INTESTINAL DISORDERS Flashcards
What is the main pathogenesis for appendicitis in adults and children respectively?
- Adults: fecaliths
- Children: lymphoid hyperplasia, often following viral infection
→ both result in obstruction of opening to cecum
Why does pain in appendicitis begin at mid epigastric region and move to RLQ?
- Visceral peritoneum inflammation causes mid epigastric pain because it is poorly localised (innervated by autonomic NS)
- RLQ pain is caused by peritoneum inflammation which is better localised due to somatic innervation
Appendicitis can be diagnosed with history and exam. If diagnosis is in doubt what can you do?
CT scan
What symptoms are meant by the term acute abdomen?
List three causes of acute abdomen that require urgent surgical intervention. Explain what would happen if intervention did not occur
- Acute onset abdominal pain
- Rebound tenderness
Appendicitis, diverticulitis, ectopic pregnancy
Untreated these conditions may cause perforation of an abdominal viscous: peritonitis, rigid abdomen, sepsis, death
What is the difference between a true and false diverticulum?
- True: involves all three layers of GIT - rare
- False: involves outpouching of mucosa and submucosa through weakend muscular layer
Both are defined as outpouchings from the GIT
Define diverticulosis
what is it caused by?
Many diverticuli in GIT, usually sigmoid colon
→ Caused by straining to pass stools, low fibre diet i.e. chronic, recurrent increased intra-abdominal pressure. Most people are asymptomatic
How do you diagnose diverticulitis? What is the treatment?
CT scan
Treated with antibiotics or surgery
List 4 complications of diverticulitis and the presenting symptoms
- Abscess: presents as diverticulitis that does not improve after antibiotics. Often requires surgery
- Bowel obstruction: may narrow intestinal lumen
- Fistula: most commonly to bladder, “colovesical fistula”. Presents as faecaluria
- Perforation: results in peritonitis (diffuse pain, rigid abdomen)
Define adhesion and what causes it
Adhesions are the most common cause of which type of obstruction?
Bands of scar tissue in peritoneal cavity, commonly formed after surgery e.g. C section, appendicectomy
Most common cause of small-bowel obstruction
What is the name for telescoping of the intestine?
Why is it dangerous? How can it present?
Which patient group is it most common in?
Intussusception
- Blood supply can be compromised leading to necrosis and GI bleeding, described as redcurrant jelly
- Common in children less than 1 year, rare in adults
- Often at ileocaecal junction
What kind of things can be a lead point in intussusception?
Michael diverticulum, lymphoid hyperplasia (strong association with enteric adenovirus), tumours
What are the two classic locations of volvulus?
what are two classic imaging findings in volvulus?
Sigmoid colon, caecum
→ Dilated sigmoid, airless rectum
Where do the majority of bowel obstructions occur?
What are the presenting symptoms?
Small intestine (75%)
Abdominal pain, nausea/vomiting, abdominal distension, obstipation (inability to pass stool/wind)
Give three causes of small-bowel obstruction and 3 of large. How can these be remembered?
Small (ABC):
- Adhesion
- Bulge (hernia)
- Cancer
Large (VAT):
- Volvulus
- Adhesion
- Tumour
What two signs would you expect to see on abdominal x-ray of someone with a bowel obstruction ?
- Dilated bowel loops
- Air-fluid levels
If a baby does not pass meconium in the first day of life, abdominal distension and bilious vomiting: what condition should you consider?
How would you diagnose?
how will you treat?
Hirschsprung’s disease
► absence of ganglion cells in colon resulting in no peristalsis → obstruction
- Rectal biopsy: rectum always involved (other areas variable)
- “Suction” biopsy: suction required to biopsy submucosa
- Will show absence of ganglion cells
Treatment: : Resection to remove colon without ganglion cells
Why should you ask the patient if they have passed gas or moved bowels after an operation?
Post operative Ileus can be caused following administration of anaesthetics
What condition must you consider in a baby presenting in the first four weeks of life with the following symptoms: poor feeding, bloating, decreased activity, blood in stool, vomiting of bile?
→ which types of baby a more susceptible to this condition?
Necrotising enterocolitis
Neonatal disorder, usually occurs in the first month of life. Much more common in premature and low-birth-weight babies. Usually affects terminal ileum or colon.
What is a classic x-ray finding in necrotising enterocolitis?
what is the treatment for this condition?
Pneumatosis intestinalis: In bowel wall, seen as a lucent area parallel to bowel
Treatment: antibiotics, bowel rest, often surgery
Improvement of abdominal pain following defecation indicates which GI condition?
Irritable bowel syndrome
