk of rendering the large bowel ischaemic
An unsuccessful attempt has been made to embolize the bleeding point angiographically, but Mr Pepper continues to bleed PR. What final treatment option do you have left?
Surgery
