Pathology of Small Bowel Flashcards
Common cause of small bowel problems
Obstruction
Typical presentation of small bowel obstruction
Distension, vomiting, borborygmus, pain, faeculent vomiting
What is borborygmus
Rumbling or gurgling sound made by movement of fluid and gas in intestines
Investigations of small bowel obstruction
Urinalysis, blood, gases, abdominal x-ray, contrast CT scan of abdomen, gastrograffin studies
What is a gastrograffin study
A gastrograffin swallow is a test to show the outline of oesophagus and stomach on plain x-ray
Management strategy for small bowel obstruction
Conservative management - Assess ABC, analgesics, anti-emetics, provide fluids with Potassium, Ryles tube, antithromboembolism measures
Why does small bowel obstruction cause alkalosis
Small bowel obstruction causes accumulation of fluid which can’t be passed onto the large intestine for absorption. This leads to hypokalaemia causing alkalosis
Function of Ryles/nasogastric tube in small bowel obstruction
To drain out GI contents and prevent aspiration
How long is drip and suck done for
72 hours, intervene earlier if it’s perforation, strangulation or ischaemia
Can hernia’s be resolved by drip and suck management
No, only adhesional small bowel obstructions
What are adhesional small bowel obstructions
Adhesion of small bowel to adjacent structures via fibrous bands, often due to injury during surgery.
How does infarction in small and large bowel vary
Small bowel infarction leads to quick death, large bowel infarction has higher chance of survival due to presence of marginal artery or drummond
Typical presentation of mesenteric ischaemia
Angina-like pain, food fear due to pain on ingestion and digestion, seems okay on the outside, thin
How does small bowel obstruction look like on x-ray
Swallowed a caterpillar - dilated loops of small bowel
What can cause mesenteric ischaemia
Embolus from atrial fibrillation
In situ thrombosis due to virchow’s triads
Diagnosing mesenteric ischaemia
Pain is much severe than clinical findings
Acidosis on gases (low pH)
Elevated lactate, normal CRP, WCC bit high
Investigations for mesenteric ischaemia
Blood gases
Blood counts
CT angiogram
Find on laparotomy
<30 cm of small intestine left in mesenteric ischaemia
Very poor prognosis as atleast 30cm of small intestine is needed to get a stoma or join the bowels
Best treatment option for small bowel haemorrhage
Interventional radioogy
What is Meckel’s diverticulum
Congenital diverticulum present 60cm away from ileocaecal valve (2 feet)
What is Meckel’s diverticulum a remnant of
Omphalomesenteric duct/vitelline duct or yolk sac
How is Meckel’s diverticulum formed
The omphalomesenteric or vitelline duct normally connects the embryonic midgut to yolk sac, providing nutrients to the midgut during embryogenic development. This duct progressively narrows and disappears between 5-8th week of gestation. However, in Meckel’s diverticulum, the proximal part of the vitelline duct fails to regress and involute, causing a remnant of variable length and location to remain
