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GI block > GI goljan bowel obstruction, hernias > Flashcards

GI goljan bowel obstruction, hernias Flashcards

1
Q

What is the most common site for obstruction?

A

small bowel

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2
Q

Radiographic findings in bowel obstruction

A

bowel distention;
air-fluid levels w/ step ladder appearance;
absence of air distal to obstruction

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3
Q

general Clinical findings in bowel obstruction

A 
Colicky pain (pain-pain free intervals);
abdominal distention;
no rebound tenderness;
tympanitic to percussion
high-pitched tinkling sounds
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4
Q

Tx for bowel obstruction

A

surgery

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5
Q

most common cause of small bowel obstruction?

A

adhesions from previous surgery (most common);
endometriosis;
radiation

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6
Q

How does Crohn’s disease cause bowel obstruction?

A

lumen in terminal ileum narrowed due to full-thickness inflammation of bowel wall;
bowel-bowel serosal adhesions

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7
Q

Define duodenal atresia and what is it associated w/?

A

atresia distal to entry of common bile duct;

assoc w/ down syndrome

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8
Q

Duodenal atresia is a bowel obstruction disorder. How does it present?

A

Hx of maternal polyhydramnios;
vomiting of bile stained fluid at birth;
Double bubble sign=> air in stomach and prox duodenum

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9
Q

who is gallstone ileus likely to present in?

A

most common in elderly women w/ chronic cholecystitis and cholelithiasis

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10
Q

What is the mechanism for obstruction in gallstone ileus?

A

fistula develops bw gallbladder and small bowel => stone passes into small bowel & lodges at ileocecal valve causing obstruction

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11
Q

Radiographic presentation of gallstone ileus?

A

air in biliary tree

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12
Q

Define Hirschsprung’s disease and how it causes obstruction

A

absence of ganglion cells in Meissner’s submucosal plexus and Auerbach’s myenteric plexus causing localized aperistalsis => NO sympa neurons in aganglionic segment => constant contraction w/o relaxation => obstruction

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13
Q

How may Hirschsprung’s disease be acquired?

A

Chagas’ disease and destruction of ganglion cells by amastigotes

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14
Q

What does Hirschsprung’s disease involve?

A

distal sigmoid and rectum => may involve entire rectum and descending colon => proximal uninvolved bowel is dilated but HAS PERISTALSIS

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15
Q

How does Hirschsprung’s disease present?

A

abdominal pain;
chronic constipation w/o large stools of retentive encopresis;
alternating signs of obstruction w/ diarrhea

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16
Q

Describe physical exam for Hirschsprung’s disease

A

absent stool on examining finger bc NO stool in rectal vault (different from other chronic constipation)

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17
Q

any associations w/ Hirschsprung’s?

A

down syndrome

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18
Q

Complications w/ Hirschsprung’s?

A

enterocolitis of dilated bowel (danger of perforation)

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19
Q

What is most common cause of death in Hirschsprung’s?

A

perforation of dilated bowel

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20
Q

How to Dx and Tx Hirschsprung’s?

A

rectal biopsy;

surgical resection of affected segment

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21
Q

What is the 2nd most common cause of small bowel obstruction? How does it do this?

A

indirect hernia;

bowel becomes trapped in inguinal canal

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22
Q

What bowel obstruction leads to highest rate of bowel incarceration?

A

femoral hernia

23
Q

Who is most likely to have intussusception causing bowel obstruction?

A

children ages 1-5

24
Q

In children, what is the nidus for intussusception?

A

terminal ileum invaginates into cecum leading to mound of hyeprplastic lymphid tissue in Peyer’s patches leading to combo of obstruction and ischemia

25
Q

How will a child w/ intussusception present? physical exam?

A

colicky pain w/ bloody diarrhea;

oblong mass palpated in midepigastrum (Dance’s)

26
Q

What is the Tx for a child w/ intussusception?

A

usually self-reduces but may require air reduction under fluoroscopy or ultrasound

27
Q

What vaccine may intussusception be associated with?

A

rotavirus oral vaccine

28
Q

In adults, what is the common nidus for intussusception?

A

polyp or cancer

29
Q

Describe who and how a meconium ileus leads to bowel obstruction

A

complication of newborn w/ CF;

meconium lacks NaCl and obstructs bowel lumen

30
Q

Define volvulus

A

bowel twists around mesenteric root producing obstruction and strangulation of bowel

31
Q

Depending on age, where does volvulus likely occur?

A

elderly=> sigmoid colon

young adults=> cecum

32
Q

Risk factors for volvulus

A

chronic constipation (most common);
pregnancy;
laxative abuse

33
Q

What are mechanisms predisposing to acquired hernias?

A

increased intra-abdominal pressure (coughing, heavy weight lifting);
weakness in abdominal wall

34
Q

What are the 5 types of hernias?

A 
direct;
indirect;
femoral;
umbilical;
ventral
35
Q

What are the borders to Hesselback’s triangle?

A

medial=> rectus sheath
lateral=> inferior epigastric artery
inferior=> inguinal ligament

36
Q

What covers a direct hernia and where does it bulge to?

A

single layer of transversalis is stretched in floor of Hesselbach’s triangle w/ bulge there

37
Q

Does direct hernia lead to obstruction or incarceration? Why?

A

no=> small bowel cannot enter scrotal sac so no obstruction or incarceration

38
Q

How can a direct hernia be Dx on physical exam?

A

when patient reclines, the bulge goes away

39
Q

Tx for direct hernia

A

sutured mesh covering inguinal canal and Hesselbach’s triangle

40
Q

What is the most common hernia?

A

indirect hernia

41
Q

Pathogenesis of indirect hernia in children?

A

persistence of peritoneal connection bw inguinal canal and tunica vaginalis

42
Q

pathogenesis of indirect hernia in adults?

A

protrusion of new peritoneal process into inguinal canal

43
Q

How can indirect hernia be diagnosed?

A

physical exam=> small bowel passes through internal inguinal ring and may enter scrotal sac thus hitting the examining finger w/in inguinal canal

44
Q

complications of indirect hernia

A

entrapped inguinal canal leading to incarceration;

strangulated obstruction causing hemorrhagic infarction

45
Q

Tx of indirect hernia in children

A

high ligation of hernia sac at level of internal inguinal ring and tightening of internal inguinal ring

46
Q

Tx of indirect hernia in adults

A

sutured mesh covering inguinal canal and Hesselbach’s triangle

47
Q

Where does the most common hernia in women present?

A

femoral hernia will have bulge located below inguinal ligament

48
Q

Tx for femoral hernia

A

transversalis fascia and conjoined tendon are sutured to Cooper’s ligament

49
Q

Who is an umbilical hernia most common in?

A

adults w/ ascites, pregnancy, obesity;

black newborns

50
Q

Define umbilical hernia

A

peritoneal protrusion extending into fascial defect contain remnants of umbilical cord

51
Q

How is an umbilical hernia typically treated?

A

most close spontaneously w/in 2nd year or can be treated by surgery

52
Q

Who is most likely to suffer from incarceration of the bowel in umbilical hernias?

A

adults&raquo_space; children

53
Q

What is a hernia where obesity is common cause? How does it develop?

A

Ventral hernia;

develops in weakened area of previous surgical excision

GI block (11 decks)

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