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Surgery > Lower GI > Flashcards

Lower GI Flashcards

1
Q

Most common cause(s) of small bowel obstruction?

A 
Scar tissue (adhesions) 
Strangulated Hernias 
Malignancy 
Volvulus 
Crohn's disease
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2
Q

Most common cause of large bowel obstruction?

A 
Cancer 
Diverticulitis 
Volvulus
Inflammatory bowel disease 
Constipation
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3
Q

What are this symptoms of bowel obstruction?

A

Cramping that comes and goes- central umbilical.
Vomiting
Bloating
Constipation and no flatus (complete blockage)
Diarrhoea (partial blockage)

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4
Q

Investigations for ?bowel obstruction?

A 
Abdominal X-ray 
Erect CXR (air - perf)
If inconclusive - early CT
Colonoscopy - risk of perf
Gastrogaffin enema
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5
Q

Most common cause of ileus?

A

Abdominal surgery

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6
Q

How to treat ileus?

A

Drip (fluids and electrolytes)
Suck (NG)

Should recover in 1-3days

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7
Q

What are the symptoms of intussusception in children?

A

Abdo pain
Lethargy
Bloody/mucus stools (redcurrent jelly)
Vomiting (can be bile stained)

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8
Q

Treatment for intussusception?

A

Children - enemas/ surgery

Adults - surgery

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9
Q

How to tell the difference between small and large bowel obstruction?

A

Valvulae coniventes
Small - completely cross lumen

Large - haustra do not cross full lumen

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10
Q

What are the indications for surgery in small bowel obstruction?

A 
Absolute indications: 
Generalised peritonitis 
Localised peritonitis
Visceral perforation 
Irreducible hernia

Relative:
Palpable mass
‘Virgin’ abdomen
Failure to improve

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11
Q

When to go for conservative management in small bowel obstruction?

A

Imcomplete obstruction
Previous surgery
Advanced malignant disease
Diagnostic doubt

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12
Q

Difference in presentation between right and left large bowel tumours causing obstruction?

A

Right (caecal) - presents like SBO - early vomiting, late constipation.

Left - LBO - change in bowel habit, absolute constipation, abdo distension, late vomiting,

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13
Q

Management of LBO?

A

Surgery -
Requires fluid and abx prior to surgery. Consent for potential STOMA.
Laparotomy (palpate liver for mets and inspect colon)
Will usually be and hemicolectomy +/- stoma

Other option is colonic stenting

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14
Q

What are the signs of volvulus?

A

LBO - pain constipation and vomiting
Disproportionate abdo distension

Severe pain and tenderness suggests ischemia
X-ray - bean shaped loop.

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15
Q

What’s the treatment for volvulus?

A

Sigmoidoscopy- for diagnostic and therapeutics.
Flatus tube can be left in for 2-3 days
80% settle with conservative mx.
Options for surgery if decompression fails or peritonitis.

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16
Q

Treatment for caecal volvulus ?

A

Surgery usually required - if ischemia needs hemicoloctomy.

If viable consider: reduction (high recurrence), right hemicolectomy, caecostomy, caecopexy.

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17
Q

What Are the indications for Surgery for bowel obstruction?

A

Strangulation

Closed loop obstruction (eg volvulus)

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18
Q

Which is the most common volvulus?

A

Sigmoid

19
Q

What causes a mid gut volvulus?

A

Usually babies

Malrotation means caecum is at the RUQ not RLQ… allows midgut to move more… and twist to form a volvulus

20
Q

What is familial adenomatous polyposis syndrome?

A

Genetic mutation in ACP gene
100/1000s of polyps
Often colon needs to be removed

21
Q

Causes of small bowel infraction?

A

Transmural - thrombosis or clots in SMA
Tumour, hernia, volvulus, intussusception etc cause compression of blood vessels

Non-occulasive eg hypoperfusion cause mucosal infarcts. Causes: Hypovolemia and low CO.

22
Q

Symptoms of small bowel ischemia,

A

Severe abdominal pain might soft..

When infarct occurs - vomiting and bloody diahorrha and abdo distension might occur

Sepsis - fever, peritonitis

23
Q

What tests do you do for small Bowel ischemia?

A

Abdo CT - shows bowel dilation, bowel wall thinkening and intestinal pneumatosis

Can do CT angio - shows the right area

Rx: revascularisation

24
Q

What’s the surgery for cancer >8 cm above the anal verge?

A

Anterior resection +/- defunctioning stoma (need a contrast enema prior to reversal of stoma)

25
Q

What are the causes of anal fissures?

A

Constipation (causing trauma) - spasm of sphincter causes pain and poor healing (ischemia)

Rarer: chrons , STI (herpes, syphillis, HIV), anal cancer

26
Q

Presentation (Symptoms and examination)of anal fissures?

A

Pain passing stool, right red PR bleed (mainly on paper)

PR (often impossible), Ulcer, skin tag. Groin LN suggest complicating factor

27
Q

Management of anal fissures acute and chronic?

A

Acute - diet and water advice, 1st line - bulk forming laxative (fybogel), lubricants, topical anesthetiser (lignocaine),

Chronic >6wk -above Mx plus
1st line - topical GTN (try for 8 weeks)
2nd line - referral for surgery or botulinum toxin injection.

Surgery - lateral partial sphincterotomy

28
Q

What’s the presentation of an anal fistula?

A

Persistent anal discharge
Perianal Pain and discomfort

Associated with: perianal sepsis (abscess), Crohn’s disease, diverticular disease, rectal Ca, immunosuppression.

29
Q

Treatment for anal fistula low vs high?

A

Low vs high depends on whether the fistula crosses the spinchter muscles above the dentate line

Low - fistulotomy and excision (laid open to heal by 2nd intention)

High - suture - a senton - passed through the fistula and gradually tightened over months (stimulates fibrosis of tract, scar tissue holds sphincter together)

30
Q

When is a hartmanns procedure indicated?

A

When there is perforation of the rectosigmoid bowel - cause by:

1) colon cancer (often causes LBO)
2) diverticulitis
3) trauma

31
Q

What is Hartmanns procedure?

A

Sigmoid colon resection plus end colostomy and rectal stump is sewn.

32
Q

What’s dukes criteria for colorectal cancer?

A

1 - confined to bowel wall (95%)
2 - through bowel wall but no LN(80%)
3 - LN involved (65%)
4 - distant mets (5%)

% - 5 year survival

33
Q

What type of cancer are the majority of colorectal cancers?

A

Adenocarcinomas

34
Q

What Are the associations with sigmoid volvulus?

A 
Older patients
Chronic constipation
Chagas' disease 
Neurological (PD, DMD)
Psych (schizophrenia)
35
Q

Management for sigmoid volvulus? Vs caelcal volvulus?

A

Rigid sigmoidoscopy with rectal tube insertion

Caecal - right hemicoloctomy is often needed

36
Q

Emergency Surgical Treatment for poorly controlled UC (including megacolon)?

A

Subtotal colectomy

37
Q

Surgical cure for UC

A

Protocolectomy

38
Q

Treatment for UC when medical management isn’t successful wishing to avoid stoma?

A

Panproctocolectmy with ileoanal pouch.

39
Q

Which disease presents with nocturnal diarrhoea and incontinence

A

Inflammatory bowel disease

Specifically proctitis

40
Q

What are the complications of diverticular disease?

A 
Diverticulitis
Haemorrhage
Fistula
Perf (and peritonitis)
Abscess
Diverticular phlegom
41
Q

What is angiodysplasia?

A

Vascular AV malformation of the gut, where there is unexplained PR bleeding and anemia.
It can be seen on colonoscopy/ endoscopy/ pill entroscopy and is usually in the caecum or ascending colon (right)

42
Q

Caecal malignancy and scanty polyps, with a death from colorectal cancer in the family at 34, suggests which genetic syndrome?

A

Lynch syndrome (HNPCC) - need colonoscopy every 1-2 years from 25years old.

Right sided mucinous tumours

43
Q

Diagnostic investigation for diverticulitis?

A

CT abdo

Surgery (18 decks)

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