Small bowel

Question 0

Small bowel obstruction- types

Answer 0

• Partial obstruction (gas is able to pass the point of obstruction)
• Complete obstruction
• Simple obstruction (mechanical obstruction of lumen but no vascular compromise)
• Strangulated obstruction (no vascular compromise plus lumen obstruction)

Question 1

Postsurgical adhesions

Answer 1

most common cause of small bowel obstruction
-colorectal surgery
-appendectomy
-gynecologic surgery
-prior adhesiolysis
-resection of malignancy
or
-prior bouts of diverticulitis or Crohn's disease

Question 2

SBO- physical examination- abdomen

Answer 2

• abdominal distention; less with duodenal or proximal small bowel obstruction than with distal bowel obstruction
• bowel sounds; hyperactive (early stages), hypoactive (late stages)
• tympanic; early presentation
• abdominal tenderness; late presentation

Question 3

SBO-physical examination- rectam

Answer 3

• collapsed rectal vault
• gross or occult blood; suggests late strangulation or malignancy
• masses; suggest obturator hernia

Question 4

SBO- physical examination- intestinal ischemia (to rule it out)

Answer 4

fever (>100F)
tachycardia (>100 beats/min)
peritoneal signs

Question 5

SBO- Plain radiography

Answer 5

at least needs two views (supine/ upright)
indicate SBO:
-dilated small bowel loops with air-fluid levels
-abnormally large quantities of gas in the SB with absent or minimal colonic gas
-“stack of coins” apearance may be present

Question 6

SBO- imanging

Answer 6

Barium- classic contrast
but should not be used if perforation is suspected.

CT- study of choice if the patient has fever, tachycardia, localized abdominal pain, and/or leukocytosis. Useful in early diagnosis of strangulate obstruction. Distinguishes extrinsic, intrinsic, and intraluminal causes of obstruction.

Question 7

SBO tx- ER care

Answer 7

• aggressive fluid resuscitation
• bowel decompression (nasogastric tube (NGT) insertion)
• correction of electrolyte imbalance
• antibiotics
• early surgical consultation

Question 8

SBO tx- non-operative inpatient care

Answer 8

non-operative trial of as many as 3 days is warranted for partial or simple obstruction
-must provide: adequate fluid resuscitation and continued NG suctioning

Question 9

SBO tx- surgical care

Answer 9

Strangulated obstruction is a surgical emergency

Question 10

Crohn disease- site

Answer 10

1: Ileocecal- mimic appendicitis, vitB12 deficiency, fat-soluble vitamin deficiencies.
2: small intestine- 2nd major, fistulas
3: colon only- diarrhea, perianal fistulas, fissures, abscesses
4: esophagus, stomach, duodenum- rare

Question 11

Crohn disease- abs

Answer 11

anti-Saccharomyces cerevisiae antibody (ASCA)- present in up to 70%

Question 12

Crohn disease- tx

Answer 12

-medical therapy
antibiotics
5-aminosalicylic acid drugs
glucocorticoids
-oral (mild- moderate)
-IV (severe)
Thiopurine antimetabolites (azathiorine and its active metbolite 6-mercaptopurine)
Methotrexate
Infliximab

Question 13

Malabsorption

Answer 13

pancreatic cause- presence of fecal elastase and chymotrypsin
D-xylose test- carbohydrate absorption
Schilling test- vitB12