Intestinal Problems 7 - Diseases of small bowel and appendix Flashcards
What are the 2 types of bowel obstruction?
MechanicalAdynamic (ileus)
What are the causes of small bowel obstruction?
Extrinsic compression (adhesions, hernias, volvulus)Intramural (crohns)Intraluminal (tumour, gallstones)Ileus
Initial management of a small bowel obstruction?
ABCAnalgesiaIV fluids (with potassium)NG tube (to decompress the stomach - ryles tube)Catheter and urine output monitoringAntithromboembolism treatment
What is “drip and suck”?
NG to decompress the stomach - “suck”IV fluids - “drip”
What electrolyte imbalance do patients with small bowel obstruction tend to have?
AlkalosisHyokalaemia
What are the appropriate investigations for a small bowel obstruction?
AXR (to look for dilated small bowel loops)CT
What type of obstructions do you always need to do surgery for?
Hernias
How long should you drip and suck for?
Up to 72 hours for adhesion however intervene earlier if strangulation, ischaemia, perforation
Surgical management of treatment of small bowel obstruction?
Laparotomy - can be done laparoscopicallyFind the obstruction by following collapse or dilated bowelResect if necessary
How does ischaemic gut appear in comparison to the normal gut?
Darker
Symptoms of chronic mesenteric ischaemia?
“angina of the gut”CrampsAtherosclerosisLoss weight as eating brings on the pain
Symptoms of acute mesenteric ischaemia?
Severe abdominal painFew abdominal signsRapid hypovolaemia
Investigations for acute mesenteric ischaemia?
Metabolic acidosisMay be increased Hb (due to loss of plasma)WCC raisedMay be a modestly raised amylaseAbdominal x-ray shows a gasses abdomenArteriography/ angiographyMany only diagnosed at laproscopy
How is acute mesenteric ischaemia treated?
resuscitation with fluidsMetronidzole and gentamicinHeparinThrombolysis can be performed if reperfusionableDead bowel resected
Investigations for chronic mesenteric ischaemia?
CT angiographyMR angiography
Treatment of chronic mesenteric ischaemia?
Angioplasty and stent insertion
When does appendicitis tend to present?
Usually childhood/ young adulthoodAnother peak in elderly population
What can happen in terms of the omentum in relation to appendicitis?
Presence of inflammation in the abdomen can bring the greater momentum over to cover itThe small bowe can adhere to this causing a phlegmonous mass
Signs of appendicitis?
Mild pyrexia (never a high temperature initially)Mild tachycardiaLocalised pain in RIFGuardingRebound tenderness
What is Rosving’s sign?
a sign of appendicitis. If palpation of the left lower quadrant of a person’s abdomen increases the pain felt in the right lower quadrant, the patient is said to have a positive Rovsing’s sign and may have appendicitis.
What is mesenteric adenitis?
Mesenteric adenitis means swollen (inflamed) lymph glands in the tummy (abdomen), which cause abdominal pain. It is not usually serious and usually gets better without treatment. Mesenteric adenitis is a fairly common cause of abdominal pain in children aged under 16 years. It is much less common in adults.
Investigations for acute appendicitis?
Blood test may reveal high neutrophil levels and high CRPUSS may helpCTAXR to exclude other causes
Management of acute appendicitis?
Prompt appendectomyAntibioticsAnalgesiaAntipyretics
Management of mass on the appendix (due to acute appendicitis)?
Antibiotics fir lineTake to theatre if worsen
