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GI > Small and large bowel diseases part 1 > Flashcards

Small and large bowel diseases part 1 Flashcards

1
Q

What does acute abdomen mean?

A

A recent, rapid onset of urgent abdominal or pelvic pathology, usually presenting with abdominal pain.

This is a common presentation and has a wide variety of causes.

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2
Q

What conditions cause epigastric pain?

A

GORD
Esophagitis
Peptic ulcer
Perforated ulcer
Pancreatitis

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3
Q

What causes right hypochondriac pain?

A

Gallstones
Liver abscess
Hepatitis
Cholangitis
Lungs causes
Cardiac causes

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4
Q

What causes left hypochondriac pain?

A

Spleen abscess
Acute splenomegaly
Spleen rupture

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5
Q

What causes right flank pain?

A

Ureteric colic
Pyelonephritis

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6
Q

What causes umbilical pain?

A

Appendicitis
Mesenteric adenitis
Diverticulitis
Lymphomas

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7
Q

What causes left flank pain?

A

Ureteric colic
Pyelonephritis

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8
Q

What causes right iliac pain?

A

Appendicitis
Crohn’s disease
Caecum obstruction
Ovarian cyst
Ectopic pregnancy
Hernias

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9
Q

What causes hypogastric region pain?

A

Testicular torsion
Cystitis
Urinary retention
Placental abruption

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10
Q

What is peritonitis?

A

Inflammation of theperitoneum, which is a serosal membrane lining the abdominal organs and walls of the peritoneal cavity.

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11
Q

What causes peritonitis?

A

Chemical irritation

Bacterial invasion
- secondary to extension of bacteria through the wall of a hollow viscus OR rupture of viscus

  • common disorders causing bacterial peritonitis:
    - appendicitis
    - ruptured peptic ulcer
    - cholecystitis
    - diverticulitis
    - strangulated bowel
    - acute salpingitis
    - abdominal trauma
    - peritoneal dialysis
  • spontaneous bacterial peritonitis
    - may develop in the absence of an infection, mostly seen in children, particularly those with nephrotic syndrome. Also seen in adults with ascites secondary to liver failure.
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12
Q

How does peritonitis present?

A
  • severe pain
  • pain on coughing or sneezing (inflammation)
  • pt lying very still
  • guarding
  • rebound tenderness (pain when you release your hand after pressing the abdomen)
  • percussion tenderness (pain when percussing)
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13
Q

Which one is more common -small or large bowel obstruction? And why?

A

Small bowel obstruction

Has a smaller lumen

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14
Q

Why does small bowel obstruction occur?

A

It usually occurs due to incarcerated (lack of blood supply) hernia or adhesions.

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15
Q

What is bowel obstruction?

A

When the passage of food, fluids and gas, through the intestines becomes blocked.

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16
Q

What causes large bowel obstruction?

A

Malignancy
Diverticulitis

17
Q

How does small bowel obstruction present?

A
  • intermittent, colicky abdominal pain
  • early vomiting, followed by constipation (because small bowel is higher up)
  • no flatus
  • dehydration, hypovolaemia
  • abdominal distention, +/- visible peristalsis
  • +/- tenderness (occurs if there’s inadequate blood supply)
  • bowel sounds may be increased (high pitched, tinkling or absent)
18
Q

How does large bowel obstruction present?

A
  • early onset of constipation, later onset of vomiting
  • faeculent vomiting (due to reverse peristalsis as there is an obstruction)
  • colicky abdominal pain
  • abdominal tenderness and distention
  • abdominal mass (due to tumor)
  • hepatomegaly (secondary to metastases)
  • dehydration
19
Q

Investigations for small/large bowel obstruction? What are you looking for?

A

Abdominal x-ray

Distended bowel loops, erect film may show air-fluid level

20
Q

How is bowel obstruction managed?

A

‘Drip and suck’
- the administration of IV fluid (drip) and the placement of an NG tube (suck).

Nil by mouth
- no food, drink, or medications through mouth

IV fluids
- for dehydration

Nasogastric tube
- for medications, prevent vomiting

Analgesia
- for pain

Abx prophylaxis

Antiemetics

Surgery indicated if:
- increasing pain
- peritonism (suggests perforation or ischaemia)
- closed loop
- complete obstruction

21
Q

What is volvulus?

A

Bowel twisting around itself and themesenterythat it is attached to.

22
Q

What is sigmoid volvulus?

A

The bowel twisting affecting the sigmoid colon.

23
Q

Presentation and diagnosis of sigmoid volvulus?

A

Abdominal x-ray →giant coffee bean sign (dilated twisted sigmoid colon)

Contrast CT →confirm diagnosis

  • sudden onset abdominal pain
  • abdominal distention
  • bowels not open
  • no flatus
24
Q

Management of sigmoid volvulus?

A

Flatus tube / rectal tube is left in place temporarily to help decompress the bowel and is later removed.

Endoscopic decompression (without peritonitis)

Laparotomy(open abdominal surgery)

Resection

25
Q

What is intussusception?

A

Part of the GI tract invaginates or telescopes into another neighbouring portion. It occurs in healthy infants.

26
Q

Presentation and diagnosis of intussusception?

A

USS

  • Severe, colicky abdominal pain
  • Pale, lethargic and unwell child
  • “Redcurrantjelly stool”
  • Right upper quadrant mass on palpation. This is described as “sausage-shaped”
  • Vomiting
  • Intestinal obstruction
27
Q

Management of intussusception?

A

-Therapeutic enemas

-Surgical reduction→if enemas do not work.
-Surgical resection →if the bowel becomesgangrenous(due to a disruption of the blood supply) or the bowel isperforated

28
Q

What is bowel perforation?

A

A hole in the wall of the small intestine or the colon, resulting in exposure of peritoneal cavity to bowel contents.

29
Q

Causes of bowel perforation?

A
  • invasive procedure
  • infection
  • obstruction
  • trauma
30
Q

Presentation and diagnosis of bowel perforation?

A
  • clinical features of the underlying cause of the perforation
  • generalised abdominal pain -sudden or progressive
  • abdominal distension, tenderness
  • signs of peritonitis
  • may become septic

USS →look for pneumoperitoneum.
erect abdominal x-ray →free air under the diaphragm suggests perforation.
CT

31
Q

What is gastrointestinal haemorrhaging? Which type of bleeding is more common -upper or lower?

A

Bleeding within the GI tract.

Upper GI bleeding is more common than lower GI bleeding due to ulcers -peptic and duodenal ulcers.

32
Q

What scoring system is used in suspecting GI bleed? What factors does it consider?

A

Glasgow-Blatchford score

  • Haemoglobin (falls in upper GI bleeding)
  • Urea (rises in upper GI bleeding)
  • Systolic blood pressure
  • Heart rate
  • Presence of melaena
  • Syncope (loss of consciousness)
  • Liver disease
  • Heart failure
33
Q

How do patients present if they have a GI bleed?

A
  • abdominal pain -epigastric or diffuse
  • haematemesis -frank, coffee ground vomit
  • melaena (black tarry stool)
  • haematochezia (blood in stools)
  • shock, syncope
  • jaundice (related to break down of RBCs, so if there’s increased RBC breakdown, then you can have jaundice due to a bleed)
  • wt loss (cancer)
  • PMH: anaemia, dyspepsia, peptic ulcer disease, previous GI haemorrhage
  • DH: NSAIDs, aspirin, corticosteroids
  • Excessive alcohol intake
34
Q

What investigations and management would you do for upper GI bleed?

A

ABCs (Airway Breathing Circulation) -resuscitation

Cross match (usually 2-6 units of blood; if needed later for blood transfusion)

Bloods: FBC, coagulation screen, LFTs, U&Es

Chest and abdominal x-ray

Urgent endoscopy -immediately in unstable pts with upper GI bleeding.

Endoscopy within 24 hours for stable pts with upper GI bleeding.

Drugs -stopanticoagulantsandNSAIDs

35
Q

How does upper GI bleed present on examination?

A
  • Signs of anaemia -pallor
  • Cold extremities
  • Postural BP
  • Dehydration -dry mucous membrane, sunken eyes, reduced skin turgar
  • Signs of liver disease: jaundice, ascites, spider naevi, asterixis

GI (12 decks)

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