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COMAT - Surgery > Small Bowel > Flashcards

Small Bowel Flashcards

1
Q

What is the most common cause of a small bowel obstruction?

A

Adhesions from prior abdominal surgeries

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2
Q

If a patient has a small bowel obstruction and no history of surgeries, what is the likely cause?

A

Tumor

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3
Q

What is the location of the small bowel obstruction called?

A

Transition point

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4
Q

What happens to the small bowel proximal and distal to the transition point?

A

Proximal = Distention
Distal = Narrowing

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5
Q

What are the early signs of a small bowel obstruction?

A

Episodic pain and increased peristalsis that results in diarrhea

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6
Q

What are the early signs of a small bowel obstruction?

A

Episodic pain and increased peristalsis that results in diarrhea

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7
Q

What are the late signs of a small bowel obstruction?

A

Abdominal distention with constant pain, constipation, nausea and vomiting

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8
Q

What are the late signs of a small bowel obstruction?

A

Abdominal distention with constant pain, constipation, nausea and vomiting

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9
Q

What will be seen on KUB X-ray with a small bowel obstruction?

A

Air-Fluid levels

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10
Q

Once you have obtained a KUB X-ray for a small bowel obstruction, a CT with/without what type of contrast should be obtained?

A

CT with IV contrast

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11
Q

What is the treatment for a small bowel obstruction without perforation or other complications?

A
  • NG tube with suction to decompress the proximal bowel distention
  • NPO, IVF
  • Ambulation
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12
Q

What causes an Indirect Inguinal Hernia?

A

Failure of processus vaginalis to fuse in males

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13
Q

Where do Indirect Inguinal hernias occur in relation to the inguinal ligament and epigastric vessels?

A
  • Superior to inguinal ligament
  • Lateral to epigastric vessels
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14
Q

Where do Indirect Inguinal hernias herniate into?

A

Into the deep ring/spermatic cord/scrotum

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15
Q

When do Direct Inguinal hernias occur?

A

In adult males who are straining

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16
Q

Where do Direct Inguinal hernias occur in relation to the inguinal ligament and epigastric vessels?

A
  • Superior to inguinal ligament
  • Medial to epigastric vessels
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17
Q

Femoral hernias occur commonly in _____. Where are they in relation to the inguinal ligament?

A

Females
- Inferior to inguinal ligament

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18
Q

Do Umbilical hernias need corrected in neonates?

A

Not usually until after 2 years old if they persist

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19
Q

Reducible hernia

A

Able to push the bowel back in

20
Q

Incarcerated hernia

A

Unable to push the bowel back in

21
Q

Strangulated hernia

A

Ischemia of the bowel is actively occurring
+ pain, overlying skin discoloration too

22
Q

What are the signs of a Strangulated hernia? What should be done?

A

Pain + overlying skin discoloration
–> Emergent surgery

23
Q

What causes Chronic Mesenteric Ischemia?

A

Atherosclerosis/stenosis of the Superior Mesenteric A.

24
Q

Describe how Chronic Mesenteric Ischemia is similar to cardiac angina

A

With stenosis in a heart vessel, there will be pain with increased blood/oxygen demand only
– The same will occur with chronic mesenteric ischemia except that the increased demand occurs after eating in order for digestion to occur

25
Q

What symptom will patients experience with Chronic Mesenteric Ischemia?

A

Pain that occurs only after eating

26
Q

What imaging should be done for Mesenteric Ischemia?

A

CTAngiogram

27
Q

What will be seen on CTA with Chronic Mesenteric Ischemia?

A

Calcifications and stenosis of the SMA

28
Q

What will be seen on CTA with Acute Mesenteric Ischemia?

A

Abrupt stop = filling defect

29
Q

What is the treatment for Chronic Mesenteric Ischemia?

A

Revascularization and optimize atherosclerosis

30
Q

What causes Acute Mesenteric Ischemia?

A

Embolus or rupture/thrombosis in the Superior Mesenteric A.

31
Q

What will be seen on exam with Acute Mesenteric Ischemia?

A

Abdominal pain that is out of proportion to the physical exam

32
Q

Once the bowel begins to die with Acute Mesenteric Ischemia, what will the patient experience?

A

Bloody diarrhea

33
Q

If Acute Mesenteric Ischemia is due to an embolus, what are 2 treatment options?

A

Embolectomy
Arterial tPA

34
Q

If Acute Mesenteric Ischemia is due to rupture/thrombosis, what are 3 treatment options?

A

Stent
Bypass
Resection of dead bowel

35
Q

What will be seen on KUB X-ray with a small bowel perforation?

A

Air under the diaphragm

36
Q

What will be seen on CT with a small bowel perforation?

A

Pneumatosis intestinalis (air in the bowel wall)

37
Q

Is a small bowel perforation a surgical emergency?

A

YES

38
Q

Carcinoid syndrome is commonly called a Small Bowel Neuroendocrine Tumor. What does the tumor secrete?

A

Serotonin

39
Q

What are 4 symptoms of Carcinoid syndrome/Small Bowel Neuroendocrine Tumor?

A
  • Flushing
  • Wheezing
  • Diarrhea
  • Right heart fibrosis
40
Q

What are 4 symptoms of a Small Bowel Neuroendocrine Tumor?

A
  • Flushing
  • Wheezing
  • Diarrhea
  • Right heart fibrosis
41
Q

What marker in the urine will be elevated with Carcinoid syndrome?

A

5-HIAA

42
Q

What is the best diagnostic for a Small Bowel Neuroendocrine Tumor (Carcinoid)?

A

Somatostatin Receptor Scintigraphy

43
Q

What is the best diagnostic for a Carcinoid tumor?

A

Somatostatin Receptor Scintigraphy

44
Q

What is the treatment for a Small Bowel Neuroendocrine Tumor?

A

Octreotide

45
Q

What is Octreotide?

A

Somatostatin analog

COMAT - Surgery (13 decks)

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