Intestine Flashcards
Top 3 Causes of SBO (in order)
ABC
Adhesions
Bulge (hernias)
Cancer (neoplasms)
SBO
most useful indicator
inability to pass fatus
AXR (3 views): triad
triad of dilated small bowel (>3 cm in diameter), air-fuid levels on upright flm,
paucity of air in colon (high sensitivity, low specifcity as ileus and LBO can present similarly)
SBO
CT scan findings of ischemic bowel/strangulation
pneumatosis intestinalis (free
air in bowel wall)
and thickened bowel wall,
air in portal vein, free intraperitoneal fuid,
and
diferential wall enhancements (poor uptake of IV contrast into the wall of the afected
bowel)
partial SBO/Crohn’s/Carcinomatosis
MNGT
onservative management with fuid resuscitation and NG
tube decompression
for partial SBO/Crohn’s/Carcinomatosis
hours of observation prior to deciding for surgery
48 hrs
for early postoperative SBO
- days of observation prior to deciding for surgery
3-5 days
postoperative:
hours/days before motility return
1. gastric and small bowel
2. colonic motility
- 24-48 h
- 3-5 days
diagnosis:
Pain “out of keeping with physical
fndings”
Intestial ischemia
Gold standard investigation
Acute Intestinal Ischemia
Ct angiogram
Hernia is more common in male or female
male
Most common hernia
Indirect inguinal hernia
What type of hernias requires UTZ with or without CT scan
obturator hernias
internal abdominal hernias
Spigelian
femoral hernias in obese patients
name the Hernia
- combined indirect and direct hernia
Pantaloon
name the hernia
-contains Meckels diverticulum
littres
name the hernia
-contains appendix
Amyand
name the hernia
-ventral hernia through linea semilunaris
Spingelian
Stangulation of hernia is most common in what type?
femoral> indirect>direct
Most common post operative complication of hernia
recurrence
Pre operative antibiotics Appendix
cefazolin + metronidazole
Most common complication of diverticulosis
Diverticulitis
Most common fistula formation in Diverticulitis
Colovesical
Rectal bleeding from diverticulitis painful or painless
Painless
Is Colonoscopy done in diverticular disease?
Yes, after acute episodes
Outpatient treatment of diverticulitis
antibiotics 7-10 days cipro+metro
when to hospitalize patients with diverticulitis?
if severe presentation, inability to tolerate oral intake, signifcant comorbidities, or fail to
improve with outpatient management
Indications for surgery diverticulitis
◆ unstable patient with peritonitis
◆ Hinchey stage 3-4 (see Table 19)
◆ afer 1 attack if immunosuppressed
◆ consider if recurrent episodes of diverticulitis (≥3); recent trend is toward conservative
management of recurrent mild/moderate attacks
Surgery for diverticulitis
- if unstable patient
hartmanns
Stages of diverticulitis describe and management
hinchey 1
phlegmon/small pericolic abscess -> medical
Stages of diverticulitis describe and management
hinchey 2
Large abscess/fistula -> medical, abscess drainage +/- resection with primary anastomosis
Stages of diverticulitis describe and management
hinchey 3
purulent peritonitis (ruptured abscess) -> resection or hartmanns procedure
Stages of diverticulitis describe and management
hinchey 4
feculent peritonitis -> hartmanns procedure
