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Year 3 Gastro > Intestinal Ischaemia > Flashcards

Intestinal Ischaemia Flashcards

1
Q

What are the 3 types of ischaemic bowel disease?

A

acute mesenteric ischaemia
chronic mesenteric ischaemia
ischaemic colitis

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2
Q

What are the features of mesenteric ischaemia?

A 
Typically small bowel
Due to embolism
Sudden onest, severe symptoms
Urgent surgery 
High mortality
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3
Q

What are the features of ischaemic colitis?

A 
Large bowel
Transient, less severe
Blood diarrhoea
Thumbprinting
Conservative management
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4
Q

What are RFs for bowel ischaemia?

A

increasing age

atrial fibrillation (mesenteric ischaemia)

other causes of emboli: endocarditis, malignancy
cardiovascular disease risk factors: smoking, hypertension, diabetes

cocaine (ischaemic colitis)

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5
Q

What are the presenting features of intestinal ischaemia?

A 
abdominal pain 
rectal bleeding
diarrhoea
fever
bloods - elevated white blood cell count + lactic acidosis
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6
Q

What investigation is done for intestinal ischaemia?

A

CT

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7
Q

What artery is commonly affected in acute mesenteric ischaemia?

A

Superior mesenteric

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8
Q

What is the management for acute mesenteric ischaemia?

A

urgent surgery is usually required

embolus = open embolectomy/arterial bypass +- bowel resection

thrombus = endovascular therapy

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9
Q

What pain is felt in chronic mesenteric ischaemia?

A

Colickly, intermittent abdominal pain

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10
Q

What causes ischaemic colitis?

A

acute but transient compromise in the blood flow to the large bowel

leads to inflammation, ulceration and haemorrhage

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11
Q

What is the investigation for ischaemic colitis?

A

AXR

‘Thumbprinting sign’ caused by mucosal oedema/haemorrhage

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12
Q

What is the management for Ischaemic colitis?

A

Supportive

Surgery if conservative fails e.g. generalised peritonitis, perforation of haemorrhage

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13
Q

Define large bowel obstruction

A

A mechanical interruption (either complete or partial) to the flow of intestinal contents, with multiple potential causes

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14
Q

What are the presenting features of large bowel obstruction?

A 
Intermittent abdo pain
Distention
N+V
Change in bowel habit 
Hard faeces (impaction) 
Soft stools (partial obstruction)
Weight loss
Palpable mass
Tenesmus
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15
Q

What are some RFs for large bowel obstruction?

A 
Colorectal adenomas/polyps
Malignancy
IBD
Diverticular disease
Hernia
Gynae conditions
Diabetes
Previous abdo surgery
Radiotherapy
Male
Obesity
Age
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16
Q

What scan for large bowel obstruction?

A

Urgent CT

May visualise obstruction, perforation, dilatation, ischaemia, malignancy

17
Q

What other investigations for large bowel obstruction?

A

FBC - iron deficiency anaemia (colorectal cancer)
High WBC may indicate perforation or necrosis
Low potassium
Raised CRP
Urea/Creatinine ratio: dehydration = AKI risk

18
Q

What is the management for suspected large bowel obstruction?

A 
Initial supportive care and A-E assessment
Manage fluids
Analgesia
NBM
Emergency surgery
19
Q

What are the 3 main types of surgery for large bowel obstruction?

A

Right hemicolectomy
Hartmann’s procedure
Sutotal/total colectomy

20
Q

What is a right hemicolectomy?

A

Any operation that removes the ileocaecal valve and the caecum.

The colonic resection can be limited to the caecum or extended to the descending colon

21
Q

What is Hartmann’s procedure?

A

Removal of the sigmoid colon with formation of a left iliac fossa colostomy

Rectal stump closed

Reversible

22
Q

What is a subtotal/total colectomy?

A

For obstructing lesions in the descending or sigmoid colon

Ileosigmoid or ileorectal anastomoses

23
Q

What are the presenting symptoms of small bowel osbtruction?

A

Abdo pain
Bloating
Vomiting
Failure to pass flatus or stool

24
Q

What are RFs for small bowel obstruction?

A 
Prev abdo surgery
Crohn's
Hernia
Appendicitis
Malignancy
Intussusception
Volvulus
Foreign body ingestion
25
Q

What investigations are done in small bowel obstruction?

A

CT
Water-soluble contrast study if pt fails to improve within 48 hours
ABG
FBC

26
Q

What is the management for small bowel obstruction when surgery is indicated?

A

Supportive care
NG decompression
Emergency surgery
Correction of underlying cayse

27
Q

What is NG decompression?

A

Prevent aspiration of vomit by gastric decompression

28
Q

When is surgery indicated in small bowel obstruction?

A

Peritonitis
Hernia strangulation
Bowel ischaemia

29
Q

What must be done if surgery is suspeted?

A

Assess bleeding and venous thromboembolism risk
Group and save
AB prescription

30
Q

How do you define dilated small bowel?

A

> 3cm on AXR

31
Q

What is volvulus?

A

torsion of the colon around it’s mesenteric axis resulting in compromised blood flow and closed loop obstruction

32
Q

What is sigmoid volvulus?

A

Large bowel obstruction caused by the sigmoid colon twisting on the sigmoid mesocolon
80% of cases

33
Q

What conditions are associated with sigmoid volvulus?

A

older patients
chronic constipation
Chagas disease
neurological conditions e.g. Parkinson’s disease, Duchenne muscular dystrophy
psychiatric conditions e.g. schizophrenia

34
Q

What conditions are associated with caecal volvulus?

A

all ages
adhesions
pregnancy

35
Q

What are the presenting features of volvulus?

A

constipation
abdominal bloating
abdominal pain
nausea/vomiting

36
Q

How is volvulus diagnosed?

A

AXR
Sigmoid - Large, dilated colon (coffee bean sign)
Caecal - Small bowel obstruction might be seen

37
Q

How is volvulus managed?

A

sigmoid volvulus: rigid sigmoidoscopy with rectal tube insertion

caecal volvulus: management is usually operative. Right hemicolectomy is often needed

38
Q

How can you identify small bowel on an AXR?

A

valvulae conniventes, mucosal folds, cross the full width of the bowel

Year 3 Gastro (39 decks)

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