Intestinal Problems 7 - Diseases of small bowel and appendix

Question 1

What are the 2 types of bowel obstruction?

Answer 1

MechanicalAdynamic (ileus)

Question 2

What are the causes of small bowel obstruction?

Answer 2

Extrinsic compression (adhesions, hernias, volvulus)Intramural (crohns)Intraluminal (tumour, gallstones)Ileus

Question 3

Initial management of a small bowel obstruction?

Answer 3

ABCAnalgesiaIV fluids (with potassium)NG tube (to decompress the stomach - ryles tube)Catheter and urine output monitoringAntithromboembolism treatment

Question 4

What is “drip and suck”?

Answer 4

NG to decompress the stomach - “suck”IV fluids - “drip”

Question 5

What electrolyte imbalance do patients with small bowel obstruction tend to have?

Answer 5

AlkalosisHyokalaemia

Question 6

What are the appropriate investigations for a small bowel obstruction?

Answer 6

AXR (to look for dilated small bowel loops)CT

Question 7

What type of obstructions do you always need to do surgery for?

Answer 7

Hernias

Question 8

How long should you drip and suck for?

Answer 8

Up to 72 hours for adhesion however intervene earlier if strangulation, ischaemia, perforation

Question 9

Surgical management of treatment of small bowel obstruction?

Answer 9

Laparotomy - can be done laparoscopicallyFind the obstruction by following collapse or dilated bowelResect if necessary

Question 10

How does ischaemic gut appear in comparison to the normal gut?

Answer 10

Darker

Question 11

Symptoms of chronic mesenteric ischaemia?

Answer 11

“angina of the gut”CrampsAtherosclerosisLoss weight as eating brings on the pain

Question 12

Symptoms of acute mesenteric ischaemia?

Answer 12

Severe abdominal painFew abdominal signsRapid hypovolaemia

Question 13

Investigations for acute mesenteric ischaemia?

Answer 13

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

Question 14

How is acute mesenteric ischaemia treated?

Answer 14

resuscitation with fluidsMetronidzole and gentamicinHeparinThrombolysis can be performed if reperfusionableDead bowel resected

Question 15

Investigations for chronic mesenteric ischaemia?

Answer 15

CT angiographyMR angiography

Question 16

Treatment of chronic mesenteric ischaemia?

Answer 16

Angioplasty and stent insertion

Question 17

When does appendicitis tend to present?

Answer 17

Usually childhood/ young adulthoodAnother peak in elderly population

Question 18

What can happen in terms of the omentum in relation to appendicitis?

Answer 18

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

Question 19

Signs of appendicitis?

Answer 19

Mild pyrexia (never a high temperature initially)Mild tachycardiaLocalised pain in RIFGuardingRebound tenderness

Question 20

What is Rosving’s sign?

Answer 20

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.

Question 21

What is mesenteric adenitis?

Answer 21

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.

Question 22

Investigations for acute appendicitis?

Answer 22

Blood test may reveal high neutrophil levels and high CRPUSS may helpCTAXR to exclude other causes

Question 23

Management of acute appendicitis?

Answer 23

Prompt appendectomyAntibioticsAnalgesiaAntipyretics

Question 24

Management of mass on the appendix (due to acute appendicitis)?

Answer 24

Antibiotics fir lineTake to theatre if worsen