INTESTINAL DISORDERS Flashcards

1
Q

What is the main pathogenesis for appendicitis in adults and children respectively?

A
  • Adults: fecaliths
  • Children: lymphoid hyperplasia, often following viral infection

→ both result in obstruction of opening to cecum

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2
Q

Why does pain in appendicitis begin at mid epigastric region and move to RLQ?

A
  • 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
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3
Q

Appendicitis can be diagnosed with history and exam. If diagnosis is in doubt what can you do?

A

CT scan

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4
Q

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

A
  • 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

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5
Q

What is the difference between a true and false diverticulum?

A
  • 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

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6
Q

Define diverticulosis

what is it caused by?

A

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

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7
Q

How do you diagnose diverticulitis? What is the treatment?

A

CT scan

Treated with antibiotics or surgery

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8
Q

List 4 complications of diverticulitis and the presenting symptoms

A
  • 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)
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9
Q

Define adhesion and what causes it

Adhesions are the most common cause of which type of obstruction?

A

Bands of scar tissue in peritoneal cavity, commonly formed after surgery e.g. C section, appendicectomy

Most common cause of small-bowel obstruction

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10
Q

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?

A

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
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11
Q

What kind of things can be a lead point in intussusception?

A

Michael diverticulum, lymphoid hyperplasia (strong association with enteric adenovirus), tumours

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12
Q

What are the two classic locations of volvulus?

what are two classic imaging findings in volvulus?

A

Sigmoid colon, caecum

→ Dilated sigmoid, airless rectum

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13
Q

Where do the majority of bowel obstructions occur?

What are the presenting symptoms?

A

Small intestine (75%)

Abdominal pain, nausea/vomiting, abdominal distension, obstipation (inability to pass stool/wind)

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14
Q

Give three causes of small-bowel obstruction and 3 of large. How can these be remembered?

A

Small (ABC):

  • Adhesion
  • Bulge (hernia)
  • Cancer

Large (VAT):

  • Volvulus
  • Adhesion
  • Tumour
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15
Q

What two signs would you expect to see on abdominal x-ray of someone with a bowel obstruction ?

A
  • Dilated bowel loops
  • Air-fluid levels
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16
Q

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?

A

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

17
Q

Why should you ask the patient if they have passed gas or moved bowels after an operation?

A

Post operative Ileus can be caused following administration of anaesthetics

18
Q

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?

A

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.

19
Q

What is a classic x-ray finding in necrotising enterocolitis?

what is the treatment for this condition?

A

Pneumatosis intestinalis: In bowel wall, seen as a lucent area parallel to bowel

Treatment: antibiotics, bowel rest, often surgery

20
Q

Improvement of abdominal pain following defecation indicates which GI condition?

A

Irritable bowel syndrome