*Intestinal Problems (lecture 7) Flashcards
What are the 2 types of bowel obstruction?
Mechanical Adynamic (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?
ABC Analgesia IV fluids (with potassium) NG tube (to decompress the stomach - ryles tube) Catheter and urine output monitoring Antithromboembolism 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?
Alkalosis
Hyokalaemia
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 laparoscopically
Find the obstruction by following collapse or dilated bowel
Resect if necessary
How does ischaemic gut appear in comparison to the normal gut?
Darker
Symptoms of chronic mesenteric ischaemia?
“angina of the gut”
Cramps
Atherosclerosis
Loss weight as eating brings on the pain
Symptoms of acute mesenteric ischaemia?
Severe abdominal pain
Few abdominal signs
Rapid hypovolaemia
Investigations for acute mesenteric ischaemia?
Metabolic acidosis May be increased Hb (due to loss of plasma) WCC raised May be a modestly raised amylase Abdominal x-ray shows a gasses abdomen Arteriography/ angiography Many only diagnosed at laproscopy
How is acute mesenteric ischaemia treated?
resuscitation with fluids Metronidzole and gentamicin Heparin Thrombolysis can be performed if reperfusionable Dead bowel resected
Investigations for chronic mesenteric ischaemia?
CT angiography
MR angiography
Treatment of chronic mesenteric ischaemia?
Angioplasty and stent insertion
When does appendicitis tend to present?
Usually childhood/ young adulthood
Another 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 it
The small bowe can adhere to this causing a phlegmonous mass
Signs of appendicitis?
Mild pyrexia (never a high temperature initially) Mild tachycardia Localised pain in RIF Guarding Rebound 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 CRP
USS may help
CT
AXR to exclude other causes
Management of acute appendicitis?
Prompt appendectomy
Antibiotics
Analgesia
Antipyretics
Management of mass on the appendix (due to acute appendicitis)?
Antibiotics fir line
Take to theatre if worsen
