Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Colorectal surgery > sepsis, perf, haemorrhoid and obstruction > Flashcards

sepsis, perf, haemorrhoid and obstruction Flashcards

1
Q

what are the mechanisms of bowel perf?

A
  • ischaemia
  • infection
  • erosions
  • physical distruption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the S&S of bowel perf?

A

abdo pain, rigidity and rebound tenderness

  • starts at site of perf and then becomes global
  • severe and worse on movement

Fever, N&V

after time the bowel becomes silent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what InV are done for bowel perf?

A

CXR/AXR - pneumoperitoneum

CT abdo

Bloods - leucocytosis

Group and Save for surgical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are treatment options for bowel perf?

A

Open laparatomy to locate site

  • resection or repair
  • drainage
  • peritoneal wash

IV fluids, IV ABx (broad spec) and bowel rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is intrabdominal sepsis?

A

an intra-abdominal collection of pus or infected material and is usually due to localised infection inside the peritoneal cavity that is contained by tissues or anatomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are the common locations of intrabdominal abscess?

A

alongside the organ of origin (e.g paracolic in diverticulitis)

Pelvic

Subphrenic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the causes of intraabdominal sepsis?

A 
sigmoid diverticulitis 
acute appendicits 
severe acute cholecystitis 
Upper GI perf 
post anastomotic leak 
infected acute pancreatitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are the clinical features of intraabdominal sepsis?

A 
constant, localised abdo pain 
malaise and anorexia 
fever
shock features 
N&V 
sepsis signs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what InV are done in intraabdominal sepsis?

A

FBC

  • increased WCC with left shift
  • occasionally leucopenia

CT abdo
- visualisation of IAA (i.e air/fluid collection)

Increased CRP and ESR

Drainage and culture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the treatment of intrabdominal sepsis?

A

CT-guided percutaneous drainage

IV Abx
- amox, gent and met

Open surgical drainage if percutaneous drainage fails

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the causes of SBO?

A 
surgical adhesions 
hernia 
Crohns 
intestinal malignancy 
appendicitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is the classification of SBO?

A

partial obstruction
complete obstruction
simple obstruction - absence of peritonitis
complicated obstruction - ischaemia, gangrene, perf

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are the S&S of SBO?

A

Constipation
Cramping, intermittent, colicky abdo pain and tenderness
vomiting and nausea
abdo distension
tinkling bowel sounds and tympanic percussion
peritonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are InV of SBO?

A

CTAP
- site and cause

AXR

  • Dilated bowel >3cm
  • central abdominal location
  • valvulae connivontes visible (lines completely crossing the bowel)

ABG

  • increased Lactate
  • Hypochloremic hypokalemic metabolic alkalosis if perfuse vomiting

FBC, U&E’s, CRP

  • increased WCC
  • hyponatraemia, hypokalaemia, metabolic acidosis
  • increased CRP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are the treatment options for SBO?

A

NG tube placement and decompression
Analgesia and anti-emetic (PR diclofenac)
Fluids (these patients nearly always fluid deplete)
laparotomy and bowel resection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the causes of LBO?

A

colorectal malignancy
diverticular strictures
volvulus (loop of intestine twists around itself)

17
Q

what the S&S of LBO?

A 
severe abdo pain and distension 
faecal impaction 
N&V (facecal vomit in late disease) 
constipation 
empty rectum 
tinkling bowel sounds and tympanic percussion
18
Q

what InV are done in LBO?

A

CTAP
- site and cause

AXR

  • dilated bowel (>6cm or >9cm at caecum)
  • peripheral location
  • haustra lines visible

FBC, U&E’s, CRP

  • increased WCC and CRP
  • hypokalaemia

ABG

  • lactate
  • acidosis/alkalosis

barium or water soluable contrast enema

  • tapering of bowel lumen at the site of obstruction
  • Complete bowel obstruction: contrast would not be visible beyond obstruction
  • Partial bowel obstruction: a trickle of contrast would be visible beyond obstruction
  • Bird beak sign seen in volvulus
  • Apple core sign seen in colonic

malignancy

19
Q

what are treatment options for LBO?

A

fluids, analgesia, anti-emetic
NG tube and decompression
Stenting
Hemicolectomy, Hartman’s procedure, subtotal tolectomy

20
Q

what are differences in how LBO and SBO presents?

A

SBO tends to be more colicky in nature, LBO can be more constant

vomiting is early onset in SBO and later onset in LBO

faecal vomiting can occur in LBO

constipation is late onset in SBO and early onset in LBO

21
Q

what are haemorrhoids?

A

excessive amounts of the normal endoanal cushions that comprise of anorectal mucosa, submucosal tissue and submucosal vessels

can be internal or external

22
Q

where does haemorrhoids typically occur?

A

3, 7 and 11 o’clock as seen in supine position

23
Q

what are the clinical features of haemorrhoids?

A

rectal bleeding - bright red post defecation

perianal pain and discomfort

anal pruritis

anal mass

24
Q

how are haemorrhoid diagnosed and treated ?

A

rigid sigmoidoscopy/protoscopy

  • banding
  • dilute phenol injections
  • arterial ligation
  • haemorrhoidectomy
25
Q

what is ano-rectal sepsis?

A

a collection of pus in the anal or rectal region. More common in men than women and has a high rate of recurrence

26
Q

what are common organisms in ano-rectal sepsis?

A

E. Coli and enterococcus

27
Q

how does ano-rectal sepsis arise?

A

plugging of the anal ducts leading to fluid stasis, collection and infection

the anal glands are located at the intersphincteric space therefore infection of these glands can spread to the adjacent areas

28
Q

how are anorectal abscesses catergorised?

A

by area;

  • perianal
  • ischiorectal
  • intersphincteric
  • supralevator
29
Q

what are the clincal features of ano-rectal sepsis?

A

pain in perianal region (exacerbated by sitting)

localised swelling, itching or discharge

may be features of sepsis

erythematous, fluctuant, tender, perianal mass O/E and tenderness on PR

30
Q

what is the management of ano-rectal sepsis ?

A

Co-amoxiclav (oral or IV depending on severity)

Analgesia

Incision and drainage under GA

Anal fistulotomy (ano-rectal abscesses often associated with anal fistula)

31
Q

what are the complications of ano-rectal sepsis?

A

Nec fasc

anal fistula

Colorectal surgery (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions