Small and large bowel diseases part 1 Flashcards
What does acute abdomen mean?
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.
What conditions cause epigastric pain?
GORD
Esophagitis
Peptic ulcer
Perforated ulcer
Pancreatitis
What causes right hypochondriac pain?
Gallstones
Liver abscess
Hepatitis
Cholangitis
Lungs causes
Cardiac causes
What causes left hypochondriac pain?
Spleen abscess
Acute splenomegaly
Spleen rupture
What causes right flank pain?
Ureteric colic
Pyelonephritis
What causes umbilical pain?
Appendicitis
Mesenteric adenitis
Diverticulitis
Lymphomas
What causes left flank pain?
Ureteric colic
Pyelonephritis
What causes right iliac pain?
Appendicitis
Crohn’s disease
Caecum obstruction
Ovarian cyst
Ectopic pregnancy
Hernias
What causes hypogastric region pain?
Testicular torsion
Cystitis
Urinary retention
Placental abruption
What is peritonitis?
Inflammation of theperitoneum, which is a serosal membrane lining the abdominal organs and walls of the peritoneal cavity.
What causes peritonitis?
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.
How does peritonitis present?
- 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)
Which one is more common -small or large bowel obstruction? And why?
Small bowel obstruction
Has a smaller lumen
Why does small bowel obstruction occur?
It usually occurs due to incarcerated (lack of blood supply) hernia or adhesions.
What is bowel obstruction?
When the passage of food, fluids and gas, through the intestines becomes blocked.
What causes large bowel obstruction?
Malignancy
Diverticulitis
How does small bowel obstruction present?
- 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)
How does large bowel obstruction present?
- 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
Investigations for small/large bowel obstruction? What are you looking for?
Abdominal x-ray
Distended bowel loops, erect film may show air-fluid level
How is bowel obstruction managed?
‘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
What is volvulus?
Bowel twisting around itself and themesenterythat it is attached to.
What is sigmoid volvulus?
The bowel twisting affecting the sigmoid colon.
Presentation and diagnosis of sigmoid volvulus?
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
Management of sigmoid volvulus?
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
What is intussusception?
Part of the GI tract invaginates or telescopes into another neighbouring portion. It occurs in healthy infants.
Presentation and diagnosis of intussusception?
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
Management of intussusception?
-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
What is bowel perforation?
A hole in the wall of the small intestine or the colon, resulting in exposure of peritoneal cavity to bowel contents.
Causes of bowel perforation?
- invasive procedure
- infection
- obstruction
- trauma
Presentation and diagnosis of bowel perforation?
- 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
What is gastrointestinal haemorrhaging? Which type of bleeding is more common -upper or lower?
Bleeding within the GI tract.
Upper GI bleeding is more common than lower GI bleeding due to ulcers -peptic and duodenal ulcers.
What scoring system is used in suspecting GI bleed? What factors does it consider?
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
How do patients present if they have a GI bleed?
- 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
What investigations and management would you do for upper GI bleed?
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
How does upper GI bleed present on examination?
- 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
