Sketchy Path: SBO, Ileus, and Hernia

Question 1

What is the most common cause of SBO?

Answer 1

Adhesions (surgery, inflammation)

kid holding on too flame shirt causing stricture

Question 2

What are the common symptoms of SBO?

Answer 2

Nausea/Vomiting
(kid about to vomit)

Obstipation
(plunger)

Colicky abd pain
(Collie riding a skateboard)

Question 3

Auscultation of the abdomen during a SBO obstruction will show what sound?

Answer 3

High Pitched “tinkling” bowel sounds

Tink Tink the rocks make as they kit the concrete

Question 4

What do you see on Xray when a pt has a SBO?

Answer 4

Dilated loops of bowel with air fluid levels as well as a transition pt which is the pt which dilated bowel meets normal bowel
(Black Cloud graffiti and transition from thin half pipe to wide)

Question 5

What causes a intestinal illeus?

Answer 5

Similar to SBO but due to Hypomotility

Guy on broken skateboard not moving

Question 6

What is the difference between Illeus Xray and SBO?

Answer 6

On xray with illeus the entire bowel is distended and no transition point is seen
(Guys uniformly dilated pants)

Question 7

What do you hear on auscultation of ileus?

Answer 7

Diminished bowel sounds

Guy with a broken bomb box

Question 8

What are some of the causes of ileus?

Answer 8

Surgery
(scapel graffiti)

Drugs
(pill bottles on floor)

Diabetes
(guy holding a jar of candy)

Sepsis
(septic sewer cap)

Question 9

What is SMA syndrome?

Answer 9

Compression of the 3rd portion of the duodenum by the aorta and SMA
(Kid on ramp being crush between the large pipe and the railing)

Question 10

What is the cause of SMA syndrome?

Answer 10

Caused by severe rapid weight loss that shrinks the mesenteric fat pads decreasing the cushioning of the duodenum
(Skateboarder losing the pads on her knees and arms)

Question 11

What do patients usually present with in SMA syndrome?

Answer 11

Pain after eating

Painful burrito

Question 12

What is intussusception?

Answer 12

Segment of proximal bowel telescopes beneath a more distal bowel
(Kid on the telescope)

Question 13

Why is intussusception considered a surgical emergency?

Answer 13

Decreases venous return which can lead to ischemia and necrosis of the bowel wall
(Telescope kid with skull shirt)

Question 14

What population is most likely to get intussusception? From what?

Answer 14

Young children due to a aggregate of lymphoid tissue post viral infection
(kid sitting on the floor with a pile of tissues around him)

Question 15

What should you suspect in an older pt who gets an intussuscpetion?

Answer 15

Meckel’s Diverticulum
(Meckel Hecklers)
Polyps and Tumors
(Polyp/Tumor hats on hecklers)

Question 16

What is the most common place to find a intussuscpetion?

Answer 16

Terminal ileum/Cecum Junction

Larger half pipe meets smaller landing zone

Question 17

What is the classic ultrasound sign seen with intussusception?

Answer 17

Target Sign on cross section

target being landed on by scooter kid

Question 18

What kind of stool does intussuscpetion cause?

Answer 18

Current Jelly

Skull telescope kid eating a jelly sandwich

Question 19

What can diagnose a intussusception? What treats it?

Answer 19

Barium Enema can both diagnose and treat

berry-yum target

Question 20

What happens when a hernia becomes incarcerated?

Answer 20

Constrction of the veins leads to decrease venous and lymphatic drainage, swelling, and decrease arterial blood flow
(Kids hand in handcuffs turning blue)

Question 21

What are the borders of Hesselbach’s Triangle?

Answer 21

Inguinal lig -inferior border
(Tarp underneath tube)
Rectus Abdominus-medial border
(Striated wooden frame)
Epigastric vessels- lateral border
(Red and blue pipes)

Question 22

Where do direct hernias go in relation to Hesselbach’s triangle?

Answer 22

Directly thru the triangle - medial to the inferior epigastric vessels
(skater going thru fence)

Question 23

Where does a indirect hernia go?

Answer 23

Lateral to the inf epigastric vessels and into the inguinal canal

Question 24

Where do femoral hernias go in relation to hesselbach’ triangle?

Answer 24

Underneath- under the inguinal ligament and into the femoral space
(Skater going under the tube)

Question 25

Which hernia is covered by all three layers of fascia?

Answer 25

Indirect since go thru the inguinal canal

skater coming out of tube has layers on

Question 26

What is the largest risk factor for an indirect hernia?

Answer 26

Persistence of the processus vaginalis

Question 27

Which hernias have the highest rate of incarceration?

Answer 27

Femoral

Skater going underneath he tube has handcuffs on