Pathology of Small Intestine and Appendix Flashcards
Small bowel obstruction comes with what kind of pain?
colicky pain increasing pressure during peristalsis pushing against obstruction – frequent
How is small bowel obstruction diagnosed?
History and examination
plain abdominal X-ray
Complications of SBO?
Strangulation
Management is different if not strangulated
3 main extrinsic causes of SBO
Adhesions
Hernias
Cancer
Intra-lumenal cause of SBO
Gall stone ileus
On X-Ray, what does a SBO look like?
multiple distended loops in the centre of the abdomen
Treatment of a non strangulated SBO
IV fluids + nasogastric suction
If no resolution over 24-48 hours then operate
Treatment of a strangulated SBO
resuscitate
antibiotics
early surgery
Symptoms of a strangulated SBO
constant pain
tender
sepsis -fever, flushed, fast pulse
shock
If a strangulated SBO was left untreated what may happen?
It would perforate and septic cascade could lead to multi system organ failure
What are the physical findings of small bowel crohn’s disease?
abdominal mass enterocutaneous fistula (inflammed bowel stuck to abdo wall, fistula between small intestine and skin)
Who is most likely to get small bowel ischaemia and infarction?
elderly patients
arteriopaths - evidence of PVD, cardiac disease, stroke etc
What are the clinical features of small bowel ischaemia and infarction?
severe, poorly localised pain
sepsis and shock
small rise in serum amylase
What treatment of required for small bowel ischaemia and infarction?
revascularisation of the intestine
resect gangrenous intestine
what is meckels diverticulum?
remnant of vitello intestinal duct
what can meckels diverticulum contain?
ectopic gastric mucosa
Is meckels diverticulum symptomatic in adults or children?
children
why can meckles diverticulum produce pr bleeding?
ectopic gastric mucosa can secrete acid leading to erosion of lining of intestine giving rectal bleeding
How is meckel’s diverticulum diagnosed?
Technicium Tc 99M scan
what age group does appendicitis affect?
any
Which group of people is appendicitis hard to diagnose in?
children and old people
What are the initial symptoms (visceral) of appendicitis?
nausea anorexia vomiting low grade fever central abdominal pain
What do the initial symptoms of appendicitis progress to (parietal)?
Appendix rubs on abdominal wall giving:
right iliac fossa pain –McBurneys point (RLQ pain)
peritonism
Treatment for appendicitis
laparoscopy, laparoscopic appendicectomy (remove appendix)
or
laparoscopy, open appendicectomy
what colour is a carcinoid tumour of the appendix?
brown- yellow nodule
What is appendicitis?
acute inflammation of the appendix resulting from obstruction of the appendical lumen
Consequences of untreated appendicitis
necrosis perforation gangrene appendical abscess formation peritonitis
In non-urgent presentations, what investigations can take place?
Contrast CT (useful but can take time to organise)
USS
Diagnostic laparatomy
What should be used in pts with appendicitis that can’t undergo surgery?
IV antibiotics (not curative but reduce mortality by 50%)
