Lower GI conditions Flashcards
What is a pseudo-obstruction in the bowel?
Ogilvie’s syndrome
Acute dilatation of colon in absence of anatomic lesion
What can cause a bowel obstruction?
Faecal impaction Thickened wall (carcinoma, crohns) Geometry (volvulus, intussusception) External compression (hernia, adhesions) Dementia, Parkinsons, MS
What is the Rockall score used for?
Assess risk of rebleed in GI bleeds
Uses age, shock, co-morbidity, diagnosis + evidence of current bleeding
S+S bowel obstruction
Colicky abdo pain, distension, N+V, constipation
Tinkling bowel sounds
Management of bowel obstruction
IV morphine + cyclizine
NG tube to suck up gastric fluids + IV fluids
Neostigmine (anti-paralytic) if paralytic ileus
Gastrografin as part of nonoperative treatment
Surgery - if bowel ischaemia present or cause that requires surgery eg hernia strangulation
Investigations + results for ?bowel obstruction
FBC, U+E (high urea, hypokalaemia), CRP, high lactate
AXR (valvulae conniventes visible in small bowel obstruction, Haustral lines on large bowel obstruction) - dilated loops of bowel with air fluid levels, proximal bowel dilation or gasless abdomen
CT is diagnostic
When are caecal + sigmoid volvulus common?
Caecal = 25-35y/o Sigmoid = elderly, constipated
Investigations for ?volvulus
AXR - coffee bean “inverted U” loop of bowel
Management of volvulus
Sigmoidoscopy + insertion of flatus tube
What criteria is used to diagnose constipation?
Rome IV
Spontaneous BM less than 3 times a week
What is the definition of chronic constipation?
Symptoms present for at least 12 weeks in last 6 months
What is functional constipation?
Without known cause
Management of constipation
Increase fibre + fluids
Manage faecal loading
Oral laxatives - bulk forming first, then osmotic, then stimulant if needed
What investigations should be done if management of constipation has failed?
FBC, TFT, HbA1c, U+E, clacium
What is the definition of acute, persistent + chronic diarrhea?
3 or more loose stools a day
Acute = less than 14 days
Persistent = more than 14 days
Chronic = more than 4 weeks
Causes of acute diarrhea
Infection, drugs, anxiety, food allergy, appendicitis
Causes of chronic diarrhea
IBS, diet, IBD, coeliac, bowel cancer
When should diarrhea be sent for microbiology review?
Systemically unwell/ needs abx Blood or pus in stool Immunocompromised Occurring after foreign travel Over 14 days
Complications of bowel obstruction
Ischemia, necrosis, perforation
What is the most common cause of small bowel obstruction?
Adhesions post surgery (appendicectomy, gynae surgery, resection for malignancy) or due to intestinal inflammation (Crohns + diverticular disease)
What is post-op ileus?
Obstipation + intolerance of oral intake after surgery
Pathology of post-op ileus
Inflammation of intestinal smooth muscle leading to disruption of propulsive motor activity in gut
RF for prolonged post-op ileus
Prolonged abdominal or pelvic surgery, lower gastrointestinal surgery, open surgery
Delayed enteral nutrition/nasogastric tube placement, intra-abdominal inflammation
S+S of post-op ileus
- Abdominal distention, bloating, and “gassiness”
- Diffuse, persistent abdominal pain
- Nausea and/or vomiting
- Delayed passage of or inability to pass flatus
- Inability to tolerate an oral diet
