GI (late) obstruction,cancers Flashcards
2 types of obstruction
mechanical and pseudo
what are investigations for bowl obstruction
bloods
erect CXR (no perforation)
CT - visualize pathology
types of mechanical obstruction
adhesion volvulus hernia intususception tumour
types of pseudo mechanical obstruction
myopathy - no peristaltic contractions
neuropathy - no smooth muscle nerve innerv
congenital - Hirchsprung disease = no nerve innervation of distal colon
what is types of obstrcutoin in small bowel
adhesions
hernia
cancer
obstruction in large bowl
cancer
diverticulitis
volvulus
obstruction in ileus (pseudo obstruction = temp paralysis)
post operation
medication
chronic disease
what is the buzz word in bowel obstruction
tinkling bowel sounds
pattern of bowel sounds in small vs large
small = normal initially, increases then decreases large = normal then increases then decreases LATER
which shows ladder pattern on abdo xray
small bowel
which is most common cause of small bowel obstructiuon
adhesions (60%)
what is adhesive obstruction
Extra luminal obstruction
post surgery
fibrous bridges between segments of bowel
what can lead to volvulus
adhesions
where is distension in small bowel obstruct
above the blockage
how can small bowel obstrcut lead to complications and what are they
obstruction - secreton of fluid above distended bowel - bacteria contam in stagnant bowel -
strangulation - impedes blood supply - GANGRENE, PERITONITIS
more dilatiation
mucosual wall oedema
increased pressure - compresses bv = ischaemia and or PERFORATION - SEPSIS
Dx of small bowel obstruction
abdo xray - central gas shadow
CT - prev surgery?- adhesionm****
Bloods - fbc = elevates WBC and electrolyte imbalance (dehyrdration)
what type of obstruction of crohn’s disease
Intramural obstruction
What is a volvulus
Type of SBO extra luminal, occurs when bowel twists around itself in mesentery causing obstruction and can lead to ischemia
what are examples of Intramural obstructions
Crohn’s or Diverticular disease
Presentation of small bowel obstruction
Colicky pain, not localised vomiting is early sign in SBO - coffe ground Constipation is Late sign in SBO distension (less than LBO) Projectile or feculent vomiting
shows signs of peritonitis if rupture
Treatment of SBO
Fluid resuscitation + Bowel decompression
Analgesia + antiemetics
Antibiotics (ampicillin + Gentamicin)
Surgery, Laparotomy to remove obstruction
causes of LBO
commonly malignancy 90%
volvulus
diverticular disease
Hirschsprung disease (pseudo ob)
what is Hirschsprung disease
no nerve innervation in distal colon = no/abnormal peristalis
pathophysiology of LBO
Obstruction causes proximal dilation. increased pressure.
This reduced mesenteric blood flow causing ischemia which will lead to dehydration and oedema in bowel.
This can progress to perforation
Indication of bowel perforation
Persistent tachycardia
Fever
Abdominal pain and tenderness, rebound tenderness and Guarding
Presentation of LBO
Colicky pain constipation, early = 'absolute' constipation Vomiting, late - goes dark brown sudden onset of pain= volvulus weight loss bloat palpable mass in abdomen (hernia, distended bowel loop) fever tenderness, rebound , guarding
Investigations in LBO
sigmoidoscopy fbc - chonic occult blood loss AXR - dilated bowel Electrolytes: Imbalance Contrast enema
Treatment of LBO
supportive measures: Antibiotics Gentamicin IV fluids resus relieve obstrutcion - stent decomp potentially transfusion Surgery emergency Laparotomy
oesophageal cancer types
squamous and adenocarcinoma
where are squamous found and wehre adenocarinoma
squamous = upper and middle adenocarcinoma = lower
which does barrets oesoph predispose to in oesophageal cancer
adenocarcinoma
RFs of oesophageal cancer
smoking alcohol barrets oesph (adenocarcinoma only) alchalasia - LOS doesnt relax coeliac - Squamous
Cf of oesophagela cancer
dysphagia WL anorexia hoarse voice vom (haematemis symptoms of GI bloos loss ADVANCED lymphadenopathy oesophagela obstruction - cough, aspriation into lungs
Dx of oesophageal cancer
silent killer
endoscopy nd biopsy
CT for mets
barium swallow - ddx of dysphagias
Mx of esoophageal caner
endoscopic resection
oesophagectomy
stage 2b and 3 = pre n post op chemo
palliative
gastric cancer RFs
H PYLORI
Gastritis
smoking
fam history
CFs of gastric cancer
WL dyspepsia dysphagia anaemia palp mass in epigastric - tender palp lymph nodes in supraclavic fossa acanthosis nigricans - dark skin discolouration and thickens in folds and creases - arm pit
what is MALT
primary gastri lymphoma - h pylori and non hodkins lymphoma
Mx of gastric cancer
surgery - partial gastrectomy
if early and confined to mucosa - endoscopic musocal resection
plus chemo perioperatively - cisplatin
colorectal carinoma RFs
elderly, IBD Fam history (FAP and HNPCC) smoking obestiy low fibre (more time in transit in contact w carcinogen)
Cfs of colorectal carcinoma
depends on location
L sided - OBSTRUCT - collicky pain, rectal bleed
= TRANSV COLON AND DESC COLON
(MELANA). mass in LIF, change bowel habits
R sided - BLEED - WL, anaemia , haematochezia (fresh blood in stools)
mass in RIF
mets - jaundice and hepatomegaly
what is a sign of colorectal cancer warning redflag
over 50yo man or post menopausal woman with iron defociency anameia = SIGN
Ix of CRC
colonoscopy and biopsy and histology
removal of polyps
CT - for staging = DUKES / TNM
2nd = barium enema
how is early diagnosis attempted
SCREENING PROGRAMME
Mx of CRC
surgery = curative
rad and chemo post op
endoscopic stents if palliative
CFs of a ruptured oesophago gastric varices
haematesis
abdo pain
Mx of ruptured varices
resus and stabilise variceal banding (endoscopic)
when does oesophag - gastric vaaricies occur
when pressure in portal system is above 10-12mmHg
compliant system dilates - varices form within systemic venous system (@gastro oesophageal junction)
