Sketchy Path: SBO, Ileus, and Hernia Flashcards
What is the most common cause of SBO?
Adhesions (surgery, inflammation)
kid holding on too flame shirt causing stricture
What are the common symptoms of SBO?
Nausea/Vomiting
(kid about to vomit)
Obstipation
(plunger)
Colicky abd pain
(Collie riding a skateboard)
Auscultation of the abdomen during a SBO obstruction will show what sound?
High Pitched “tinkling” bowel sounds
Tink Tink the rocks make as they kit the concrete
What do you see on Xray when a pt has a SBO?
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)
What causes a intestinal illeus?
Similar to SBO but due to Hypomotility
Guy on broken skateboard not moving
What is the difference between Illeus Xray and SBO?
On xray with illeus the entire bowel is distended and no transition point is seen
(Guys uniformly dilated pants)
What do you hear on auscultation of ileus?
Diminished bowel sounds
Guy with a broken bomb box
What are some of the causes of ileus?
Surgery
(scapel graffiti)
Drugs
(pill bottles on floor)
Diabetes
(guy holding a jar of candy)
Sepsis
(septic sewer cap)
What is SMA syndrome?
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)
What is the cause of SMA syndrome?
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)
What do patients usually present with in SMA syndrome?
Pain after eating
Painful burrito
What is intussusception?
Segment of proximal bowel telescopes beneath a more distal bowel
(Kid on the telescope)
Why is intussusception considered a surgical emergency?
Decreases venous return which can lead to ischemia and necrosis of the bowel wall
(Telescope kid with skull shirt)
What population is most likely to get intussusception? From what?
Young children due to a aggregate of lymphoid tissue post viral infection
(kid sitting on the floor with a pile of tissues around him)
What should you suspect in an older pt who gets an intussuscpetion?
Meckel’s Diverticulum
(Meckel Hecklers)
Polyps and Tumors
(Polyp/Tumor hats on hecklers)
What is the most common place to find a intussuscpetion?
Terminal ileum/Cecum Junction
Larger half pipe meets smaller landing zone
What is the classic ultrasound sign seen with intussusception?
Target Sign on cross section
target being landed on by scooter kid
What kind of stool does intussuscpetion cause?
Current Jelly
Skull telescope kid eating a jelly sandwich
What can diagnose a intussusception? What treats it?
Barium Enema can both diagnose and treat
berry-yum target
What happens when a hernia becomes incarcerated?
Constrction of the veins leads to decrease venous and lymphatic drainage, swelling, and decrease arterial blood flow
(Kids hand in handcuffs turning blue)
What are the borders of Hesselbach’s Triangle?
Inguinal lig -inferior border (Tarp underneath tube) Rectus Abdominus-medial border (Striated wooden frame) Epigastric vessels- lateral border (Red and blue pipes)
Where do direct hernias go in relation to Hesselbach’s triangle?
Directly thru the triangle - medial to the inferior epigastric vessels
(skater going thru fence)
Where does a indirect hernia go?
Lateral to the inf epigastric vessels and into the inguinal canal
Where do femoral hernias go in relation to hesselbach’ triangle?
Underneath- under the inguinal ligament and into the femoral space
(Skater going under the tube)
Which hernia is covered by all three layers of fascia?
Indirect since go thru the inguinal canal
skater coming out of tube has layers on
What is the largest risk factor for an indirect hernia?
Persistence of the processus vaginalis
Which hernias have the highest rate of incarceration?
Femoral
Skater going underneath he tube has handcuffs on
