Small Bowel Flashcards by Callum Donoher

What are the normal diameters of small bowel, large bowel and the caecum?

Small bowel < 3cm
Large bowel < 6cm
Caecum < 9cm

Rule of 3s

How well did you know this?

Not at all

Perfectly

How is small bowel identifiable on a plain abdominal radiograph?

Central
Full thickness Plica circularis

How well did you know this?

Not at all

Perfectly

How does large bowel appear on a plain abdominal radiograph?

More peripheral
Partial thickness haustra

How well did you know this?

Not at all

Perfectly

How do patients with small bowel obstruction present?

Nausea + vomitting
Abdominal pain (acute abdomen)
Abdominal distension
Constipation + NOT PASSING FLATULUS

How well did you know this?

Not at all

Perfectly

What is typically found on examination when assessing for obstruction?

Abdominal pain
Tenderness
Distension
Hernial orifices (may have obstructed hernia)
Bowel sounds (may be tinkling)

How well did you know this?

Not at all

Perfectly

What are the 4 most common causes of small bowel obstruction?

Adhesions
Hernias
Malignancy
Intussusception

How well did you know this?

Not at all

Perfectly

What investigations would you do for a patient when suspecting bowel obstruction?

FBC (infection? Bleeding?)
U+Es
CRP
G+S
Clotting
VBG

How well did you know this?

Not at all

Perfectly

What imaging is done for a patient with a ? Bowel obstruction?

CT abdominal-pelvis IV contrast

Can also give gastrograffin since its a useful contrast and helps resolve bowel obstruction

Can do a abdominal x-ray to easily identify small bowel obstruction

How well did you know this?

Not at all

Perfectly

What is the management for a small bowel obstruction?

IV fluids (DRIP AND SUCK)
NG tube
Urinary catheter (Fluid balance)
Analgesia
Anti-emetics
Gastrograffin
NBM

Surgical management if obstruction not relieved

How well did you know this?

Not at all

Perfectly

What are the 3 most common causes of large bowel obstruction?

Malignancy
Volvulus
Diverticular disease

How well did you know this?

Not at all

Perfectly

What are the possible complications of the formation of an ileostomy?

Anastomotic leak
Parastomal hernia
High output stoma
Bowel obstruction at exit

How well did you know this?

Not at all

Perfectly

What is the difference between an ileostomy and colostomy?

Ileostomy:
-RIF
-spouted (contents are alkaline so irritant to skin)

Colostomy:
-LIF
-flush to skin

How well did you know this?

Not at all

Perfectly

What are some differentials for a patient with a groin lump?

Inguinal hernia
Femoral hernia
Lymphadenopathy
Lipoma
Groin abcess
Psoas abcess
Saphena varix
Pseudoaneurysm

How well did you know this?

Not at all

Perfectly

What are some questions you should be asking a patient with a groin lump?

Bigger when cough
Can it be reduced
Vomitting
Abdo pain
Opening bowels
Flatulus

How well did you know this?

Not at all

Perfectly

What should you be looking for on examination of a groin lump?

Abdomen
External hernial orifices
Location of lump
Cough impulse
Reducible (if so how)

How well did you know this?

Not at all

Perfectly

What are the risk factors for developing a hernia?

Male
Old
High BMI
Raised intraabdominal pressure:
-weight lifting
-chronic cough
-chronic constipation

How well did you know this?

Not at all

Perfectly

What are the 3 types of hernia?

Obstructed
Strangulated
Incarcerated

How well did you know this?

Not at all

Perfectly

What imaging is used for a groin lump that you are unsure if it’s a hernia?

What imaging method is used if you think a hernia is obstructed, strangulated or incarcerated?

Unsure = USS

Obstructed, incarcerated or strangulated = CT Abdo-pelvis IV contrast

How do you examine a hernia?

Look at location
Feel it:
-painful?
-reducible? (Push from the bottom up)
-soft?
-can you get above the lump
Cough impulse (see if it increases in size or see if it reappears if you manage to reduce it)
Assess while standing up as well

If its an Inguinal hernia, try and push it up through the deep ring, occlude it then get them to cough to see if it re emerges

What is the presentation for an obstructed hernia?

Several pain
Non reducible
Vomitting
Can’t open bowels or flatulus
Tender mass

What investigations and imaging would be done for an obstructed inguinal hernia?

Erect chest x-ray + CT AP IV contrast

Bloods
FBC
U+E
CRP
INR (Clotting)
LFT
Amylase
ABG (Lactate)

How is an obstructed inguinal hernia managed?

If INR was elevated what would be given to correct this?

Analgesia
IV Fluids
NG tube (fluid balance)
Catheter

Surgical repair

Prothrombin complex concentrate

What is the surgical management of a hernia?

Open/laparascopic repair of hernia

What are the surgical complications of an open/laparoscoppic mesh repair of hernia?

URINARY RETENTION
Haemotoma
Seroma
Recurrent hernias
Infection
Damage to surrounding structures (vas. Deferens, testicular vessels)
Chronic pain

What is the difference between an indirect and direct inguinal hernia?

Indirect travels through both the deep and superficial inguinal ring Direct travels only though superficial ring Indirect emerges laterally to the inferior Epigastric vessels Direct emerges medially to the inferior Epigastric vessels

What is the name of the anatomical space that a direct inguinal hernia normally passes through?

Hesselbachs triangle

What are the borders of Hesselbachs triangle?

Laterally = inferior Epigastrics Medially = lateral border of Rectus abdominis Floor = inguinal ligament

What are the borders of the inguinal canal?

Floor = inguinal ligament Posterior = transversalis fascia + conjoint tendon Roof = internal oblique and transverse abdominis Anterior = external oblique aponeurosis

What are some gene mutations that increase the chance of developing small bowel cancer/

Tumour suppressor gene p53 Oncogene KRAS

What type of cancer is small bowel cancer normally?

Adenocarcinoma

What are some risk factors for small bowel cancer?

Age Crohns Coeliac Peutz-Jeghers syndrome Lynch syndrome HNPCC FAP Smoking Obesity Low fibre Alcohol High red meat intake

What is a Meckels diverticulum?

When the Vitelline duct that connects the yolk sac and the small intestine does not obliterated during embryonic development after week 4

What condition with a high mortality presents with extreme abdominal pain, hypotension and a pulsatile mass?

AAA rupture See vascular for management

What is acute mesenteric ischaemia?

Sudden decrease in bowel blood supply leading to bowel ischaemia and necrosis

What are the 4 causes of acute mesenteric ischaemia?

Thrombus in situ Embolism (THINK ATRIAL FIBRILLATION) Non occlusive cause Venous occlusion and congestion

What are some risk factors of acute mesenteric ischaemia caused by embolism?

Smoking Hyperlipidaemia Hypertension

How does acute mesenteric ischaemia present?

Generalised out of proportion abdominal pain Nausea Vomiting Non specific tenderness If bowel perforated will be peritonitis

What investigations and imaging would be needed when suspecting acute mesenteric ischaemia?

URGENT ABG (lactate/state of acidosis) FBC U+ES Clotting G+S LFTs CT AP IV contrast in artieral (angiogram) and portal venous phase

How is acute mesenteric ischaemia managed?

Fluid resus Escalate to surgical registrar Catheter Fluid balance chart Broad spec abx Early ITU input Surgery

What is the surgical management of acute mesenteric ischaemia?

Excision of necrotic or non viable bowel Revascularisation of bowel

What is an absolute contraindication to a laparoscopic procedure if a patient has an issue with their small bowel?

Small bowel dilataion > 4cm

What is the position of an Inguinal hernia in relation to the pubic tubercle?

Superomedial to pubic tubercle

What is the position of an femoral hernia in relation to the pubic tubercle?

Inferolateral to pubic tubercle