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GI pathology II Flashcards

1
Q

what is peritonitis?

A

Inflammation of the peritoneum

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2
Q

what is the peritoneum?

A

a Thin layer of cells that covers the external surface of all abdominal and pelvic organs

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3
Q

In peritonitis what normally causes the damage to the peritoneum?

A

Bacterial Infection

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4
Q

what are typical clinical features of peritonitis?

A
  • tachycardia
  • pyrexia
  • constant abdominal pain
  • abdo tenderness and guarding
  • rebound tenderness
  • localised pain during distant palpitation
  • abscent bowel sound
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5
Q

what investigations can be done for peritonitis?

A
  • clinical history
  • FBC
  • serum amylase (will show if pancreatitis is a problem)
  • X RAY
  • CT
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6
Q

what are basic management principles for peritonitis?

A
  • IV fluid
  • antibiotic therapy
  • gastric aspiration
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7
Q

what are the two types of intestinal obstruction?

A
  1. mechanical

2. paralytic

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8
Q

what is mechanical obstruction?

A

The luminal contents can’t pass through the intestine due to a physical blockage

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9
Q

what is paralytic obstruction of the intestine?

A

The luminal contents can’t pass due to cessatation of normal gut peristalsis

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10
Q

what is simple obstruction of the intestine?

A

obstruction refers to bowel obstruction without compromise to the blood supply of the affected segment

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11
Q

what is a strangulating obstruction of the bowel?

A

bowel obstruction with compromise to the blood supply

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12
Q

what is open loop obstruction?

A

The intestinal flow is blocked but proximal decompression is possible through vomiting.

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13
Q

what is a closed loop obstruction?

A

Both inflow and outflow are obstructed causing a build up of gas and secretion in the affected part

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14
Q

what are examples of closed loop obstruction?

A
  • torsion of a loop of s.intestine around an adhesion
  • incarceration of bowel in a hernia
  • volvulus
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15
Q

what are common causes of small bowel obstruction?

A
  • adhesions
  • hernia
  • intussusception
  • volvulus
  • crohns
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16
Q

what re common causes of large bowel obstruction?

A
  • colorectal cancer
  • diverticular strictures
  • sigmoid volvulus
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17
Q

what is an adhesion?

A

A band of fibrous tissue that binds together normally separate anatomical structures

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18
Q

what is the first two common causes of bowel obstruction in the uk?

A
  1. adhesions

2. abdominal hernia

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19
Q

what is intussusception?

A

a segment of small bowel prolapses into the immediately adjoining bowel.

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20
Q

what is a volvulus?

A

An abnormal twisting of a segment of bowel around it’s site of mesenteric attachment.

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21
Q

what are precipitating factors for a volvulus?

A
  • an abnormally mobile loop of intestine
  • ## an abnormally loaded loop
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22
Q

where is the most common site for volvulus to form?

A

Sigmoid colon

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23
Q

what is the most common type of bowel cancer?

A

Adenocarcinoma

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24
Q

what are common causes of bowel obstruction in neonates?

A
  • congenital stenosis
  • volvulus
  • hirschsprungs disease
  • meconium ileus
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25
what are common causes of bowel obstruction in infants?
- intussusception - hirschsprungs disease - strangulated hernia - mechels diverticulum
26
what causes colicky pain in bowel obstruction?
The bowel proximal to the obstruction has increased peristalsis in an attempt to overcome the obstruction
27
what causes bowel dilatation in a blockage?
1. accumulation of gas | 2. accumulation of intestinal secretions
28
what happens to the pressure in the wall as the bowel distends?
due to laplaces law it increases
29
how does strangulation occurs due to laplaces law in obstruction?
The radius becomes increased meaning more tension. This causes veins to collapse and then arteries
30
what is the order of events from strangulation to death due to bowel obstruction?
Strangulation --> ischaemia - -> infarction - -> perforation --> peritonitis - -> death
31
what is ischaemia?
a reversible process due to blood flow interference disrupting tissue function
32
what is infarction?
Irreversible | tissue death due to interruption with blood flow
33
what is necrosis?
cell death due to a pathological process
34
what is gangrene?
infarction with super imposed bacterial invasion of the tissue
35
what are the four cardinal clinical features of mechanical bowel obstruction?
- colickly pain - abdominal distension - vomit - absolute constipation
36
where is the colicky pain in mechanical bowel obstruction?
small bowel colick in the central abdo | large bowel colic in the lower 1/3 of the abdo
37
How can you tell if its a simple obstruction or a strangulating obstruction?
strangulation features are similar to peritonitis - a toxic appearance with tachycardia and fever - colicky pain - tenderness, guarding and rebound pain - abscent bowel sounds
38
when is surgery indicated in bowel obstruction?
- if the underlying cause needs surgical treatment - the patient doesn't improve with conservative management over 2 days - signs of strangulation and peritonitis
39
what are some causes of paralytic ileus?
- post operative state - generalised peritonitis - drugs - electrolyte imbalance
40
what drugs can cause paralytic ileus?
- opiates | - anticholinergics
41
what causes colicky abdominal pain?
stretching or contracting a hollow viscus
42
what are major risk factors for developing Ogilvie syndrome?
- severe blunt trauma - orthopaedic trauma - joint replacement - cardiac events
43
what is Ogilvie syndrome?
A type of paralytic ileus which affects the large bowel due to interference with autonomic nerve supply to the gut
44
what is infarction?
Tissue necrosis due to interference with the blood supply
45
what are the main causes of bowel infarction?
- strangulating bowel obstruction - occlusion of a mesenteric artery by an embolus - occlusion of a mesenteric artery by a thrombus - occlusion of a mesenteric artery by an aortic dissection extending into the mesenteric artery - compression of veins in the bowel wall
46
what is the triad of symptoms seen in bowel infarction?
Acute colicky abdo pain rectal bleeding shock
47
what is the general management of bowel infarction?
- IV fluids - broad spectrum antibiotics - laparotomy to remove dead bowel
48
where is the most common place for diverticular disease to develop?
The sigmoid colon
49
what is a diverticulum?
.A pouch of colonic mucosa that has herniated through the muscularis propria and now lies in the fat outside the bowel wall
50
what two factors are important for diverticula formation?
1. areas of weakness in the colonic wall | 2. raised intraluminal pressure
51
An important factor for developing diverticulas is the increase intraluminal pressure what can cause this?
Insufficient fibre in the diet
52
why is the sigmoid colon the most common place to develop diverticula?
It has the smallest diameter so intraluminal pressure is more likely to be high here
53
what is diverticulosis?
Diverticula are present but asymptomatic
54
what is diverticulitis?
An acutely flamed diverticulum
55
what initiates acute diverticulitis?
Faecal matter impacts and obstructs the neck of a diverticulum leading to bacteria trapping and mucosal injury
56
what is the presentation of acute diverticulitis?
``` Abdominal pain (often left iliac fossa) Malaise Fever localised tenderness No peritonitis ```
57
how can acute diverticulitis lead to abscess formation?
There is an acute inflammatory response to the diverticula that can extend past the diverticula to the surrounding tissue leading to abscess
58
how can a diverticula lead to bacterial peritonitits?
acute diverticulitis --> pericolic abscess develops due to inflammatory response --> abscess perforates into the abdominal cavity
59
how can a diverticula lead to faecal peritonitis instead of bacterial?/
If the inflamed diverticulm perforates into the abdominal cavity directly before developing an abscess.
60
why can strictures form because of diverticular disease?
- there is smooth muscle hypertrophy and hyperplasia - fibrosis is around the diverticula this leads to a reduced diameter
61
why can diverticular disease mimic colorectal cancer?
- intermittent abdominal pain and altered bowel habit - affect similar age groups - positive FOB and iron deficient anaemia

T IoD cellular pathology (10 decks)

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